Put yourself in the shoes of a patient. How often are you asked about your smoking and drinking behaviors? I think that I get asked maybe once out of every four visits to a healthcare provider, whether it is a primary care or specialist visit. I think that many people assume that a non-smoker or non-drinker will remain so and that a drinker or smoker will remain so, yet it puzzles me that so many people think this way considering the changing stress levels and life experiences that one has as he or she moves through the teenage and young adult years. A non-smoker/non-drinker last year may very well be using a new substance this year, and providers or their staff should be asking and updating their records.
Now, how many times have you been asked a thorough sexual history? I’m not even sure that I have ever been asked, outside of: “Are you sexually active?” And as many of you may be able to attest to, a person’s sexual activity is much more likely to change over time when compared with a person’s patterns of substance use. So why aren’t providers collecting this history?
I think one of the main reasons that providers stay away from sexual history is that sex may not pertain to the patient’s presenting complaint. It is easy to justify to oneself that it is not necessary to broach the topic of sex so as to avoid an uncomfortable situation. Because why should I ask a person who they are involved with (that question we all know so well from Doctoring, “Are your partners men, women, or both?”) when the patient has an upper respiratory infection? Hey, the patient might lie to me anyway, right?
Well, let us not forget that medicine is not only about treating disease once it presents itself but also prevention of disease. And as we second-years move through the REBLS block at UA COM-P, we have learned about different manifestations of sexual dysfunction, many of which patients may not be likely to volunteer information about. The responsibility falls to the healthcare provider to ask the appropriate questions so that he or she can prevent disease or treat the problem.
For those who hold the viewpoint that when a patient has not volunteered personal information about themselves they have broken your trust with a lie of omission, reflect on why we all chose to pursue this profession. Let us all reflect on the society that we live in today. I hope that you can understand the fear that a person may have when faced with the choice to tell a healthcare provider something about themselves that is looked on with disgust and hate by others in this country. In some cases, something that is not visible, not obvious by the color of skin or choice of dress. And if your response is, “I am an accepting and non-judgmental person and patients should feel safe to be honest with me,” what are you doing to communicate this? It is naïve to assume that all your patients feel accepted in our society because, in reality, more closed-minded people exist than we like to admit to ourselves.
We learn to ask personal questions in our history-gathering, and there is a reason for asking them. Will you be courageous enough to go there? And what will you do to help your patients feel safe to be honest with you?
Corey Edwards is a second-year MD/MPH student at UA COM-P. He grew up in Gilbert, AZ, with a fraternal twin brother and younger sister. After graduating from the U of A in 2014 with a BS in biomedical engineering, he spent time teaching marching band, scribing in an emergency department, and teaching/tutoring for Kaplan Test Prep. Currently, Corey is a student leader of the Emergency Medicine Interest Group, Simulation and Advanced Medical Technologies Interest Group, LGBTQ in Medicine, American Medical Association UA COM-P Student Chapter, Wilderness Medicine Interest Group, New Hope Teen Pregnancy Program, and Wellness Program Executive Committee.