Introduction to Sensitive Topics
Sean Reed, M.D.
Assistant Professor
Department of Family Medicine
Sensitive Topics
Death and dying
Family interactions (spanking)
Racial and ethnic experiences
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Bowel and bladder
function
Sexual orientation
and practices
Illegal drug Physical
use deformities
Sensory deficits (blindness, deafness)
Alcohol use
Mental illness
Spirituality and religious beliefs
Prison
Violence/Abuse
Literacy
OBJECTIVES
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
19 y/o woman with a sore throat
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College student
Sore throat for 5 days
Fever 101
Strep test negative
Gonorrhea
Leading Causes of Death, Youth Ages 10-24
Rationale: Nosey or Necessary?
vs.
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)
Change can make a difference
50% of health problems are caused by
behavioral risk factors
The Envelope Please
Personal Biases / Attitudes
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.
Barriers
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Physician’s own discomfort/biases/beliefs
The patient doesn’t want to talk about it
Jargon
Lack of specificity
Time
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
To communicate about your communication to help
overcome barriers or resolve a problem
If a patient raises an issue - GO FOR IT
If you think something needs to be addressed – GO FOR IT
When in doubt, anxious or lost – GO FOR IT
Jargon
“I did not have sexual
relations with that
woman”
Vol. 281 No. 3, January 20, 1999; Would You Say You "Had Sex" If . . ?
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.
FIRED!
When Dr. E. Ratcliffe Anderson, the American Medical Association's executive
vice president, announced on January 15, 1999, that he had fired the editor-inchief 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."
Lack of Specificity / Time
Structured Approach
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Comfortable setting
Relaxed style
“Routinize” questions
Language
Confidentiality
Empathy
Avoid assumptions
Ask patient’s permission - “Is it OK…?”
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…?”
Note Taking
When a patient divulges some highly personal information
consider not writing it down immediately
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
Thank You
http://www.random.org/