Lesson I Learnt from Jefferson -- Sexual & Interpersonal Relationship

Sometimes in your interview, you will come across people with gay or lesbian relationship. First and foremost, do not show any signs of surprise since it will make patient feels uncomfortable. Try to be neutral and more understanding.

Before I begin, quick mention on what kind of words to be used. Start of by asking permission. "I care about you. To do that, I need to ask something private"/ "As a physician, I need to know that. It will be kept confidential." Reassure the patient that you are asking in good will and that you will keep his/her private live in secret. (Homosexuality is still a big issue here despite efforts of making homosexual legal). Afterwards, ask about the sexual history. "Are you in a relationship? With men or women or both?" Same rule applies, do not beat around the bush. Ask straight, but don't do it too prominent, of course.

Ask about screening tests done in any couples. Tests like HIV testing and STDs. (People always think HIV test first then other tests, therefore I can't think of any other tests which you can do)

Ask about a possible abuse relationship. This is not a funny issue as domestic violence or sexual assault is pretty common. Approximately 25% of women in US will be abused by a current or former partner sometime during their lifetime and most of the time (85%), victims are women[1]. Kick start this by asking "How's your marriage?" or "How's things going on at home?". If you suspect possible abuse, initiate SAFE questionnaire. 1. Stress/Safety; 2. Afraid/Abuse; 3. Friends/Family; 4. Emergency plan. Then proceed to Abuse Assessment Screen (AAS) to access how severe the abuse can be. One point I want to mention is patient may indirectly hint you that they are in an abuse relationship. Remember that women tend to cover up this messy relationship and tend not to talk about them too much. Say for example, patient may say their relationship is good but they did argue. Argue but still in a good relationship? Ask more...

Depressed patient. They won't say anything (sometimes), even though they start speaking, it will be slow. It's pretty hard, actually, to get a full history done by a short period of time due to the slow nature of the interview. Nevertheless, you need to be patient and try not to hurry the patient too much. It's bad. Question patient intention of how to overcome them. Let's just start a scenario like this. Firstly, NO BEATING AROUND THE BUSH. Ask him/her "I think you are feeling depressed because ..." Explain to him/her and explore whether he/she has suicidal intention. Questions like "Do you feel you want to harm yourself/other people?" should be asked. Optional question like "Do you own a gun?" can be asked.

P/S: As long as you see a gown, please drape. Assure patient that you have the best quality of care and that you do your best to help. Scenario: Patient indecisive of admission to hospital for treatment as he/she is afraid that he/she will end up dying like of his/her parents who have the same disease as he/she. Assure her: "We have the equipments to make you feel better and that we need to put you early to hospital." (S.P. amazed but the bolded phrase. This is just an example I made up with the intention which I feel from the S.P.) Night sweats. Can be lymphoma, TB etc. In diarrhea, talk about quality of stool (watery? Color? Frequency?) When you want to do examination on female patients, due to modesty, you would need to ask "May I go under the gown?"

Reference:
1. Fortner K B, Szymanski L M, Fox H E, Wallach E E. The Johns Hopkins Manual of Gynecology and Obstetrics. Baltimore: LWW; 2007, p. 355