A young Black man has been living with #HIV for 4 years.
He is adherent with his meds. The lab report shows he has been undetectable since he started treatment.
He works 16-hour days in a factory and is seen at a busy urban HIV clinic.
He has private insurance.
1/
He is adherent with his meds. The lab report shows he has been undetectable since he started treatment.
He works 16-hour days in a factory and is seen at a busy urban HIV clinic.
He has private insurance.
1/
His last in-person visit with the clinic was in January 2020, right before the #COVID19 pandemic shut the world down.
All was well during that appointment.
His doctor continued his prescription with a year's supply of refills.
2/
All was well during that appointment.
His doctor continued his prescription with a year's supply of refills.
2/
He is scheduled a 3 month follow-up telemedicine appointment during the #COVID19 pandemic.
All continues to be well at that visit.
It's April. Flowers are beginning to bloom.
He is given another telemedicine appointment 3 months later.
He misses that one.
3/
All continues to be well at that visit.
It's April. Flowers are beginning to bloom.
He is given another telemedicine appointment 3 months later.
He misses that one.
3/
Failed attempts to reschedule are noted in the electronic medical record.
The reasons for the missed appointments are not.
Summer breezes by. Leaves turn orange.
A telemedicine appointment in October is cancelled, documented as "attempted contact for new appointment."
4/
The reasons for the missed appointments are not.
Summer breezes by. Leaves turn orange.
A telemedicine appointment in October is cancelled, documented as "attempted contact for new appointment."
4/
Still no reason given for the missed appointments.
The next electronic medical record entry title reads:
"Treatment refill denied." Authorized by his doctor.
It's now January 2021. A chill is in the air.
He has not been seen in-person or via telemedicine for 9 months.
5/
The next electronic medical record entry title reads:
"Treatment refill denied." Authorized by his doctor.
It's now January 2021. A chill is in the air.
He has not been seen in-person or via telemedicine for 9 months.
5/
Next entry is from the front desk - the young man called to get a refill on his meds.
He was running out.
Since he had not been seen in over 6 months, he is told he will have to wait on the refill until he speaks with the next available provider, which is over a month away.
6/
He was running out.
Since he had not been seen in over 6 months, he is told he will have to wait on the refill until he speaks with the next available provider, which is over a month away.
6/
The chart documents that he drops an "F bomb" during the phone conversation.
He also tells the front desk person he does not like the nurses or his doctor there.
The doctor acknowledges all of it in a chart note:
The F bomb.
No visits in 9 months.
No labs in 12 months.
7/
He also tells the front desk person he does not like the nurses or his doctor there.
The doctor acknowledges all of it in a chart note:
The F bomb.
No visits in 9 months.
No labs in 12 months.
7/
An administrator remarks how he is now "bordering on dismissal" for his inappropriate conversation.
The label has now been placed.
His narrative being told for him.
Another noncompliant angry Black man.
He misses a telemedicine appointment a week later.
He's over it.
8/
The label has now been placed.
His narrative being told for him.
Another noncompliant angry Black man.
He misses a telemedicine appointment a week later.
He's over it.
8/
Now he sits in front of me in a sterile exam room.
It's March.
A new clinic.
A new doctor.
A fresh start.
He is anxious being off medications for so long and states he "never felt comfortable" with the doctor and staff at the other clinic.
I pray I can restore his faith.
9/
It's March.
A new clinic.
A new doctor.
A fresh start.
He is anxious being off medications for so long and states he "never felt comfortable" with the doctor and staff at the other clinic.
I pray I can restore his faith.
9/
One ounce of empathy.
One phone call to a provider.
One moment of listening.
One affirming word.
One extra month of meds.
That's all it would have taken.
Patients fall out of care for many reasons.
One staff member can prevent that from happening.
If they choose to.
10/
One phone call to a provider.
One moment of listening.
One affirming word.
One extra month of meds.
That's all it would have taken.
Patients fall out of care for many reasons.
One staff member can prevent that from happening.
If they choose to.
10/
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