introduction to sensitive topics sean reed, m.d. assistant professor department of family medicine
TRANSCRIPT
Introduction to Sensitive Topics
Sean Reed, M.D.Assistant Professor
Department of Family Medicine
• Sexual orientation and practices
• Illegal drug use
• Alcohol use
• Spirituality and religious beliefs
• Violence/Abuse
Sensitive Topics
Death and dying
Family interactions (spanking)
Racial and ethnic experiences
Bowel and bladder function
Physical deformities
Sensory deficits (blindness, deafness)
Mental illness
Prison
Literacy
1. Describe a rationale for asking people questions about sensitive topics
2. Be more aware of your own attitudes/biases
3. Review barriers to addressing these issues
4. Describe a general approach to sensitive topics
OBJECTIVES
19 y/o woman with a sore throat
• College student• Sore throat for 5 days• Fever 101• Strep test negative
Gonorrhea
Leading Causes of Death, Youth Ages 10-24Leading Causes of Death, Youth Ages 10-24
Rationale: Nosey or Necessary?
1. Helps expand/develop the differential diagnosis (Ddx)
2. Predicament (patient’s plight / coping mechanisms)
3. Builds rapport
4. Opportunity for education / prevention (safe sex, healthy lifestyles)
vs.
Change can make a difference
50% of health problems are caused by behavioral risk factors
The Envelope Please
We all have biases. We need to be aware of them and make sure they don’t get in the way of our patient care.
Personal Biases / Attitudes
• Physician’s own discomfort/biases/beliefs
• The patient doesn’t want to talk about it
• Jargon
• Lack of specificity
• Time
Barriers
Patients Don’t Want to Talk About it
Patients ready and willing to talk!
One study involving 1900 patients (mean age of 40) found that 97% of participants were comfortable discussing questions regarding HIV risk behaviors, domestic violence and drug and alcohol use with their doctors.
Metacommunication
If a patient raises an issue - GO FOR ITIf you think something needs to be addressed – GO FOR IT
When in doubt, anxious or lost – GO FOR IT
To communicate about your communication to help overcome barriers or resolve a problem
Jargon
“I did not have sexual relations with that
woman”
When Dr. E. Ratcliffe Anderson, the American Medical Association's executive vice president, announced on January 15, 1999, that he had fired the editor-in-chief of the Journal of the American Medical Association (JAMA), he said that an important factor in his decision was the publication of a research article on the sexual attitudes of college students. It was not just the content of the article that was at issue, he said, but the fact that the article had been advanced for publication ahead of schedule with the intent of influencing a major political debate. In this case, the issue studied was whether people consider oral–genital contact to be "having sex."
Results Individual attitudes varied regarding behaviors defined as having "had sex": 59% (95% confidence interval, 54%-63%) of respondents indicated that oral-genital contact did not constitute having "had sex" with a partner. Nineteen percent responded similarly regarding penile-anal intercourse.
Vol. 281 No. 3, January 20, 1999; Would You Say You "Had Sex" If . . ?
FIRED!
Lack of Specificity / Time
• Comfortable setting• Relaxed style• “Routinize” questions• Language• Confidentiality• Empathy• Avoid assumptions• Ask patient’s permission - “Is it OK…?”
Structured Approach
1. Comfortable setting- private, quiet area, sitting
2. Relaxed style- how many voices do you have?
3. “Routinize” questions- don’t overdo it
4. Confidentiality- perhaps best done at the beginning of the
interview or even the relationship- you might choose to re-emphasize this concept (adolescents)
5. Language- consider this patient’s educational level, cultural background, etc.
6. Empathy- taken too far this can work against “routinizing” and a “relaxed style”
7. Avoid assumptions
8. Ask patient’s permission/Allow the patient to prepare- “Is it OK…?”
When a patient divulges some highly personal information consider not writing it down immediately
Note Taking
Summary
• Take note of your own biases and attitudes
• Patients do want to talk about sensitive issues
• Be specific / avoid jargon
• Develop a relaxed routine
• When in doubt, metacommunicate
