General Notes/Announcements
After a certain day, please let people out of the front door of the clinic.
3 jobs opening: bookkeeper, funding coordinator, BBC coordinator (email Yves for more information)
Respect training 1/29/11 - HIV counselling technique training. Everyone welcome to come. 9-3pm
SFDPH is doing research/recruiting
Christopher does recruiting for SFDPH study. He is doing this now by approaching random people in the lobby. SFDPH has approached us about doing more of an active recruitment. Possibly using information from our paperwork or having HPS counselors identify people who fit the study. 1-2 people would be here from SFDPH who would talk briefly to referred client and get their contact information. More will be discussed during the quarterly meeting.
Quarterly Meeting at Yves' house 1/28 at 2PM. Yves lives by MacArthur BART. Not members welcome to attend. Bring food :).
Possibility of doing presenations for clients in waiting room.
When people are being turned away (for various reasons) or have to leave without being seen, we should refer them to another section and give them more options then telling them to come back next Sunday.
Dr. Keith's notes
A thing about the charts. Be as descriptive as possible. It will help with presentation to SP and we can get a sense of the questions asked during chart review. Using the term "asymptomatic" can be problematic if they reported a chief complaint. Be complete and note why the CC is not a concern.
There is a shift coordinator meeting in February. If you guys have things about communication with shift professionals and needs or feedback. Email Dr. Keith. This will be a good way to give organized feedback to us.
Dave
52yo MSW
Told 5 days ago F partner tested + for syphilis. Says he has had a lot of tests done but not certain he has had a syphilis test. He had his 1st shot and will contact Kaiser to see if he needs extra shots. We also took a blood draw. He was frustrated about the wait.
Eric
28yo MSM
Noticed discharge in underwear. 1 partner in last 1.5y. Found out partner cheated on him. He has GNIDs in gram stain, treated with cef and doxy for urethral gonorrhea. Emotionally distraught, comfor
Jobert
23yo MSW
Returning molluscum client. There were 4-5 new bumps. A lot of the ones treated had not healed. All new ones were treated and transmitted to F partner.
45yo MSM
HIV+. Stinging urination. Rash recently disappearing. Really nervous client. We did 2 catches on urine. 16 1st catch, 3 2nd catch. We did a urinalysis which showed blood which may have been caused by weight-lifting. Dx with NSU and rash caused by folliculitis. Treated with doxy.
55yo MSM
Monogomous partner who was not being monogomous dx with GC. He hasn't had an STD test since 1982 when he was Dx with syphilis and he has never had an HIV test. He seemed more open to getting an HIV test after the appointment, but he was
Jason
23yo MSW
He indicated that he had painful urination sporadically since he was 6 years old. His WBC count came back 0 but his urinalysis came back with 2+/moderate bilirubin and 15/small ketones. Dr. Keith followed up by asking questions about history of bladder and kidney problems, etc. His mom had a history of diabetes, which may explain ketones.
Dr. Keith: It is important to ask about substance use. In this case the bilirubin caused by 8-10 shots a day 3-4 times a week. Substance use can lead to sexual risk and other problems.
Jason: Doing a dipstick routinely for clients is new to us and we should add it into the training.
Brian L.
45 MSM
Seen last week. The medic indicated that he was exposed to syphilis and the guy left. The chart did not indicate why he was not treated. The blood tube was not sent out. I would encourage medics that if we do not treat, we should say why. He did not have a lot of time because he had to leave so his blood was drawn but he was not given medication.
Evan: I thought that the window period was greater than one month.
Brian: It's 10-90 days.
41 MSW
Possible exposure to urethral CT. Wanted to come in in 2 weeks for another urine sediment because he wants to have sex as soon as possible. Told him to come in in 4 weeks. We usually don't do test of cure.
33 MSW
He had a funny feeling in his penis 1 week ago. Started after up vaginal sex. Sx have not changed and he has been drinking energy drinks. Everything was normal. Dipstick shows ph 8.5. Told to increase water intake.
41 MSW
Burning during urination. Got better but returns when having sex. When don't have sex pain=4. During sex=8. They have vaginal, anal, oral sex without lubrication for 1.5 hours, 3x a week. Does drink coffee. He has +1 bilirubin and dehydrated. His alcohol intake has significantly reduced since drinking really heavily 1 year ago.
Dr. Keith: Dipstick was useful in talking about getting medical care.
Dave: Today's dipsticks were a lot more useful today than in other weeks.
Steve
none
Yves
22yo MSW
He has Kaiser health insurance. Told by partner that she was + for HSV-2. He was tested and came back + for HSV-1. His parents read his mail and that he had a + HSV-1 and got chewed out. The appt was less of a medical appt and more of a counseling appt. He was basically in here to ask questions. Medics need to be able to explain things to allay fears. Some things are more significant and others are not as significant. Dr. Keith really helped calm him down because an antibody test does not necessarily mean that someone has HSV-1 and should be Dx by physical Sx. One other thing is that some of our clients have health insurance. This client felt like he was treated like a freak by his healthcare providers for asking questions.
John: One good thing about the SFDPH recruiters is that they can answer questions that they may have.
#clients = 34 clients seen, 3 left without being seen.