ABC of sexual health: Taking a sexual history

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Abstract
Making patients feel comfortable If the doctor's attitude is matter of fact, then the patient will relax and become matter of fact, too. It must be emphasised that, whatever the patient may admit to, the doctor must be non-judgmental. A patient's approach to the problem is often tentative and hidden by euphemism, with statements like “I think I need a check up” or “By the way, I have a [discharge, itch, soreness] down below.” These comments may well be slipped into a consultation about some other problem, and the doctor has to decide whether to compromise and try to investigate the matter immediately or persuade the patient to come back for a longer consultation. Various interview techniques can be used to help patients relax more quickly; most are used by many doctors intuitively. These include the manner of greeting a patient, seeing that the patient is seated comfortably, and ensuring privacy (especially in a hospital clinic). If the seat is placed at the side of the desk, there is a greater opportunity to observe the patient's body language, as well as this being a more friendly arrangement. Postural echo, when doctor and patient sit in mirror images of each other's position, indicates empathy between the speakers Useful observations on patients' body language include Their use of their hands and arms—such as uneasily twiddling with a ring, defensively crossing arms, or protectively holding a bag or briefcase on a lap Pectoral flush, which creeps over the upper chest and neck (in some younger men as well as women) and which indicates unease despite outward appearance of calm Body's position in the chair—the depressed slump, tautly sitting bolt upright, or the relaxed sprawl Postural echo, when doctor and patient sit in mirror images of each other's position—adopted when there is harmony and empathy between the speakers

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