to motorola2 - citrobacter2

[ArchivalUser]

hi could u please tell me how to ask about sexual hx
if an old man only sexually active with his wife should i ask him about condom
or a women only sexually active with her husban & on ocp,how to counsel her if she has one partner ?
sometimes i don't find anything in the hx to counsel about, so will i lose points or how, can u help me please i'm confused
thanks

[ArchivalUser]

it is okay to ask about condoms at any age. No SP will give you negative for asking about it. But in a case like how u specified I dont think you are going to get scored less if you dont ask.

You should ask the following 5 questions. Before asking these you should ask for permission saying "Mr. Smith I now need to ask you certain personal questions in order to arrive at a more accurate diagnosis. Is that ok with you?"

Are you sexually active?
With men or women or both?
How many active partners do you have?
Have you had other partners in the past?
Do you use condoms?

Based on the answers of above you should determine if the patient is at high risk of STDs. If so you can tell them "Mr. Smith as your concerned physician I should warn you that your sexual habits put you at a high risk of sexually transmitted diseases including Hepatitis, HIV and Gonorrhea. It is safest to have one constant partner and use condom everytime you have sex. Oral and anal sex also increases the chances of infection and a condom should be used at all times. If you wish we can test you for such infections. Also Mr Smith, don't be afraid to talk about safe sex with your partner. Your partner is probably just as concerned about risks as you. Talking about safe sex is an expression of caring for your partner and yourself."

From : http://score99.blogspot.com/2009/05/step...eling.html

[ArchivalUser]

thanks so much
if the pt is not at risk at all like a women only sexually active with her husban & on ocp, should i counsel her about condom or not ?
thanks

[ArchivalUser]

I am not sure. I probably would not counsel her from the STD point of view but say something like.

"Mrs. Smith OC pills are excellent method of contraception but like all other methods they have their failure rate. Many doctors now recommend using two modes of contraception to decrease the chance of unwanted pregnancy. I usually recommend condoms as they protect from sexually transmitted infections too."

[ArchivalUser]

thank u soooo much

[ArchivalUser]

one more q please
sometimes i can't find anything in the hx to councel about
what should i do
r theres caes with no counseling
thanks

[ArchivalUser]

You will always have things to counsel about. If nothing counsel about warning signs. For example in a case of diarrhea counsel about danger signs of dehydration. In a case of chest pain about danger signs of MI etc.

And if there is nothing. Complement them about how well they have maintained their health and talk about benefits of exercise and a balanced diet!!!

If you have a specific case please post it on my blog on

http://score99.blogspot.com/2009/05/step...eling.html

or email me on score99.blogspot.com

[ArchivalUser]

thank u so much

[ArchivalUser]

Motorola2 can you tell me how to counsel a difficult or angry patient.

[ArchivalUser]

you get angry at them! hehe