Something to consider about being unmedded, from a poz unmedded pig..

[PhoenixGeoff]

As a gay physician and a barebacker I can't resist adding my two cents here. Although HIV related care is not a significant part of my practice, I have absolutely kicked patients out of my practice for refusing recommended treatment and will continue to do so.

It's good having the perspective of a physician here. I suspect that many of us don't properly appreciate what we put our doctors through.

A couple questions, if you don't mind:

What do you think of a patient who might want to follow your advice, but is having difficulty with it for some reason. Say, perhaps an addiction he's struggling with (or perhaps not willing to struggle with) that gets in the way of effective treatment. I'm thinking specifically of methamphetamine here, which can both throw the scheduling of meds off and fuck with the user's desire to adhere to treatment, but there's any number of other situations that might cause problems with adherence and long-term health. To put it in an entirely different and non-sexual context, what do you say to smokers who refuse to take your advice and quit?

On a related note, given that you bareback yourself, and given that you're obviously aware of the risks that go with that decision, not just of HIV transmission but of other STDs as well, what's your advice to patients regarding HIV prevention and risk reduction? If you advise condom use, does it bother you that you don't take your own advice? Do you feel more of an obligation to "toe the party line" as a health professional?

What might be your criteria for kicking a patient out of your practice? Are these people who have their head stuck firmly in the sand and refuse to see the dangers of their course of action? I assume you discuss different treatment options up front. Would you kick someone out if you suspected that there was some underlying mental illness or addiction problem leading to the decision? And have this happened with people other than HIV patients?

[pisstopper]

Thanks @MascMountainMan. You raise a lot of issues here and I'll try to respond as concisely as possible. Compliance with treatment and recommendations is a complicated issue. First off, it should be noted that most docs see some difference between prevention of a problem that hasn't happened yet and treatment of a problem that has already occurred. A patient that doesn't follow my advice to avoid smoking, poor dietary habits, owning a firearm, or any number of things that may or may not eventually result in a specific problem at a specific time is one thing. A patient with diabetes who refuses to take insulin is quite another. There is plenty of grey area here. And sometimes "treating" a condition is really about preventing it from getting worse as in the case of an HIV infection in most instances. Docs generally will be more concerned about patients who refuse treatment recommendations than they will be about those who refuse to accept prevention advice. There is also an issue with how serious and imminent the consequences of these refusals are. Refusing a surgery for a life threatening aortic tear is treated more seriously than refusing to exercise regularly though both choices may result in the same end point at different times.

When does treatment refusal become serious enough to make a doc feel that there is no point in continuing to treat a patient? That would depend on many of these factors and the physician's own personal assessment of these risks. However another big one that enters the picture is effort. A patient who is trying to change things, quit meth use for instance, but is periodically failing or one that is unable to comply with treatment due to homelessness or mental health issues or any other mitigating factors is a different situation than someone who just outright refuses on principle. That being said these are not instantaneous decisions. Everyone deserves a chance to have things explained to them and discussed with them over a reasonable and appropriate amount of time for consideration. Struggling with treatment decisions is normal. Refusing to make that struggle and accept the status quo is another matter entirely. The smoker who refuses to quite? I advise they should. At 22 I counsel them, provide referrals and offer meds that could help. At diagnosis of their emphysema during their 2nd pneumonia in their 40s or 50s I explain again why quitting still matters and how the course can still be changed. At 60 when they go to light up with their oxygen tank actively pumping away through nasal canula threatening an explosion on top of their impending mortality, it may be time to talk about them going elsewhere for care.

As for me and barebacking - Yes i do advise patients to practice safe sex always. Do I feel an obligation to do so? Yes but I don't view it as toeing the party line. It's the truth. If you don't want to lower your risk you can. Am I a hypocrite for not following the advice I give others. Absolutely. And its just as true when I don't eat and exercise like I should. However, I'm not particularly bothered by this. In the end patient's shouldn't be paying me to be their buddy or their confessor. They should be paying me to share what I know with them both as a matter of cognitive knowledge as well as clinical experience. It may help relieve their suffering and live longer and it may not. There is no point left in treatment if I have nothing to offer them in this regard. I'm not my patients' friend or confessor or guardian.

For what it's worth. Yes I have a doctor of my own. Yes he knows I bareback. He tells me I shouldn't. He hasn't threatened to remove me from his practice. Would he care for me if I became infected with HIV? Probably. He has certainly treated me for STDs in the past. If I refused to take HIV medication if he recommended it would he discharge me from his care? He might well on such a day. And while I might not be happy about it, it wouldn't surprise me either.

[wood]

@pisstopper, Really great to hear from an actual physician in here. Please keep the responses coming. One question I had is what are your personal thought on PrEP, and would you go on it yourself as someone who is a medical professional and also engages in risky behavior.

