History Taking and Examination

History Taking & Examination

Safe Clinical Environment Sexual History Communication Skills Ethics Mistakes During History Taking The Importance of STI Tests Testing Recommendations How to Examine Sensitive Areas

Taking proper sexual history from adults and adolescents helps in the screening for high-risk sexual behaviors, identification of sexual problems such as sexually transmitted infections (STIs), provision of information, and support to patients. Discussing sexuality with a provider may be uncomfortable at any age, so a good doctor must assure his patients, provide them with a safe space, and establish trust .

Safe Clinical Environment

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4. Creating a welcoming safe clinical environment for all patients should begin at registration. Establishing your patient’s name and pronouns, as well as their sexual orientation and gender identity, are important in medical care. Some patients may not be comfortable talking about their sexual history, sex partners, or sexual practices. Some patients may have experienced abuse or trauma in their lives or while in a medical setting. All clinicians need to apply patientcentered, sensitive care to all interactions. Some patients may be experiencing intimate partner violence and seeking care for medical health concerns could be their only opportunity to access safe resources. Try to put patients at ease and be prepared to link patients to needed resources. Let them know that taking a sexual history is an important part of regular medical care.

Sexual History

First, the doctor should greet the patient, Introduce themself, gain consent to speak with or examine the patient and describe what they will do. Should they wish to take notes as they proceed, they should ask the patients permission to do so. The doctor must explain to the patient that the questions aren’t an intrusion in his relationships but, they are to help them provide the best healthcare.

To further guide the dialogue with the patient, the 5 “Ps” may be a useful way to help you remember the major aspects of sexual history.

Partners

The number, gender, new, and risk factors of patient’s sex partners

Past History of STIs

Symptoms, STIs testing, and partner's STI history

Pregnancy Intention

Contraception use and wanting to have (more) children, when, and prevention until when

Practices

Sex practices like types of sex, drug use, or masturbation

Protection from STIs

Abstinence, or not having sex, number of sex partners, condom use, the patient’s perception of their own risk and their partner’s risk, and STI testing.

By the end of the interview session, the patient may have come up with information or questions that they were not ready to discuss earlier. Ask your patient about a history of trauma, sexual abuse, or violence, as these are common, and patients may benefit from additional care.

Also consider asking about sexual functioning, including pleasure and performance, and referring for care, as indicated. For patients at risk for STIs, be certain to encourage testing and give positive feedback about prevention methods that the patient is willing or able to use .

Communication Skills

The language and communications skills are very important in the process of taking a sexual history, so there are some instructions that should be followed:

1-Appropriate greeting and maintaining eye contact are important to establish a good rapport between the doctor and the patient.

2-Patients are often vague or use euphemisms if embarrassed. Listen and watch to ensure you have understood and whether you need to ask further questions to confirm. Use open questions to initiate the consultation, clarifying with closed questions if required.

3- Pay attention to the patient’s Facial expressions, body movement, posture, gestures, eye contact, in addition to loudness or tone of voice.

4-Do not make assumptions; use neutral terms such as 'person' or 'partner' (rather than 'boy/girlfriend' , 'wife/husband') until you have confirmed an individual's sexual orientation and relationship status. Do not ask whether individuals are married or not; rather, ask how many partners they have had.

5-If discussing sexual behaviors, ensure that the patient understands any medical terminology you may use and that you understand their slang terms. Some patients prefer doctors to use colloquial terms to discuss sex; others would find this off-putting. There should be a capacity to accommodate and communicate with those whose first language is not Arabic.

Ethics

First, being serious is a key requirement, because it can build up trust to ensure good cooperation for a complete and accurate sexual history. Doctors should be patient and attentive when listening to the patients.

Second, respect for the patient’s privacy is an important act of professionalism. The environment should be welcoming and comfortable but private and isolated. Companions may prevent the patient from telling some personal information so the doctor must see the patient alone.

Third, Patients should be assured of confidentiality which can only be broken in exceptional circumstances when it is in the patient's or public's interest.

Fourth, the doctor should take consent before doing anything.

Fifth, the doctor must only ask for the information he needs and if the patient didn't come with a complaint related directly to sex, the doctor can check if the patients will be comfortable to discuss their sexual concerns after explaining to the patient why he is asking these questions

Sixth, All patients should be treated equally, regardless of their personal differences, Discriminating against patients for any reason is strictly prohibited

Mistakes during History Taking

Although the doctors are aware of the ethics of taking history and they know to what extent taking a sexual history is a sensitive process, they can still make mistakes that can lead the patient to feel bad or uncomfortable during the consultation like:

1 .Having the consultation in front of parents or partners makes the patient uncomfortable.

2. Not minimizing note taking especially in the sensitive questions that include private information.

3. Assuming a patient’s gender identity, sexual orientation, and sexual behaviors and judging them for it.

4. Using leading questions instead of open-ended questions to give the patient the chance to express his complaint freely.

