- This topic has 2 replies, 3 voices, and was last updated by SarahMurphy.
February 20, 2020 at 11:29 am #17590
I felt this conversation could have been improved overall. The social worker seems to jump into the conversation without asking the patient open ended sexual health questions. I would have liked to see more of that explored and an opportunity to develop rapport. I could tell the patient felt very awkward about the discussion, however this was never addressed. It would have been nice to see the social worker pause to ask how the patient felt discussing these personal issues and then acknowledge and validate the feelings she had. I also felt as if her cautions were not clear; stating things like, “exchanging bodily fluids” is much to vague and confusing. I see many patient in our clinic who benefit from very black and white/ detailed explanations of what we are referencing. Overall the approach was poorly done.March 3, 2020 at 12:09 pm #17766
I agree with all your comments regarding this video and how there are multiple ways to improve this healthcare workers interactions with this patient. One thing that I noted was both of their body language, they appeared to be both closed off and uncomfortable during this conversation. I think one important thing that this social worker could’ve done before initiating this conversation was to consider her own bias and opinions regarding sexuality. And on the contrary, she could’ve explored the patient’s opinion regarding sexual identity and activity.
The social worker discussed about referring her to someone as well, although, this was not discussed. There was no feedback loop regarding the patients current understanding of safe sex practices and verbal read back and confirmation of understanding what “exchanging bodily fluids” meant. For instance, the social worker said “not to make out with someone who is coughing and sneezing.” While this may be true, we should emphasize immunocompromised patients from protecting themselves from those are physically ill and showing symptoms, we need to emphasize the less obvious symptoms of illness that can be exchanged through non-safe sexual practices. Many STIs do not exhibit symptoms, which may not be obvious to the individual who is most at risk for contracting them.
Additionally, I do not believe the social worker is in her scope of practice for discussing safe sexual practices. Education regarding safe sex and appropriate discussion topics should be given to this social worker for future interactions. Appropriate resources and referrals should be emphasized during this discussion and provided to the patient.
In all honesty, I do concur with you that this approach was extremely poor and there was no concrete information provided. Unfortunately, this patient may be more at risk with the information the social worker provided her with.March 16, 2020 at 4:06 pm #18043
I agree. The most disturbing part of this conversation for me was trying to figure out what she meant by “exchanging body fluids”. If I cannot determine what the instruction is I imagine an AYA would struggle as well. I think like Heather said it would have been better to say making out or kissing. I think it is important to distinguish what sexual practices would cause an exchange of bodily fluids including oral sex, vaginal sex, or anal sex. Although this was also mentioned above, a baseline is really needed to determine what the patient is currently doing or interested in doing. However, at the chance she would not be honest with the social worker it is still always good to say what is not safe.
I had a conversation about safe sex with an AYA autologous stem cell transplant patient and a provider once and when the provider left the room the patient said to me I am going to have sex no matter what he says. I was able to have another conversation with the patient reiterating what was safe and what was not and providing the patient with more needed resources.
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