Emily Peterson*, Sarah Zarwi*, Aimee Lombard*, Anmol Singh*, Sarah Norman*, Chancée Forestier*
* American University of the Caribbean School of Medicine
This case serves as a foundation to study the intricate public health elements such as social reproduction, domestic violence, and mental illness which irrevocably amplify the complexity of communicable diseases. While our patient was diagnosed with HIV in 1985, she presented to her care team in 2008 with a history of bipolar disorder and psychotic disorder and was suffering from domestic abuse by her partner. The patient is HIV+ through the father of her first child. She was born to HIV+ parents and although she was born healthy, her chances of contracting HIV later in life increased significantly. Additionally, exposure to early trauma and subsequent PTSD/psychosis predisposes individuals to participate in risky behaviors that increase the likelihood of HIV infection, as well as worsen health outcomes secondary to potentially poor compliance with antiretroviral therapy. Even with an improvement in medicine and healthcare surrounding HIV, the stigma of this status is a challenge that many patients still face. It is essential to take these intangible factors into consideration when treating complex patient cases and establishing safe patient-physician relationships. Understanding the interconnectedness of various public and social issues presented in a patient case is essential to improving health outcomes in vulnerable populations. Given that she is a victim of domestic abuse among other unfortunate factors, this case focuses on the importance of the communication aspect of a patient-physician relationship. The bridge between patient-centered conversations and public health was tested by this case. The patient’s story is an excellent example of how physicians need to master not only the medical portion of diagnosing and treating, but to understand how to effectively care for the patient individually and holistically.
Our case is truly a demonstration of the invaluable notions brought forth by public health ideologies. Topics such as domestic violence, psychological illnesses, and social reproduction severely affect a patient’s outcomes, disease prevalence, and compliance. While the case presented is very complex, it is not unique. Unfortunately, this patient’s story is shared by many. As student physicians we need to educate ourselves and understand the implications social factors could inflict on our future patients.