posted
A tangent from the "abstinence versus safe sex" thread and arising from a recent conversation with a friend...
Taking a Sexual History. I'm in Med School, and part of the training is history taking. One section is sexual history. I want to know what you think of the questions. These questions are from our Suggested Questions for history taking, they are mostly verbatim.
Do any of them in particular make you feel uncomfortable/embarassed/offended? Why? Do you think your doctor shouldn't ask certain questions?
- Now I'd like to ask you about your sexuality. - These are questions I ask all my patients. - Are you sexually active? - Have you ever engaged in any sexual activity? What kinds? - How many partners have you had, ever? - Are you currently involved with men, women, or both? - Anything different in the past? - How is your relationship with your partner? - Do you have any concerns about pregnancy or pregnancy prevention? - Do you have any sexual problems or concerns? - Have you noticed any changes in your sexual functioning lately? - Have you had problems or concerns in the past? - Have you ever had concerns about getting a sexual disease? - Are you practicing safe sex? (condoms, dental dams, etc) - Have you had a sexual relationship with a person at risk for HIV disease (IV drug user, man who has had sex with men, prostitute) - Have you ever been sexually or physically abused? raped? - Do you have any other questions or concerns?
--------- My friend said that he would be offended if his doctor asked him if he had had sex with a man. He felt the doctor would be implying he looked gay, which he found offensive. I thought this was ridiculous, but he maintained he felt it was a common straight-man-perspective.
However, in Med school, it's suggested that we not assumed heterosexuality in our history taking. It puts up an immediate wall between us and someone who isn't heterosexual. Isn't this worth making some people uncomfortable?
Posts: 1892 | Registered: Mar 2002
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posted
When I talk to my doctor (who I really like), I feel fine answering questions like this, because I'm confident in the "security" he keeps, i.e. that he wont tell anyone or really think anything of it besides the medical implications (or at least he'll keep what he thinks to himself ).
The one question I think I may feel werid about is
quote:- How many partners have you had, ever?
Actually, I would have little problems with it since I could just say "0" but it does seem a little unnecessary.
One thing is, my old doctor would have me fill out a little form with a whole bunch of stuff (all sorts of things, not just sexual history) and I tried to answer truthfully, as in I felt I was in poor shape so I marked that and he seemed very concerened. I suppose he has to but it made me feel uncomfortable answering any of the questions in the positive (they were all bad if you answer yes) since I felt like a small concern could only be treated as a major problem.
posted
While it is ridiculous to take offense at the question, I have to wonder about its significance. Are there any STDs that can be transmitted only man to man or woman to woman? Why not just ask the number of lovers and/or amount of sex the subject has?
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posted
I would not be offended if a doctor asked me whether I have ever had sex with a man. As long as the question is not the first one out of their mouth and is burried among lots of other questions, I would just assume, as any rational person would, that the question is a standard one and nothing personal was meant by it.
Posts: 4116 | Registered: Apr 2002
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posted
You're missing what to me is a VERY important question.
Do you know the sexual history of your partners?
I would only ask this if I was concerned (based on the other answers) that the person might need an STD workup though.
Of course, you might elicit the "I don't know" answer to some of the questions you posted and arrive at the same point...
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posted
Oh, and none of those questions would bother me, but I'd make up a comedy routine about it later.
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I think it's because if you're having sex with a man and you're a man, there are specific STD-prevention comments the doctor can make. Plenty of homosexual men don't think they need protection when they have anal or oral sex. But they need that information.
And unfortunately, homosexual men are at a higher risk statistically of getting STD's. So if your patient has had homosexual relationships, you'd suggest STD testing and be a little more pushy about it than in a low-risk patient.
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posted
Also, MSM (men who have sex with men) are at higher risk for some other diseases, such as Hepatitis A.
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posted
Lalo, one of the inconvenient truths that exist today is that certain groups have a much higher risk factor for some diseases. That's important for a doctor to know.
I'd rather a doctor be aware and right than politically correct.
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posted
I have never had any doctor ask me such questions to this extent. Usually all they ask is "Are you currently sexually active?" (which for the past few years, unfortunately, my answer has been no), but I guess if you say "yes" they usually just follow it up with "what contraception are you using?" That's about the end of it.
