Physician’s assistants and nurse practitioners are midlevel practitioners, meaning that their responsibilities lie somewhere between those of a nurse and those of a physician. Midlevel practitioners assess medical problems, order tests, and recommend treatments. They work with varying degrees of independence, depending on state laws, the medical problems they care for, and their relationship with the other health care providers.     Midlevel practitioners often have specialized training in one area of medical care, including care of people with HIV infection. They are especially valuable in highly specialized areas of medical care because they have often acquired, through training and experience, an expertise not usually found among physicians who care for people with many different diseases. Many comprehensive care programs for people with HIV infection rely heavily on midlevel practitioners.     Physician’s assistants have two years of specialized training, must pass a board exam every six years, are required to have at least one hundred hours of postgraduate education every two years, and are licensed. Physician’s assistants must practice under the supervision of a physician. They may prescribe drugs in some states but not in others.     Nurse practitioners are registered nurses who have nine additional months of advanced training or have received a master’s degree in nursing. Nurse practitioners do much of what physician’s assistants do, but they are not required to serve under direct supervision of a licensed physician.*164\191\2*

Finally, after you accept what you must, control whatever else you can. A friend of Steven’s felt he was being a burden to his parents and moved into a private home for people with AIDS; he liked the home particularly because he felt needed by other people there. Another friend of Steven’s had wanted to be sick at home, but after he had diarrhea and his sister had to change his sheets and wash him, he decided to go to the hospital instead.     If you cannot control your life in big ways, control it in small: you never lose control over everything. Lisa would ask her husband, “Do you want the water glass here or there? Do you want to wear your blue shirt or your white one? Do you want cocoa or coffee?” When Dean needs to go to the hospital, he routinely takes along his own lamp and radio. You can always affect the course or quality of your life somehow.     This strategy of controlling what you can extends to the social service and medical systems.
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