Dear Doctor, Why Do You Care How Many People I Sleep With?

I am a doctor, sometimes, that is my shame.

Dear fellow professional:

Did someone ever teach you how to ask someone their sexual history?

Did you get any systematic training  in handling sensitive issues?

Do you know if you sound judgemental while posing a question to a patient?

Do you know there are professional and standard methods in approaching sensitive issues?

Can you put a patient at ease when talking about their substance abuse issues?

Do you ask more than is relevant to the medical situation?

Do you explain to your patient why you need to ask such personal questions?

Do you say “you should not smoke”, after asking if she smokes?

 

I am a doctor, sometimes, that is my shame.

I studied at one of the best centres for medical education in India.

Yet

For every 100 lecture on what to ask, there was maybe, one lecture on how to ask.

“Get the patient’s sexual history”, I was instructed

The patient was a 20 something woman. I was a 20 something guy. Her mother was with her. There were 15 patients waiting. It was a disaster.

10 years in the medical system, multiple postings in gynaecology, yet not one workshop on “how to ask the awkward questions?”

It was assumed that I would know, or learn. That the patient would understand that I had to ask these questions. That it was the patient’s “duty” to answer.

“Do you smoke?” Can mean many things, do you know that?

Tell me, I am eager to know.

Inspired by a recent conversation on twitter

 

Featured Image by  jakebouma

9 thoughts on “Dear Doctor, Why Do You Care How Many People I Sleep With?”

  1. Anand, I’m so glad you brought this up.

    What you’re speaking about is etiquette and a lack of training, but I’ve also been on the receiving end of something a lot less subtle.

    As Vidyut says, I end up volunteering information, because, after all it’s about my health.

    What I’m going to tell you has happened umpteenth times, but one particular incident is too appalling to not be shared.

    I had some severe sexual trauma after which I was unable to get help for 2.5 years. When I finally had the money for tests necessary, I took myself to a pathologist who decided to start the tests with “You should not do things like this.”

    The needle was under my skin.

    “But it was rape.”

    “Yes, you should not do things like this, it is not in our culture.

    For fuck’s sake. What part of R.A.P.E. did she (yes, a SHE) not understand?

    I don’t care if she is good or bad at her job. I will never trust her again.

    Since my entire family visits her for tests, I requested her to not share the info. “Yes, we are very professional,” she said.

    There is much more than this, but really when it comes to sexual trauma, I fail to understand how anyone can pass judgement. And that in a situation where a needle is an inch inside someone’s arm?

    I felt safer having been raped in a foreign country where I barely spoke the language on a cold winter evening when the whole world was on Christmas vacation. But not at my pathologist’s in India next door. Because there, if I needed help, I could have called the police (not being able to think clearly enough to speak a foreign language or to report anything without someone’s help stopped me from doing this), and they would have helped.

    In India, victims of sexual trauma are fucked. Literally. Beginning with the behaviour of doctors, police, a culture of denial, and the list goes on — even counsellors have been judgemental.

    So yes, etiquette and training is terribly important. So is sensitivity. Can there be some sort of psychological test for who is and isn’t allowed to handle such situations?

    1. I can’t imagine what you go through in terms of sensitivity in India, because we may have banned sati and dowry, but we are a far way from believing that women have a right to dignity. You have cops in domestic abuse cases advising women to adjust as much as possible, you have husbands furious with their wives because some lecher paid them too much attention. It doesn’t surprise me at all that you were advised not to do “things like this”.

  2. Interesting post I never ask an unmarried female patient history of sexual intercourse unless there is strong possibity of STD.If so I will first explain why I am , try to get as much privacy as possible and then ask.

  3. Don’t know if it matters, but if I must share my sexual history, I’d prefer to do it with someone my age than an uncle type. However, less judgmental and not over friendly would be key in keeping me comfortable through the thing (and I’m quite bold). Listening, but not intruding – after all, it is intimate information made known to someone not intimate at all, or worse, intrusively intimate, as in the case of physical examinations.

    If a doctor lectures me on what to do, I walk out. Recommendations are welcome, respected and accepted, but I’m not paying them to give them a glorious microphone for their beliefs in life at the expense of my dignity. But that’s me. I imagine someone less confident might clam up and simply not share anything that could result in a lecture. Its not like we can go back in history and change things in order to reply. If it won’t work, we can only lie. <== spoken from a totally woman perspective.

  4. I sometimes make it easy on the doctor. In describing the symptoms, I provide the information that I smoke as a part of it. Forget dilemma, most doctors don’t ask it at all and it could be a factor.

    For example, I had quit when I was pregnant, and went all through pregnancy without my doctors ever asking me my smoking history. Luckily, they were to keep the family happy, and the doctor I was following the advice of, knew the details.

    The fact remained that I had a history of smoking that doctors taking care of me for six months didn’t even bother to ask. It is “supposed” to be an important part of the history, because smokers can have some additional risks.

    So, when I intend to act on the advice of the doctor, I usually volunteer the information, because the doctor may have his reasons, but at the end of the day, its my health.

  5. Well Anand, I do ask about sexual history, being a venereologist, and also given that multiple cutaneous conditions could be mimiced by certain STDs. The questioning depends on how pertinent the situation is.

    Frankly, in a busy OPD, the question is pretty straight. I see to it that the patient’s bystander is no where around and we have adequate privacy. I then counsel, I almost always do, stressing more on what relevance it has to his/her condition. As for abuse, the situation is more complex and time-demanding; so I ask to come on my non-OPD day so that we could sit and discuss.

    I think I have learnt these questioning from my teachers in Dermatology, but yes, a formal programme would surely be helpful for all.

    1. thanks Tanumay, it is important that the doctor-side difficulties be presented too. But, i am sure you will agree that learning things, and such crucial things, only by watching seniors is not a very effective method- for the patient.

      1. Isn’t most of clinical medicine learnt that way? from senior clinicians? Or do u recommend a Macleod’s textbook? I guess, with practice as well, things improve- ask the NACO PPTCT counsellor who screens for HIV everyday.

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