I don't think I would feel uncomfortable or offended by any of the above questions, but I might burst out laughing...
(my daughter happened to read over my shoulder right as I was scanning through the original post, and she said, "BOTH????!! There are people that do that??!!" I started laughing. I really thought I had covered all the facts of society with her, but obviously that one shocked her, because she hadn't imagined it before...)
posted
It wouldn't bother me. How can the doctor know your sexual orientation?
You know what's funny though. My wife got a new gynechologist once who went through the list like you have above. He asked, "Do you have any children." She said, "No." He said, "Are you planning to have children in the next ten years?" She said, "No."
Then he started yelling at her about not having kids. Seriously, a doctor. She, of course, never went back. But I often wonder why he got so upset about it.
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posted
Farmgirl: Heh. I was wondering if people were going to be confused over "dental dams" which I had never heard of until freshman year of college.
Slash: Boo on the doctor for being so opinionated on something that isn't his business.
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posted
I can't imagine being offended by those questions. Why on Earth would I be? It sounds like your friend has a bit of a problem to me.
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posted
I wouldn't be offended by any of those, they don't seem that different from the ones the red cross asks you when you give blood, except there are none about haveing sex with people who are from or have recently been to sertain countries. But then again I tend to be less ofended then some people by queastions which imply that I am gay, mainly because I am mistaken for a girl at least a couple times a month.
Maybe I should get a hair cut Posts: 733 | Registered: Sep 2003
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posted
My doctor, no not at all. Although I would be curious why he thought I was worried about getting pregnant.
Now a teacher/stranger/peer that would be a little odd.
Edit: That whole thing about not assuming heterosexuality is somewhat silly. Only 90% of the population is straight. It's a safe bet your patient is too. It's like asking a person's race when they have pale skin. Now there are some exceptions (Michael Jackson per se), but it is still a pretty safe bet.
[ January 15, 2004, 07:36 PM: Message edited by: Ryan Hart ]
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posted
Well Ryan, it's similar to not asking a 14 year old if he or she is sexually active during an annual check-up. Sure, 95% of 14 year olds aren't sexually active so why bother asking?
If you assume all your patients are straight, you put up a wall that says "I am only willing to talk about straight sex. Don't talk to me about your gay problems." You miss people, people who are underserved in health care. They worry that you are a judgemental person who would treat a gay patient with less respect than a straight patient. So they keep their problems secret, whether or not you are actually a judgemental person.
Posts: 1892 | Registered: Mar 2002
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posted
Of course, answering these questions for a doctor wouldn't bother me. Like many people, my answers would be pretty boring. At least, I've done a couple surveys related to this topic, and it didn't bother me.
And if the doctor discloses personal information, they aren't ethically fit to be a doctor, IMHO.
Posts: 1813 | Registered: Apr 2001
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posted
None of those would bother me, but I do think Bob's suggestion of asking whether the patient knows their partners' sexual history is a good one. These lists of questions always make me feel so straightforward and uncomplicated, like taking the purity test before having dated much...
I once had a nurse, while questioning me, ask if I was happy in my marriage. I wasn't too thrilled about that one, especially as she was asking stuff in a very casual way. (I might not have been as offended if it has obviously been a list. But still, I don't think it's really an appropriate question.) The same nurse went right on to give me some of the best medical advice I've ever had, so I don't hold it against her. Even though she looked slightly pitying when I told her I didn't feel STD testing was necessary. Posts: 335 | Registered: Feb 2001
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posted
I second what Marek said. These questions also made me think of the blood donor questions, which I understand are necessary, so I'm fine with them. Same idea here.
Hmm, I need a haircut too . . .
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posted
I'm fine with a doctor asking me relevant questions. That doesn't mean that some of them might not make me uncomfortable, but that I can understand if there is a need. Are you comfortable with having a proctological exam? Will you have one anyway if it's medically called for?
A question I notice missing is "For how long have you been sexually active?" Anecdotally I know of a case where this question would have been relevant and was not asked, and it would have saved a lot of time.
I do wonder why a doctor would need to ask all of these questions of every patient, though. It seems to be a much more thorough questioning about sex than one receives on any other topic. I think questions about current behavior might be almost universally relevant, but I'm not sure that questions about stuff that's in the distant past are as relevant. I wouldn't feel comfortable lying to a doctor, so being asked questions whose relevance I did not understand would simply make me uncomfortable as I answered truthfully.