5. Interrupting the patients instead of listening to them carefully for the sake of reaching an accurate diagnosis.

The Importance of STI Tests

1. Plenty of STIs are asymptomatic, with mild symptoms, or mistaken for other infections. 2. Without testing, people infected with STIs might spread the infection to others. 3. STIs may lead to serious health complications.

Testing Recommendations

Each STI has a specific diagnostic test. Tests may be part of a routine health screening or ordered when a patient has signs and symptoms related to an STI. STIs screening is recommended for those at high risk. This includes people:

Generally speaking, Everyone aged from 13 to 64 should be tested for HIV at least once, based on risk level. People practicing unsafe sex, IV drug users, people with multiple sex partners, and homosexuals should have regular STI testing.

With an STI-infected partner With multiple sex partners Having unsafe sex Using IV drugs Homosexuals & bisexuals

How to Examine Sensitive Areas

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6. Consent must be given voluntarily and freely by the patient. Do not pressure them into getting the exam. Thoroughly explain the procedure and its purpose to the patient before obtaining their consent. Provide the patient with privacy to dress and undress. Provide drapes and gowns that allow for adequate coverage of the body during the exam. Only expose the parts of the body that need to be examined and leave them uncovered for the shortest time necessary. If the patient withdraws their consent, the physician must stop the examination.

Activities

Activity 1: Guess the questions asked during taking sexual history

Goals

Materials

Methodology

Expected time

Make the participants aware about the right way for taking sexual history.

Sticky notes, markers and flipchart Trainer gives the participants sticky notes and asks them to write examples of questions they think the doctor will ask during taking sexual history, then they will put the sticky notes on a flipchart and the trainer takes a sample of the sticky notes and starts to discuss them with the participants. Works physically. 20 minutes

Activity 2: Comparison between the right and wrong way for taking sexual history

Goals

Make the participants know the ethics of taking sexual history and how to treat the patient without judgement.

Materials Methodology

Expected time

Papers and markers for writing the 2 scenarios Trainer chooses 6 participants and divides them into 2 teams, each team consists of 3, one is a doctor, one is a patient and one is a nurse. Each team will be given a scenario, one scenario is the right way for taking history and the other scenario is the wrong way, after that the trainer will reflect on the two scenarios and tell the audience the ethics and the right way for taking sexual history.

30 minutes

Sample Statements

Activity 1:

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3. 4. At this point in the visit I generally ask some questions regarding your sexual life. Will that be ok? Do you have any questions or concerns about your sexual health? Do you and your partner(s) discuss STI prevention? Have you been diagnosed with an STI in the past? When? Did you get treatment?

Frequently Asked Questions (FAQs)

Q1 . What if the patient refused to disclose information?

Confidentiality between the doctor and the patient mustn’t be broken. If the patient refuses to disclose information, the reasons should be considered and respected. Yet, if another patient or healthcare provider is at risk of infection, the doctor would inform the patient that disclosure is necessary and obligatory.

Q2.If the patient refused to get examined, what should the doctor do?

Consent is a must for an STI examination. The doctor should make sure that the patient fully understands the importance and procedures of the test, the consequences of his refusal, and the complications of the suspected disease.

Q3. Is the gender of the examiner important to the patient or not?

Yes, sometimes. New research suggests that “female physicians were more likely to see female patients, had longer visit durations and were more likely to perform female prevention procedures and make some follow-up arrangements and referrals.

Q4. What if a family member asks how the patient is doing?

Confidentiality shouldn’t be broken. Ethically, the doctor shouldn’t share any information about the patient’s health with anyone without the patient’s consent.

Q5. What are the cases in which confidentiality can be breached?

1- Concern for the safety of other people 2- Legal requirements to report certain conditions or circumstances

Q6. Who should get tested?

All sexually active people are at risk for STIs, yet not every person needs testing for STIs. STIs screening is recommended for those at high risk; due to age, gender, health history, number of sexual partners, and sexual orientation. This includes people: with an STIinfected partner, with multiple sex partners, having unsafe sex, and using IV drugs. In addition to homosexuals & bisexuals.

Q7. When to take an STI test?

If your sexual history and current signs and symptoms suggest that you have a sexually transmitted disease (STD) or a sexually transmitted infection (STI), laboratory tests can identify the cause and detect coinfections you might also have.

Q8- What are the types of STIs tests?

Blood tests. HIV, syphilis

Urine samples.

Fluid samples. For open genital sores

References

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8. https://patient.info/doctor/sexual-history-taking https://link.springer.com/chapter/10.1007/978-981-13-7677-1 _ 35

https://siecus.org/wp-content/uploads/2018/07/1.7-Taking-ASexual-History.pdf#page3 https://www.aafp.org/dam/AAFP/documents/patient _ care/sti/hop s19-sti-script.pdf https://labtestsonline.org/std-testing https://www.cdc.gov/std/treatment/sexualhistory.pdf https://assets.publishing.service.gov.uk/government/uploads/syst em/uploads/attachment _ data/file/138296/dh _ 103653 __ 1 _ .pdf https://health.uoregon.edu/sensitive-exam