Do you trust me?
Do you trust your healthcare provider? Sounds like a crazy question, doesn’t it? If you didn't, you'd be looking for someone new but how deep does that trust run? Certainly, there's an expectation to accurately diagnose and treat common ailments but do you trust him or her enough to tell them the whole ugly truth even when it paints you in a bad light?
It's completely normal for people to want to put their best foot forward and present their best selves--even in the exam room. This may lead patients to withhold certain details about their health or their private lives that they find embarrassing. Take for example a patient who downplays the number of alcoholic drinks they consume or the amount they smoke--withholding this information cause a missed opportunity to screen for relevant conditions or may have been the missing piece to a perplexing puzzle.
Sexual history is another delicate subject that can be tough to open up about. Knowing how many partners one has had and the type of sexual activities in which one is engaging can again trigger certain screenings, treatments, and risk-reducing education. Similar scenarios are commonly encountered when discussing depression, obesity, insomnia, and substance abuse.
Being less than honest about seemingly routine inquiries could also drastically alter outcomes such as, "are you taking your medication as prescribed?" or "are you having any side effects?". Primary non-adherence is the term we use to refer to prescribed medications that are never even picked up from the pharmacy. Some estimates have pegged such non-adherence as high as 30%! This could be due to cost, difficulting getting to the pharmacy, language barriers or lack of confidence in the treatment plan; all concerns that a patient may not raise with their provider without a strong relationship built on trust and mutual respect.
As difficult as it may be to open up about the things that we dislike most about ourselves, our perceived failings or those things we deem "too private or uncomfortable" for discussion, we must not withhold information from those who we expect to make decisions regarding our well-being.
An important first step is realizing that it's all in a day's work for healthcare professionals. You may not have more than a few genital exams your entire life, but it's something we do every day. What’s uncomfortable or embarrassing for you is routine for us. That doesn't excuse clinicians from needing to treat delicate situations with respect and professionalism, however.
Another recommendation is to establish care with a regular general practice provider whom you can see for various ailments and with whom you can develop a relationship. Mutual trust will develop over time. Also, don't skip your yearly physical which is an excellent opportunity to talk about habits and activities that just may be more relevant to your care than you might think.
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