Range of Psychological Suffering In AIDS

Health care professionals will always be called upon to care for patients who have infectious diseases, diseases not known to the medical community, or new diseases that are rare but that may become more common in the future. New diseases are likely to be seen when genetic change in causative organisms or changing modes of agriculture put human populations into contact with new pathogens. This is especially true in developing countries where populations are high, and people live in crowded conditions without proper sanitation. Even though health care professionals are prepared to respond to the medical, surgical, and psychological needs of patients, they face additional challenges when helping people with the acquired immunodeficiency syndrome AIDS, a deadly infectious disease.

One of the most important skills for medical assistants is the ability to respond to patients with special needs in an empathic way. Medical assistants will respond to the needs of patients with AIDS and individuals who test positive for the virus in an ambulatory care setting rather than a hospital or surgical center. In some measure, the ambulatory care setting removes the medical assistant from the demanding daily physical care of these individuals who can be so devastated by the ravages of AIDS. The psychological and emotional demands of the medical assistant, however, are as great, if not greater, than those placed upon health care professionals in a hospital or surgical center.

Infection with HIV causes extreme distress. The onset of symptoms is typically accompanied by the fear of developing AIDS. Distress is evident in the preoccupation with illness and patients' fears of getting cancer and other life-threatening diseases. Anxiety and depression are common. At the time of diagnosis, patients' responses may include denial, numbness, and inability to face the facts. Patients are angry at the disease, at the discrimination that often accompanies it, at the prospect of a lonely, painful death, at the lack of effective treatment, at medical staff, and at themselves. In many cases, guilt develops about past behavior and lifestyles, or about the possibility of having transmitted the disease to others. When the disease has been contracted through contaminated blood or blood products or by individuals who felt they were protected or safe from the disease, the anger may turn into rage. Sadness, hopelessness, helplessness, denial, and withdrawal are often exhibited. Some patients contemplate suicide. Because social and physical assistance are needed, a strong network of friends and family is particularly important. In the case of homosexuals and persons addicted to intravenous drugs, however, there are a large number who are estranged from their family's support system. Persons with AIDS may feel added strain if this is the first knowledge their families have of any high-risk behaviors associated with the transmission of disease. The psychological suffering leads to physical symptoms such as tension, tachycardia, agitation, insomnia, anorexia, and panic attacks. Persons who test positive for HIV often express an exaggerated sensitivity to disease and see any new symptom as bringing them closer to death.

As a medical assistant, you face the challenge of caring for persons with a life-threatening disease; you must comfort persons who face great suffering and death. You will become a source of information for patients with AIDS and their support members. You must be particularly sensitive and respectful toward individuals who are viewed as social pariahs. You will have to examine your own beliefs and lifestyle. You must be comfortable with your own sexuality and the sexuality of others whose lifestyle may differ from yours. You must replace any fear you have regarding the disease with knowledge based on medical fact, and always practice standard universal precautions As well as assisting your physician or employer in providing the best possible medical care, many nonmedical forms of assistance may be required by persons infected with HIV or AIDS. You may need to make referrals to community-based AIDS service groups, health departments, and to social workers for planning physical and financial assistance. Trained hospice volunteers or AIDS volunteers also are helpful to families and significant others, as well as to patients with AIDS.

There may be the need for patients with AIDS to obtain legal assistance and to identify their wishes and directions for care during the terminal stages of their illness. A living will or physician's directive might be encouraged. Refer to Chapter 10 for more information on physician directives. Patients who are losing mental acuity should be encouraged to appoint a legal guardian or durable power of attorney. As much as possible, be responsive to the family members or the significant others related to patients with AIDS. Answer any questions they may have regarding their fear of contracting the disease. It may be helpful to remind them that AIDS is difficult to contract, even among people at high risk for the disease. The risk of transmitting AIDS from daily contact at work, school, or at home is low. In virtually all cases, direct sexual contact or sharing of IV drug needles is the leading cause of transmission.