Please enable JavaScript.
Coggle requires JavaScript to display documents.
TM: Sensitive Histories in General Practice (i) (Common red flag…
TM: Sensitive Histories in General Practice (i)
What?
Sexual complaints
STIs
chlamydia
anogenital warts
Vaginismus (muscles around vagina involuntarily tighten whenever there's an attempt to penetrate it)
Anorgasmia
Erectile dysfunction
Genital complaints
Rectal complaints
Breast complaints
Can be anything depending on patient's own attitudes + sensitivities
Irish patients
Culturally less comfortable with nudity, sexuality etc than some other European counterparts
esp Travellers + other minority groups
sometimes different attitudes towards male vs females healthcare staff
Patient's perspective
confidentially assured
suitable environment
reaction is natural (but judgement unhelpful)
note taking - be careful when + what you write
Patient's anxiety often quite high
premature reassurance blocks communication
They will be studying you, your clothes, your demeanour, for any trace of negativity
Poor 1st impressions tend to lead to dissatisfaction
impacts on willingness to disclose information + take advice
HCP's perspective
come from varied ethnic + social backgrounds
have our own attitudes about what's embarrassing
will evolve as we mature + our experiences broaden
Natural desensitisation takes time (can't be faked)
if you are uncomfortable be open about it
patient–doctor interaction (PDI) skills essential
time pressures
we are trained to subtly minimise the amount of info in a hx
interruptions
be wary of patients with 'blunted effect' or 'hand on the door' complaints
present with a different complaint
brings up real issue @ end on consultation
out of fear or the issue being insensitive
may be helpful to offer vocal if patient struggling e.g. vagina vs vulva
underage/chaperone issues
can be non-medical person, e.g. family member
Common red flag consultations in GP
bad news
end of life
Sexual health / sexuality
recurrent vaginal irritation
painful intercoarse
male dysuria
menopausal patients
STI screen
HIV
endemic in SSA - so screen this high risk pop
antenatal screening NB
chemical dependency + addiction
Drs hate asking + patients get defensive answering
formulate Qs that prevent supposition
e.g. "would you ever drink alcohol?" instead of "how much do you drink?"
abbreviated Qs get abbreviated answers
psychiatric
watch phrasing: "how are you?" is less threatening than "How are you feeling?"
family violence
GI complaints
can be difficult area of discussion for some patients
vocal limitations
social stigma
Defensive patients
often angry at you before you greet them
can be due to previous experiences experiences with healthcare
challenge is to remain neutral
can be a red flag for a psych disorder
Sex toys can transmit bacteria (lesbians)
Some STIs can be contracted by virgins
herpes + warts
e.g. self inoculation
so condoms not 100% sufficient
don't require intercourse for transmission
media exaggerates stats
relative vs absolute risk