A different slant on surgery and HIV.

Health care for HIV positive patients at St. Mary's Hospital, London, emphasizes confidentiality, full discussion of management options, treatment tailored to the individual's needs, and a supportive, community-like environment where formal or informal counseling is available at every stage. HIV testing does not take place without counseling, both before the event and after a positive test result, by those who know about the virus and about AIDS. Rather than adapting the existing imperfect models of conventional medical care, new models have been developed which stress the value of honest communication, the role of the patient in decision making, the benefit of care by a multidisciplinary team, and the departure from traditional paternalism. The author comments that the same sort of time, personal support, and flexibility in care should be provided for all patients, regardless of diagnosis.