Posts: 1112 | Registered: Jan 2003
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In the HIV/AIDS street outreach project, we just assumed that if you came to us you needed the information and instruction/condoms/bleach kits. Otherwise, we just asked you if you would like information pertaining to safe sex.
I have never had a doctor ask all those questions except once - when I was facing a hysterectomy.
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posted
Icarus: the only reason this feels thorough is because you've probably never had a true thorough exam. Anyhow this is often done with a form in the waiting room, which may or may not be the best method.
I'm in the middle of learning the entire history/physical exam and it's shockingly long. I've never been told to move my neck in each direction or count backwards from 100 in groups of seven. Course, I've been to very few doctors.
Posts: 1892 | Registered: Mar 2002
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posted
I reckon you're right. Still, there are seventeen questions here. I've never been asked seventeen questions about, say, my stomach, though it would not seem out of place if I were complaining about a stomach malady.
quote:- Now I'd like to ask you about your stomach. - These are questions I ask all my patients. - Do you digest food often? - Have you ever eaten? What kind of food? - How many restaurants have you eaten at, ever? - Do you currently eat at home, restaurants, or both? - Anything different in the past? - How do you like fast food? - Do you have any concerns about botulism? - Do you have any diarrhea or constipation? - Have you noticed any changes in your gas lately? - Have you had problems or concerns in the past? - Have you ever had concerns about getting ulcers? - Are you practicing safe eating? (fiber, beano, Prilosec, etc) - Have you eaten at the home of a person at risk for dysentery (hospital employee, Denny's chef, bachelor?) - Have you ever had vomiting induced? been force-fed? - Do you have any other questions or concerns?
posted
I ask patients a LOT of questions the first time I meet them. I ask about everything, and that includes a lot of social history questions. I do tailor the questions to the person, tho. Usually I am careful to just matter-of-factly, bluntly ask some sexual history questions tailored off of things we have already discussed. If I am not sure about sexual orientation I am careful to use the word "partner" instead of he or she. The patients always seem to pick up on that, especially the ones with same sex partners, and they usually volunteer that information at that point. Sometimes they volunteer the information very shyly. Most of the other sexual history questions seem to get brought into the conversation rather smoothly at that point. I can't tell you how many times I get told about past abuse or date rape. AND how many times I find out I am the first person who has been told that information, because I am the first person that bothered to ask. And it never occurred to them to tell anyone before. I hardly ever have anyone get offended at my questions although occasionally I'll find someone who starts answering in monosyllables and I back off at that point and go onto something easier.
I am afraid I don't ask men about impotence enough. My patients tend to have health problems like diabetes and thus have a high rate of impotence. I keep telling myself to ask but men immediately stop making eye contact when I bring the subject up and it just seems to be very hard to discuss.
On the other hand, I ask at LEAST once or twice during the first visit if there are any questions, any questions at all that the patient has been dying to ask a health care worker and I sit quietly and let them think about it. They seem to like that.
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posted
Suneun, what really amazes me is how many times someone comes in and tells me they want a physical because they have had one every year for the past 20 years and they like the reassurance it gives them. So I ask all my questions, and I do a complete exam. Often the patients keep exclaiming that they never got asked so many questions before, ever, and that they have never before seen half the physical exam testing that I am doing on them. I find that pretty scary. What kind of physical isn't complete??
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posted
I would never be offended at a doctor asking me questions that were relevant to the way he/she needed to treat me.
I used to think my doctor was just making small talk when he would ask me about the kids and whether or not they were in preschool, etc. Instead he was assessing me, and how I was doing at home and it's a good thing he did because my ob/gyn was the first medical person to notice my depression. Most of it came out when I burst into tears when he asked me if I got any time to myself during the day.
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posted
I take issue with this statement/question. EVERYone is at risk for contracting HIV. Not just IV drug users and homosexuals and people who take money for sex. HIV can be contracted through all types of sexual contact and even open mouthed kissing. I dont like statements that reinforce safe feeling lies.
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No Dave, it can't. Doctors, correct me if I'm wrong, but although trace amounts of the virus have been found in saliva, there has not been a single case of HIV being transmitted by a thorough kiss.