[Guest JizzDumpWI]

From my POV the doctor patient relationship is a two way street. Patients can fire docs, and docs can fire patients. Regardless, said patient is free to find other care. If my doc is prescribing things which I know are hurting me, as in rawTOPs case, then it is up to is to find another doc. (I have been in that situation and once it was clear he was not listening it was my pleasure to fire him. But it would have also been a service to me to suggest I find myself another doc rather to continue to not listen).

If I am a patient and repeatedly refuse to follow docs advise, why on earth would/should I continue to see that medico? I think the notion that doc who fires patient = bad doc is a flawed notion. And more patients need to consider changing med providers from time to time to get fresh eyes.

[fuckall30]

Hello to all and very good reads from different sides of the table on the subject. I am just adding my two cents to the subject matter.

I have a very large medical history background being raised as a 3rd generation Nurse with many practitioners in the family, military nursing, PA training with a 600 patient workload and than switching from the conventional side to holistic side of treatment. I have worked the last 8 years as a Massage Therapist with training in holistic practice as well (although always still learning). I have had the chance to look at HIV/AIDS from two sides of the house when it comes to medicine and both have vary different degrees of prognosis, diagnosis and treatment.

Conventionally speaking:

HIV is an incurable disease that will eventually lead to AIDS at varying rates depending upon the patients lifestyle and strain contracted. Prevention is by far the best medicine but that is not what this site is truly all about now is it ~. After being "gifted" as we call it with HIV life often takes on a whole new meaning with a whole new lifestyle to join with it. Medically one needs to not only find a Doctor but one who truly looks at the whole person which is rare in conventional medicine. Let me explain that in more depth. You are a human being therefore you are what is most important when it comes to any form of treatment. Diet is a major form of treatment for ANY disease, howbeit less than 25% of medical schools in the US train doctors in nutrition look it up the stats may shock you. Second exercise comes in many forms and does not mean living in the gym but having steady exercise and being aerobic. Emotionally you can raise your viral load and lower your t-cell count immensely so staying around depressed people will affect your numbers. These all need to be examined before meds should be considered as very little is talked about when it comes to how medication depletes the body of vital nutrients and minerals and renders some ineffective. So these are things to think about when considering your physician, if he/she is not willing to go over these than they are not the physician for your greater benefit. Disclaimer - If there are emergencies than listen to your doctor until the imminent threat is resolved.

Holistically speaking:

This is my realm of current work and I will choose to stay on this side of the house. This section by no means rules out all conventional medicine as it has it's own place in treatment although that should be the short-term in it's extent of reach. Again a few of the above mentioned will be placed here but with a bit more detail.

1. Diet here does not actually mean eating small amounts of food but rather the choices of foods. Organic foods should be the highest on the list of your foods and as much as possible raw. Eating the rainbow of colors will make sure you have a balance of everything your body needs to handle problems that may arise. I recommend the book "Prescription for Nutritional Healing" as a great resource to keep up dated and on your book shelves. It is very in depth and a great starting guide to learning how food not only affects your body but what a lack of nutrients, micro-nutrients and minerals will cause.

2. Exercise is somewhat self explanatory but I will still give some info here that is often over looked when it comes to physical fitness. No matter what your form of exercise may be there are still a few things to keep in context for full performance and benefit. Massage therapy shortens recovery time, lowers stress hormones in the body, increases circulation and keeps the body limber. Finding a good therapist is just as important as finding a good doctor. When looking consider the following, Training duration as well as in what modalities. What is their focus, sports, chronic pain, etc. This is the area most falter in when selecting a therapist and often does not lead to the accomplished goals of treatment. Another source of great benefit is in the practice of Yoga. Most of the population does not do enough stretching in general and another % of those that do may not stretch properly or enough. Doing Yoga at least 3 times a week at the beginning middle and end of your week before bed is a great way to receive max benefit with as little input depending on your time schedule, (bottoms who do Yoga also have better orgasm climaxes as well just a side note after continued practice).

3. Emotional may be last on this list but by far not least. Keeping a positive outlook takes work and should not be looked at as a privileged but earned through daily practice. This area in holistic practice comes not only from within yourself but your input. Music choice, television, reading material be it online, book or magazine. Think carefully before ruling out this section, companies pay millions for 15 sec of your time during superbowl so if they will pay that much how much are you giving away free to people to control your thoughts. People are your other choice, find those who are doing things you would be happy to look back on and say you were glad to be friends, Sky dive, fish, camp and so on live your life and have sex (also good for emotional).

Here is just a bonus, women have to have quality sex to live longer men just have to have more sex. LUCK OF THE DRAW HAHA BITCHES lol. So go have fun.

With all of this being said your health is in your hands so don't let others tread on it without your full knowledge of what they are doing. There are ways to live a full healthy clean life if you so choose and if you want to live a nasty get right down to it Woof life you can do that too and still be healthy and happy just all depends on how you want the cards to be dealt out not just deal with what is dealt to you. Enjoy everyone Off my Soapbox now haha.