COMMUNICATION WITHFEMALE PATIENT

Made Kornia Karkata

DOCTOR’S COMPETENCIES

• Communication

• Standard in moral and ethical conduct

• Competencies in implementing medical knowledge and technology.

• Standard in doctor-patient relationship.

PATIENTS SEEK

• Respect , courtesy , privacy• A provider that understands each patient’s

situation and needs • Complete and accurate information• Access and continuity of care• Fairness (kejujuran) and results

Doctor-patient communication

• Good communication is essential to patient assessment and treatment.

• Foundation of communication is based on key skills: empathy, attentive listening, expert knowledge and rapport.

Two points

• Taking history about sex behavior and problem.

• Examining Sex organs in pregnancy and gynecologic problems.

Taking a sexual history

• Why is it important to talk about sex?– Even rare but actually happen– And not as easy as imagine

• Difficulty talking about sex :– Personal embarrassment with the subject– Students feeling that they are to young to ask older

patient in detail about sexual relationship– Concerned that the patient may feel offended– The believe that sexual history is not relevant to the

complaint

When to talk about sex

• Where patients present with a problem which is likely to be sexually related.

• When patients have medical or social problems which may lead to sexual difficulties

• Sometime, very rare, when sexual problems are not related to medical treatment ( sex during pregnancy; sexual harassment , sex post operation etc)

Barrier in sex communicationMisconceptions about sexuality

• Elderly people do not have sex• Gay men only have sex with men• A married person couldn’t have STD• Young people under legal age don’t have sex• Everyone understand the basic of reproduction.• The presence of sexual problems usually means that

patient also has psychological problems.• Patients will raise the issue of sexual problems if they

have any concern.

Female patient

• Unique• Vary in sexual and reproductive experience

and organ function• Fearful of gynecologic examination, she

considers private and embarrassing• The privacy of all discussion• Review past medical history, family history,

social history,

continued

• Number of pregnancies, deliveries, abortions, contra-ceptions, STD, drug usage, sexual practices, marital status.

• Current medication, drug allergy • Moral standard, religious belief , sexual

practices and experience may be different• Abnormal practices / lesbian / anal sex etc

Patient with Obgyn problems

• Women with their uniqueness• Mostly to eastern culture• Expose to genital organs, the forbidden area• In pregnancy, deal with health of mother and

baby• Need special treatment / approach

The 3 components• The patients– Shy, embarrassed – Afraid / scare– Sense of painful– Inconvenience.

• The doctors– Mostly male doctors– Non sensitive

• Place of examination

The patient

• Age : adolescence, young adult, married, divorcee, menopause ?

• Primi gravida (kehamilan pertama) ? Multiparous woman ?

• In Happiness or sadness?• The first experience or familiar with• Alone or accompanied by mother/elder sister

etc ?

Place of examination

• Opened, not special and no privacy• crowded room• Uncomfortable room• Image of teaching hospital• No toilet / rest room

The doctors

• Most of them are men• Manhood behavior, hard, loud, rough

and mostly non sensitive• Not catching the unspoken language• No respect to patient as a complete

human being. • in a hurry, lack of time

What should be done?

• Doctor should endeavor the combination of three factors to result in: Conducive, emphatic , smooth, comfort and painless contact/ discussion.

• Make a good rapport , minimize controlling speech habits such as interrupting, issuing commands and lecturing.

The physician’s role

• He is : a good listener, empathetic, honest and genuine.

• Listen more and talk less.• Using understandable language, appropriate

body language, open dialogue, appropriate emotional content, humor and warmth.

• NOT: confrontational, combative, condescending, overbearing, judgmental

EXAMINING WOMEN• History taking• General Physical examination • Examination of Specific area (obgyn)• Related supporting examination• Making diagnosis / differential diagnosis• Working plan of therapy• Counseling and informed consent• Therapy : medication or surgery• Three C (complete, correct, clearness) of medical record• Strict Confidential.

Example

• Semi-closed room• The existence of female nurse• The nurse help to put off underwear• The nurse help the patient to sit on

gynecologic table• Vaginal examination : smooth, careful, not

forced, the sequence, confidence and not rough, do serious and no joking.

Example (2)

• Systematic sequence • Only ONCE , NO repetition• Eye contact• No sexual harassment• Ended with conclusion and clear

information to the patient

Special condition

• From young lady to menopause• Infected genital organ.• Deviation of sexual behavior : gay, lesbian • From gonorrhea --- HIV/AIDS• HIV positive in pregnancy• Case of criminal rape • Case of Unwanted pregnancy• etc

conclusion

• Female patients need special treatment• Doctor should master how to Talk about sex

and examining woman’s body. • Doctors should know woman’s nature and

characters.• Being respect, courtesy and privacy• Smooth, careful, not force and responsible• Ended with information to make confidence

and trust