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GENERAL HEALTH
Teaching Sexual Health and Responsibility – Every Practitioner’s
Responsibility
By Maureen N. Letts, 4th year medical student,
Univ. of Cincinnati College of
Medicine (USA)
After spending the month of February [2003]
working at the Cincinnati Health Department’s Sexually Transmitted Diseases
(STD) Clinic, my eyes were opened to some of the challenges and barriers
that arise when educating patients about sexual health. It is typically a
host of poor choices lead many patients to the STD Clinic. Embarrassment,
fear of being judged, and ignorance of the facts make many hesitant to
disclose the truth of their behavior once they arrive. The fact is, the
rate of HIV/AIDS continues to rise in the African-American community, and
yet many patients’ attitudes and practices are unchanged.
Many of these clinic patients, who range in
age from early teens to middle- and older-aged adults, take comfort in the
fact that most sexually transmitted infections (STIs) can be treated with an
injection or short course of antibiotic pills. They neglect to see the
potential long-term consequences of STIs and the serious threat of HIV. To
my surprise, however, the majority of patients are willing to listen, talk
realistically about their practices, and ask questions when they have a
non-judgmental and receptive health care provider with whom they can
interact.
For these very reasons, it is the
responsibility of every practitioner to break down these barriers by
providing a safe haven for discussion, initiating dialogue, and providing
the hard-core facts related to patient sexual health and responsibility with
every patient encounter.
In order to approach sensitive issues related
to sexual health with patients, one must first facilitate an environment
where open discussion can take place.
Many physicians display patient information
pamphlets in their waiting areas or posters in examination rooms that
address health topics. By including information on topics such as safe sex,
HIV, birth control, and abstinence, patients become aware that these issues
are of concern to their doctor, and thus, should be their concern too.
Furthermore, health care providers should regularly ask questions related to
sexual health as a part of a comprehensive interview.
Although some patients may be hesitant to
respond initially, addressing these issues shows the physician’s interest in
the patient’s overall well-being. Patients should be made aware that
questions regarding sexual health are not specifically directed towards
them, but instead that the physician discusses such issues with all
patients. When the health care provider creates a safe haven for discussion
of sexual health early in the doctor-patient relationship, it opens the door
for honest dialogue in the future.
It is vital that health care providers initiate this
dialogue with all of their patients, regardless of age, cultural difference,
or sexual preference. Although teenagers and young adults are statistically
shown to participate in more risky sexual behavior, adults and elderly
patients are not immune to the consequences of unsafe sexual activities.
Discussions with teenage patients should encompass body
image and self-esteem, as well as making mature and responsible decisions
about engaging in sexual activity, birth control, and protection from STIs.
Adults should be counseled on responsible sexuality, birth control, and
sexual dysfunction. Additionally, they should be encouraged to have open
and honest discussions with their adolescent and teenage children at home.
Finally, all patients should be screened for sexual abuse and intimate
partner violence.
Although most people will respond to these types of open discussions, the
occasional patient will be apathetic or obstinate to your advice. When
this type of situation arises, it is time to give them the cold, hard facts
and ask the tough questions. “Did you know that HIV/AIDS is the leading
cause of death in African-Americans from ages 25-44?” “Are you ready
to be a father?” “Do you realize that you are putting your unborn
child at risk?” When patients understand the impact of a single poor choice
in the present on their future health and wellness, they often become more
attentive and willing to heed a physician’s advice. This is when
effective patient education can take place.
By
creating a setting conducive to the discussion of sexual health and
responsibility with patients, and providing pertinent factual information,
health care providers form an important partnership with their patients.
When the physician takes responsibility for allowing issues of sexual health
to be addressed and engages the patient in the discussion, it empowers them
to take more responsibility for their care as well.
There are no easy answers, and many challenges remain, but
influencing a change, one patient at a time, is a success indeed!
Since the publication of this article, Maureen has graduated and obtained
her M.D. Click
HERE
to read more about her graduation
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