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posted
There has been exactly one case reported wherein this was found to be the means of transfer. It is classified by the CDC as "Extremely low risk, but possible"
I actually spoke with an RN today who made it clear that it can very easily be transmitted in this manner provided there is an open sore, cut or trauma of some kind in both mouths (trauma so slight it can be caused by simple toothbrushing or biting of the cheek is enough for transmission.)
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posted
I was checking that out too kat. While there has never been a documented case, the consensus seems to be unsure with deep French kissing, particularly if one has sores or cuts in one's mouth.
posted
Unless I'm mistaken the queastions were for a general medical history particularly the gategory of sexual activity, so again I figure the queastions are what they are for the same reason the red cross asks what they ask (I keep referring to that because I've given blood a few times, but been asked this type of queastions by a doctor only once), they are likely just look for the patiens with the highest risk, but they still probably do several tests that detect an irregularity as severe as AIDS. And this all based on logic in my own mind which lacks medical knowledge entirely so if I'm way off, then I can easily accept that.
Also maybe it is just me, but those queastions I understand more because they would indicate a higher risk, and since as you said everyone is at risk somewhat the doctor would obviously know that already, so if they were asking me about who I had kissed, and how, and when, and how often without already being looking for something specific I would be sort of uncomfortable and confused by it. On the other hand if I had so much as a sore throat which I do fairly often have, then I wouldn't think twice about it, so to me at least it is my ability to understand why I'm being asked something that makes it seem reasonable.
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posted
Quick aside: Funny, I don't think I've ever used the word trauma to describe a cut or sore in my mouth. How ironic, compared to a paper cut (no pain)... my typical reaction to biting my tongue is something like, "#$%!, not again #$%%*$! #&*$@!"
Posts: 1813 | Registered: Apr 2001
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posted
I'm not offended by the questions, and have answered similar questions when I go to the gynecologist. However, it seems like better data could be derived from more direct questions that actually asked what the doctor wanted to know.
Such as: Are you sexually active? Have you had an STD test? Have you had an STD test since your last partner? Has your partner had an STD test? Would you like more information on preventing STDs? What form of birth control do you use? Would you like more information on birth control? Have you had problems trying to get pregnant?
posted
GradStudent: perhaps better data, but we are generally supposed to begin with open-ended questions in order to field the kinds of things they wouldn't normally ask.
Do you have any sexual concerns?
might be answered with a truthful, "yes, i've been having this problem..."
than if you give them a bunch of yes or no questions:
Do you have pain during sex?
"well,... y- not really,... no."
Posts: 1892 | Registered: Mar 2002
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posted
What rivka said. I answer these questions every time I donate blood. They also ask quite a few other (very specific) questions, in addition to asking if I've had sex with someone whose sexual background I didn't know in the last 12 months each time.
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quote: My patients tend to have health problems like diabetes and thus have a high rate of impotence. I keep telling myself to ask but men immediately stop making eye contact when I bring the subject up
Oh, Theca, please! On behalf of their wives/partners, ASK them. They will never volunteer the information.
posted
The one thing I did find sort of offensive that was related to this subject was one time when I was giving blood and a nurse for The Red Cross looked at me for a minute like she was considering something, and then asked me if there was even any need to go through the sexual history queastions.
But the other times I've given blood they asked all the queastions without hesitateing even though they were also on a form I had to fill out.
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posted
I wouldn't have any problem answering those questions, because the doctor would clearly be awed and shamed by my magnificently gorgeous body.
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posted
Suneun-Being in the same situation you are (med student, now on clinical rotations) I have been working with some Family Practice doctors and doing a fair number of new patient interviews and some complete physicals (though not nearly the hours long ordeal they taught us-and probably you too!).
I have found that, even as a student, people are really open to personal questions coming from who they see as the doctor. It is a humbling experience. And being 100% nonjudgemental is critical. There are a lot of doctors out there (just like there are a lot of people in the world) who are very judgemental and can prevent good doctor-patient interaction by letting personal biases into the interview. My theory is no assumptions, just straight forward questions that are open ended. And I have yet to meet someone who was offended by any of those questions. Uncomfortable, perhaps, but not offended.
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