Talk about sex? Your doctor would rather not ... and you'll be lucky to even get a greeting

24 July 2021 - 09:17 By sipokazi fokazi
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Doctors and patients should be talking much more about sex, according to Deidré Pretorius of Wits University.
Doctors and patients should be talking much more about sex, according to Deidré Pretorius of Wits University.
Image: nappy.com/@rawpixel.com

Nearly one in seven South Africans is HIV-positive, so you might think conversations with your doctor about your sex life would be commonplace.

The opposite is true, and in some cases you'll be lucky if the doctor even greets you, according to new research at Wits University.

Deidré Pretorius, from the school of family medicine, filmed 151 routine consultations with patients suffering from diabetes and hypertension — conditions where sexual dysfunction is common — and found only five in which sex was discussed.

Even so, the conversations were paternalistic and lacked privacy, warmth and respect, Pretorius said in the journal Sexual Medicine.

And in consultations that lasted between 8 min and 23 min, only between 2 min and 8 min involved interactions with patients. The rest of the time was spent looking through files and writing notes.

Pretorius said her findings in Klerksdorp, North West, uncovered a stumbling block for the public healthcare sector’s efforts to provide preventive and inclusive health services at clinic level.

Interactions with patients were superficial, and from the doctors' perspective “appeared to be focused on getting the patient out of the door”, she said, calling for training to improve doctors' clinical approach to patients, consultation skills and time management.

“But more importantly, an attitude shift around the importance of sexual wellbeing must happen. Doctors need to reflect on their practice and ask themselves if they are there to chase patient numbers or to render a comprehensive service,” said Pretorius.

“Dealing with patients with diabetes and hypertension must be a red flag regarding quality of life, which includes sexual wellbeing.

“The health system can support the doctor better with technology to prevent valuable consultation time being lost due to poor administration of files and laboratory results.

“Such changes are important, but these will be insufficient if doctors themselves do not change. This requires an attitude change on the part of the doctors involved, which will also involve having to deal with their personal perceptions of professionalism and their relationships with their patients.”

Global research suggests only between 10% and 58% of doctors routinely ask patients about sexual practices, partners, previous sexually transmitted infections (STIs), prevention of STIs and pregnancy, and factors such as sexual wellbeing, trauma, gender identity and sexual orientation.

'Again?' That's what a doctor said to a young man who arrived in his surgery with a sexually transmitted infection.
'Again?' That's what a doctor said to a young man who arrived in his surgery with a sexually transmitted infection.
Image: 123rf/studiostoks

In Pretorius' study, even when an STI was the reason for a young man's visit, he was greeted by the doctor exclaiming “Again?”

The patient bowed his head, removed his cap, looked embarrassed and said simply, “Yeah”, said Pretorius.

In another consultation, a 63-year-old man cheerfully greeted the doctor but the medic did not return his greeting, leaving the patient offended and subsequently giving one-word answers.

Pretorius and her colleagues said the doctor’s conduct clearly left the patient feeling disrespected.

“Professionalism is an important component of the patient-doctor relationship that was lacking in these consultations. Greeting, politeness, and using a person's name are not only expressions of professionalism, but also signal respect in most African cultures,” they said.

“Communication skills, including the verbal and non-verbal exchange of information and ideas between individuals, are core to the doctor-patient relationship. Poor eye contact and poor listening were the two factors most prominent in these consultations.

A consultation in which a 47-year-old woman complained about pain after sexual intercourse was different.

The 25-year-old male doctor greeted the patient, introduced himself and acknowledged the patient’s name. This “resulted in the patient disclosing intimate information”, said Pretorius.

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