What is your approach to discussing sexual subjects?
Patients usually raise these subjects to me because they come in with a specific problem they want to discuss. With other patients, especially adolescents, I raise the topic of sexual health as part of a well exam, often using questionnaires. Our nurses will sometimes broach the subject, which helps identify the youngsters’ questions, which they then bring up to me.
You mentioned adolescents. How do you address other topics with them?
We have healthy living questions and risk factors questions—for example, are you using drugs? Do you have friends? How do you get along at home? Do you participate in activities out of school? Are you sexually active? And if the answer is yes, we might ask, “Are you engaging in oral sex or intercourse?” Again, the atmosphere must be empathetic and inviting so that the patient will feel safe discussing these issues.
Problems may be brought to me by family members who are concerned about behavior at home, poor grades at school, or socialization. I live in an area where there is a large heroin problem, which we deal with on a daily basis, so families sometimes want drug testing for their child.
Most patients will have a least one person in the family who is not happy with what is going on, and they won’t be happy either because they are being accused. My job is not to be an accuser but to discuss drug use from a health perspective, offer to help, and find out if they are or are not using.
Because I work entire families, I can sometimes facilitate a balanced look, help all family members deal with the situation and help parents take a more positive and less judgmental approach toward their children.