Practice-based & Life Long Learning

As part of the curriculum, the students attended a patient panel led by sexual assault survivors. This panel made me reflect on how physicians could change practices to make victims of sexual assault feel more comfortable with their physician. After hearing the woman’s story about how she had all the signs of sexual abuse when she presented to the physician, but this was not considered as a possibility due to her high socioeconomic status, I really wondered how the system failed her. I recently went to the OB/GYN for an annual visit and thought how I would feel if I were in their shoes, would I feel comfortable opening up? I checked in to the office and was taken to a seat in a back hallway where other employees and patients were walking around. The MA asked about my sexual activity, whether I felt safe at home and whether I drank alcohol or did drugs. She also asked me if I had any problems I wanted to discuss with the doctor. She asked these questions from a list on my chart and showed no genuine interest in my responses. I felt as if others were listening to my answers, because I was not in a private space. Then I was taken in the room and spoke with the doctor, who did not ask any more questions about violence or sexual abuse, but only asked whether I was having any problems. I wondered if this was how she treated all her patients or if she assumed that since I was young, healthy and from an affluent neighborhood, I would not have been a victim of sexual violence or have problems otherwise. I mentioned to the physician that they should have the MAs talk to the patients in the private patient rooms, because I think that would make anyone feel more comfortable when talking about such a sensitive topic.

I learned during this visit that it is important to treat everyone the same and ask all the screening questions to everyone. You can never assume that a patient does not have certain problems. The physician should be the one to ask the most personal questions, since they are the ones building a relationship with the patient. I also realized that when the physician came off as rushed, I felt uncomfortable asking questions and telling her my problems, because I felt that would be a bother to her. Even if I am rushed, I will try to show the patient that they are my priority in that moment. I really appreciated the women who were willing to share their stories and experiences during the patient panel, as it made me really think about how physicians can impact patients’ lives.

As a future OB/GYN, this made me reflect on how I would like to screen for sexual assault and any sensitive topics, such as sexual dysfunction and high risk sexual behavior. I think it is important to really give the patient your full attention when going through the social history. This can be done by sitting down in the room, getting off the computer and asking questions more naturally. My goal is to ask each patient screening questions about sexual assault at their annual visit, while I am off the computer. I will assess whether I have completed this goal after three months in to my intern year.

Sexual assault. ACOG Committee Opinion No. 777. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e296–302.

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