COMMUNICATION WITH FEMALE PATIENT

Made Kornia Karkata

DOCTORS 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 patients 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 communication Misconceptions about sexuality

Elderly people do not have sex Gay men only have sex with men A married person couldnt have STD Young people under legal age dont 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 physicians 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 womans body. Doctors should know womans nature and characters. Being respect, courtesy and privacy Smooth, careful, not force and responsible Ended with information to make confidence and trust