When risk is low: primary care physicians' counseling about HIV prevention.
To explore the conceptualization of risk by primary care physicians about behaviors associated with a relatively low risk of HIV transmission, we performed open-ended telephone interviews with 59 primary care physicians throughout the United States. During the interviews, physicians were asked to respond to a series of clinical vignettes presenting situations where the risk of HIV transmission is relatively low or unknown. We performed a qualitative content analysis of physicians' responses to these clinical vignettes. We found that relatively few information-gathering statements were made in an effort to elicit the patient's perspective regarding risk, and that risk counseling by physicians often followed an 'all or nothing' heuristic that manifested itself as the advice to take maximum precautions under situations of any perceived risk, no matter how small. In addition, HIV testing was often incompletely explained. When combined with the all or nothing heuristic, this created advice that was potentially harmful by using testing as a means to achieve zero risk and forgo protective strategies in settings where patients may potentially be in the HIV negative 'window' phase of infection.
Haidet
Paul
P
General Medicine Section, Houston Veterans Affairs Medical Center, 2002 Holcombe Boulevard (152), Houston, TX, 77030, USA. phaidet@bcm.tmc.edu
Stone
David A
DA
Taylor
William C
WC
Makadon
Harvey J
HJ
D015492:AIDS Serodiagnosis; D001900:Boston; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control*; D006302:Health Services Research; D006801:Humans; D008297:Male; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment