Taking History on Sensitive Topics

What topics are considered sensitive when taking a patient history?

Alcohol and drugs, physical abuse or violence, and sexual history.

What should you keep in mind when taking a history from a patient with alcohol or drug use?

The patient’s history may be unreliable; signs and symptoms of use may be masked, so use all your senses, establish rapport, remain professional, be honest and open, and assure the patient that information will be kept confidential.

How should you handle suspected physical abuse or domestic violence?

Report all cases to the appropriate authorities, do not accuse anyone, check for inconsistencies in histories, separate parties to interview individually, call law enforcement if necessary, be observant, nonjudgmental, and document facts objectively, including pertinent statements in quotation marks.

Why might patients not reveal sexual history, and what should you assume for women of childbearing age with lower abdominal pain?

Religious beliefs, cultural stereotypes, and societal expectations may prevent disclosure. Assume they may be pregnant unless ruled out by history or other information.

What questions should be asked regarding sexual history in female patients?

Last menstrual period, normality of periods, unusual vaginal discharge or bleeding, sanitary products used if bleeding, urinary frequency or burning, severity of cramping, foul odors, sexual activity, possibility of pregnancy, use of birth control pills.

What questions should be asked regarding sexual history in male patients?

Pain with urination, discharge, sores, increased urination, burning or difficulty voiding, recent trauma, recent sexual encounters, and potential for sexually transmitted diseases.

What is the key approach to taking history on sensitive topics?

Never be judgmental and maintain professionalism and confidentiality.