Dr. Sherman Williamson, a family physician in Orange, has been treating people infected with acquired immune deficiency syndrome since early on in the AIDS epidemic.
Thirty of his patients have died, and he is now treating "at least 50" who have tested positive for the human immunodeficiency virus (HIV) that causes AIDS.
It is not a medical specialty Williamson sought out. It developed because he was willing to treat AIDS patients and to learn more about the disease--a willingness that appears to have set him apart from many of his colleagues.
Although AIDS patients--and gay men at risk--have long complained about the difficulty of finding informed, compassionate medical care, recent statistics add weight to their argument:
--According to a random sampling of Los Angeles County physicians done last year by the County Medical Assn., only about a fourth of the doctors surveyed said they were interested in treating AIDS patients or felt competent to do so.
--In a 1987 study of physicians in Sacramento, 35% said they would not care for AIDS or HIV-positive patients; an additional 15% were undecided.
--In a recently completed American Medical Assn. study on physician knowledge and attitudes about AIDS, 91% of the physicians surveyed said that medical doctors should take a leadership role in addressing AIDS, but "80% felt that their professional colleagues were not completely prepared to deal with AIDS patients."
Such statistics, coupled with the personal experiences of many HIV-positive patients, have contributed to a rising tide of complaints by AIDS specialists: that doctors don't want to treat AIDS patients because it is disheartening work, that many physicians are ill-informed about the symptoms and course of AIDS and therefore fail to diagnose it when aggressive treatment would make the most difference, and that doctors in general are uncomfortable asking questions about life style and sexual orientation--a squeamishness that can have life-threatening consequences for patients at risk.
These problems are only being compounded, many critics say, as the numbers of HIV-positive people across the nation increases. (According to the latest government estimates, 365,000 people will be diagnosed with AIDS by Jan. 1, 1993.)
AIDS specialists say that although there are certainly numerous physicians across the country who have responded in a positive, responsible and caring way to the disease, there simply aren't enough of them.
"Many doctors think that AIDS will never touch their doorstep," said Dr. Constance B. Wofsy, co-director of AIDS programs at San Francisco General Hospital. "There is such a denial process. Many feel that the AIDS specialists must be the ones to deal with it."
From traveling with colleagues, Wofsy said she has noticed that the trend in any given city is for a small group of physicians to take on care of HIV patients.
"There is an expectation that those doctors will deal with it," she said. "In general, many doctors feel it is someone else's problem."
"It is an avoidance phenomenon," said Sherman Oaks AIDS specialist Dr. Joel Weisman, who, with Dr. Michael Gottlieb, reported the first cases of AIDS in Los Angeles in June, 1980. "In an ideal world, every physician should treat the patient with AIDS. In the real world, that's just not going to happen."
In Los Angeles, Dr. Martin Finn, director of the AIDS program for the Los Angeles County Department of Health Services, says that he knows of no more than 100 doctors who are caring for AIDS patients in this area.
"And they tend to cluster around hospitals with AIDS units," he said. "I think one of the things we're seeing here is a new subspecialty. And what we will be seeing in the next year is another cadre of subgroup, because we're moving toward the use of the antivirals (antiviral medicines to treat the disease).
"There aren't enough people who know how to use them, so we'll have to rotate patients through the immunologists and allergists."
Williamson, an Orange County practitioner for 10 years, said he has already had difficulty getting specialists to assist him as consulting physicians in treating AIDS patients. So, over the years, he has developed his own network of referral physicians, cardiologists, gastrointestinal specialists and pulmonologists who are willing to do so.
"I call first myself, because it's only appropriate that the physician make the contact," he said. "Some will just tell me, 'I would prefer not to.' (But) I would rather have them turn me down than (turn down) the patient," said Williamson, who admitted he is sensitive about his patients being rejected.
"Too many have been told to seek treatment somewhere else. But there are no somewhere elses in some places."
"As a physician, I am truly embarrassed by the response of so many of my fellow physicians," said Dr. Neil Schram, an internist at Kaiser who sees many HIV patients and is a member of the Los Angeles County Medical Assn.'s AIDS committee.