Exam 1 - Sensitive Topics Flashcards
What are the main sensitive topics for patients to discuss?
Societal taboos Sexual practices Death and dying Financial concerns Racial and ethnic bias Family interactions Mental illness Drug use in pregnancy Same-sex practices
Guidelines for discussing sensitive topics
Do not judge the patient.
>Your goal is to learn about the patient and help that patient achieve better health.
Explain why you need to know certain information.
Find opening questions for sensitive topics and learn specific kinds of information needed for your assessments.
Consciously acknowledge any discomfort you feel.
>Denial may lead you to avoid the topic.
How can you make sensitive topics more comfortable?
Read medical and lay literature about the topic.
Talk to selected colleagues and faculty about your concerns.
Take special courses to help you explore your own feelings.
Keep an open mind.
Reflect on your own life experiences.
DO NOT share them with your patients.
Listen to experienced clinicians.
Important topics of sexual history
Pregnancy
STDs/STIs, including HIV and AIDS
Sexual dysfunction due to certain medications or medical conditions
When do you ask a sexual history?
GU symptoms, OB/GYN symptoms, and if a comprehensive history is needed.
Important to ask all populations, regardless if they are:
Elderly
Disabled
Chronic illness
What are some ways you can ask about sexual history?
“I need to ask you some questions about your sexual health and practices.”
“I routinely ask all patients about their sexual function.”
“To figure out why you have this discharge and what we should do about it, I need to ask some questions about your sexual activity.”
Helpful hints with sexual conversation
Have a “matter of fact” style.
Use specific language.
The term “sexually active” is too ambiguous.
Refer to genitalia with explicit words such as penis and vagina, avoid saying “private parts.”
Choose words that the patient understands or explain exactly what you mean
You NEVER make assumptions.
Marital Status
Domestic partnership does not always imply same-sex couple.
Sexual Preference
Sexual Behaviors
Attitudes toward pregnancy and contraception.
Alcohol usage opening questions:
“Tell me about your use of alcohol.”
“What do you like to drink?”
Assess what your patient considers alcohol to be.
Ask quantity consumed at any one given time.
“How much wine do you drink at one sitting?
To detect problem drinking, ask:
“Have you ever had a drinking problem?”
“When was your last drink?”
If within last 24 hours-suspect problem drinking.
CAGE Questions?
Cut down
“Ever felt you needed to cut down your use of ______?
Annoyed with others’ comments about your drinking?
Guilty
about your use of _______?
Eye opener
Need to use in AM to function?
TWO or more positive answers are strongly associated with addiction.
When you suspect ETOH abuse, ask about history of any of the following:
Seizures
Accidents/injuries while drinking
Blackouts (loss of memory during drinking)
Job problems
Conflicts in relationships
Legal problems
Ask specifically about driving or operating heavy machinery
Illicit drug use opening questions
“Have you ever used any drugs other than those prescribed for medical reasons?”
“Have you ever used drugs not prescribed to you?”
Ask about pattern of use.
Last use, how often, substances used, amount?
Ask about modes of consumption.
Injected, smoked, snorted, inhaled?
**Adopt the CAGE questions.
Follow up questions when suspecting drug addiction:
Consider asking “Are you always able to control your use of drugs?” “Have you had any bad reactions?” “What happened?” “Any drug related accidents, injuries, or arrests?” “Job or family problems?” “Have you ever tried to quit?” “Tell me about it.”
Family Violence
High prevalence of physical, sexual, and emotional abuse.
Many authorities recommend routine screening of female patients for domestic violence.
Approach questions to family violence:
Start the interview with general questions.
“Since abuse is common in many people’s lives, I’ve begun to ask about it routinely.”
“Are there times in your relationship that you feel unsafe or afraid?”
“ Many women tell me that someone at home is hurting them in some way, is this true for you?”
“During the last year, have you been hit, kicked, punched, or otherwise hurt by someone you know, if so, by whom?”
**Go from GENERAL to SPECIFIC.
Clues to physical abuse
Unexplained injuries.
Injuries in multiple stages of healing.
Injuries inconsistent with the patient’s story.
Delay of patient seeking treatment for trauma
If patient’s partner/family has a history of alcohol or drug abuse.
If the partner dominates the interview, will not leave the room, or seems unusually anxious or solicitous.
What to do when you suspect abuse?
Spend time alone with the patient for further questioning.
Be aware of diagnoses that have a high association with abuse.
>Pregnancy
>Somatization disorder
What do you ask when you suspect child abuse?
Ask parents
“What is your approach about discipline?”
“How do you cope with a baby who won’t stop crying?”
“Do you have any fears that you may hurt your child?”
Find out about how caregivers or companions handle these situations as well.
All abuse is reported to the appropriate county agency!!!!!
5 Stages of Grief
Denial and Isolation Anger Bargaining Depression or Sadness Acceptance
Learn to be sensitive to the patient’s feelings at any stage of the process.
The stages may occur sequentially or overlap.
Death and dying patient
Get to know the WHOLE patient.
>The patient’s illness is only part of the patient.
GIVE the patient opportunities to talk.
>You need to listen and not be rushed.
Understand the patient’s wishes about treatment and end of life decisions.
»This is not the time to assert your own belief system.
What two things do you need to do when you find out that your patient is dying?
- Asking about Do Not Resuscitate (DNR) status is difficult if you have not established a good rapport with the patient.
- Important to establish a health proxy who can act as the patient’s health decision maker.
>“Who” is allowable by law varies state to state in the US.
>There still exists inequity in same-sex marriages such that a partner may not be allowed by law to carry out the patient’s last wishes.
