Patient-Provider+Communication+About+Sex

Christina Libs


 * Patient-Provider Communication About Sex **

Patients and providers are both responsible for keeping the best possible record of the patient’s health. The doctor’s job consists of making sure potential problems are resolved as quickly as possible, and the patient should always be aware of his or her body. Revealing a promiscuous past is something that not many people are comfortable talking about, but when it comes to discussion with a healthcare professional, it can be very helpful for patients to be open and honest in order to get the best care possible. Studies have shown that 40% of women admit to having occasional partners on an anonymous questionnaire, while only 14.2% reported the same thing to their healthcare provider (Castelo-Branco et al. 2010). Physicians and healthcare providers have the power to influence their patients to practice safe sex and lead healthy lives. This underscores the idea that doctors have a direct impact on their patient’s quality of life. Communication between patients and providers is an issue that affects almost every person in the United States, and the level and willingness of disclosure can measure the quality of life patients lead.
 * Importance**

There are three main models of patient-provider communication, the paternalistic model, the consumerism model, and the mutualism model (Emmers-Sommer et al., 2009). These three models describe how patients and providers relationship inside and out of the office or appointment.
 * Models of Communication**

The paternalistic model sees the healthcare provider in a controlling role. They are seen as the expert and rarely questioned on their diagnoses. There is little interaction between the provider and patient, instead the patient follows exactly what their healthcare provider directs them to do. For example, a young woman goes in for a doctor’s appointment and wants to start using birth control. The doctor advises that she use a diaphragm, and she decides based on her trust of her doctor’s knowledge, that this is the best option for her. She starts using the diaphragm and doesn’t explore other birth control options such as “The Pill”.
 * Paternalistic** [[image:doctor-examining-patient.jpg width="211" height="137" align="right" caption="Paternalistic Model: Doctor instructs patient on the best health option."]]

The consumerism model sees the patient in control. There tends to be a focus on what the patient wants because they are viewed as a consumer. This model is underscored by the onset of self-diagnosis provided by websites such as [|WebMD.com] and [|MayoClinic.com]. For example, a middle-aged man walks into his doctor’s office, and while being seen, asks about erectile dysfunction. He says that he’s seen ads on TV and due to some research he has done online, he believes he needs to go on the prescription drug, Cialis. The doctor tells him more about Cialis as well as other comparative prescriptions drugs, but the man specifically wants to use Cialis based on his own interpretation of his condition and what he thinks is best.
 * Consumerism**

The mutualism model proposes equal levels of control and engagement in the interaction between healthcare provider and patient. This model rarely occurs, as many patients do not tend to have a close communicative relationship with their providers. An example of mutualism would be when a patient goes in for a doctor’s appointment and describes the symptoms they’ve been having concerning intense migraine headaches. The doctor and patient then discuss what the symptoms may represent, and the doctor suggests a course of action and the patient counters with another option. They decide on a prescription that they both feel comfortable with and set a date to check up on the progress of the patient’s health.
 * Mutualism**

There is some controversy considering the necessity of interpersonal communication becoming required for healthcare providers during their time at medical school. Some believe that there is simply not enough time during medical school to teach the extra information, while others believe it simply isn’t the doctor’s job to be warm and open but to focus on the biological and physiological side of practicing medicine. Those advocating for such training cite studies that show a mutual respect between doctor and patient can be achieved through increased communication (Parvanta et al, 2011). Many doctors are trained in ‘short cut’ medicine, for which the overall goal is to cut down on the amount of time each patient spends with a doctor. The doctor wants to quickly establish all of the symptoms, decide what is wrong, tell the patient what to do about it, and move along to the next person in line.
 * Medical School Training**

These types of models and classic training methods impact the frequency and quality of communication about sexual health that patients and providers have. Barriers that can hinder sexual communication between a patient and a provider include insufficient training, ethnic differences, lack of time, and fear of embarrassment (Verhoeven, 2003). In particular, the fear of embarrassment is not only a worry for the patient, but also a worry from the doctor. Doctors can feel embarrassed if a patient is significantly older than themselves, they can have not want to seem accusatory of the patient, and they can even feel uncomfortable discussing homosexuality based on basic moral beliefs. Due to social stigma, lesbian women often find it hard to reveal their sexual orientation to their healthcare provider (Klitzman and Greenberg, 2002). Such reservations stemming from the patient can inhibit a doctor’s ability to evaluate their health and wellbeing. Additional barriers that come into play include taboo sexual topics and
 * Sexual Communication**

Women and younger patient tend to be more expressive to healthcare providers about sex. Older generations were raised in a society where sex was not discussed, which can lead to unease and a lack of knowledge when issues of sexually transmitted infections (STIs) and erectile dysfunction (ED) are relevant. Women are more likely to talk about contraception and pregnancy with their doctors while men are more likely to talk about risk assessment and sexual behavior. Counseling for psycho-social effects of sexuality are not normally discussed, and therefore many lesbian, gay, bisexual and transsexual (LGBT) patients are less likely to disclose their sexual practices.
 * Who does it more?**


 * References**

Castelo-Branco, C., et al. (2010). Do Patients Lie? An Open Interview vs. a Blind Questionnaire on Sexuality. // Original Research- Epidemioligy, // 873-880. J Sex Med, 2010.

Emmers-Sommer, T. M., et al. (2009). Patient-Provider Communication About Sexual Health: The Relationship with Gender, Age, Gender-Stereotypical Beliefs, and Perceptions of Communication Inappropriateness. // Sex Roles, // 182-196. Springer Science + Business Media, LLC 2008.

Klitzmann, R. L. and Greenberg, J. D. (2002). Patterns of Communication Between Gay and Lesbian Patients and their Healthcare Providers. // Journal of Homosexuality, // 65-75.

Parvanta, C., et al. (2011). Patient-Provider Communication. // Essentials of Public Health Communication, // 313-324. Jones & Bartlett Learning, LLC, 2011.

Verhoeven, V., et al. (2003). Discussing STIs: doctors are from Mars, patients are from Venus. // Family Practice, // 11-15. Family Practice Vol. 20, No. 1, Oxford University Press, 2003.


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