Dr. Lipman is called into hospital rooms to consult when patients develop pneumonia and post-op complications such as bladder and skin infections. HIV is still the leading disease of his outpatient practice. He earned his degree from the University of Buffalo and has practiced in Las Vegas for 13 years. Here are the highlights from his recent interview with Cate Weeks:
People confuse infectious diseases with contagious ones. When I walk into a patient’s room and introduce myself, the family members always worry.
When I was finishing my training, the smartest physician I knew was chief of infectious diseases. He said stay and work with me. So I did. This was in the early 1980s, and HIV was emerging, so it was an exciting time for the field.
People forget what it was like then. I mean, we didn’t wear gloves when we examined patients—ever. I came home every day with blood under my fingernails. Blood on my hands. Blood on my clothes. Young physicians today just can’t imagine that. I can’t either, really.
One time I was moonlighting in the E.R., and a nurse was having trouble getting an IV into a gunshot victim who clearly had AIDS. She turned and accidentally stuck me. A month later—the exact incubation period for HIV—I got a flu-like illness. I started panicking. I had a nurse draw my blood, and when I sent the sample for testing I told them that even if the screening came back negative they should send this particular sample on for the more specific test. When the screenings came back, my number wasn’t on the list of negatives. My wife was pregnant with our daughter. I thought, What am I going to tell her? What if the baby is positive, too? Turned out the guy told me it was positive just because only positive screens go on for further testing. I was OK, but now I know what it feels like to be told you have a fatal disease. I think it’s made me more sensitive to my patients.
The progress we’ve made in treating HIV has been nothing short of miraculous. When I started, a third of the hospital was related to HIV. Then over the course of 10 years, it was no longer a death sentence. Now we deal with complications in HIV people that everybody gets—diabetes, heart disease, cancer. It’s very unusual for me to have an HIV patient in the hospital.
The biggest thing that scares me now is the potential recurrence of SARS. It cycles, but the virus is still around. And viruses get smarter. Gonorrhea is making a resurgence because it’s become resistant to almost all the medications we use to treat it.
I wish I could make prescriptions more affordable. Insurance companies keep moving the medicines with the least side effects to their higher tier with higher co-pays. It’s always a battle to get them to pay.
When I started as a doctor, you were the patient’s advocate. Now doctors are practically employees of insurance companies. They can throw you off their panels. I’m lucky to be a bit insulated from that, because I’m not a primary-care physician.
The medical community in Las Vegas is fragmented. There are really good physicians, and there are representatives of the worst kind of medicine—the ones that are profit-driven. When something like the hepatitis C outbreak happens in your community, you should be concerned.
Always get a second opinion if it involves an invasive procedure. Check the state database to see if a physician has any disciplinary issues. And check in the state they’ve been previously licensed. Doctors move to escape a bad reputation.
Avoiding the flu and colds is just luck. You just have to do the basics like wash your hands and avoid having people cough on you—which is hard in my profession. I wash my hands so often that my skin cracks.
I’m totally not a germaphobe. I’ll eat the two-day-old leftovers sitting on the counter, but I really don’t like bathroom doorknobs.