OM SWASTYASTU

COMMUNICATION WITH
FEMALE PATIENT
Made Kornia Karkata

PATIENTS SEEK
Respect , courtesy , privacy
A provider that understands each patients
situation and needs
Complete and accurate information
Access and continuity of care
Fairness 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, STD , homo /lesbian 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 ? 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.

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 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

How do you communicate with?

A young 15 yrs old girl , who is victim of a
rape by boys-gang and finally come to
the clinic with pain and slight hematoma
of physical violence at the vulva?
A 17 yrs innocent-looking girl who is
pregnant of 12 weeks gestation but denies
to have had sexual intercourse with her
boy-friend ?

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

Thank you very much