Family Medicine

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    Southern African HIV Clinicians Society genderaffirming healthcare guideline for South Africa
    Rutendo Bothma; Willem Venter; Anastacia Tomson; Chris/tine McLachlan; Camilla Wattrus; Kevin Adams; E et al
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    Evidence for use of a healthy relationships assessment tool in the CHARISMA pilot study
    Elizabeth E. Tolley; Andres Martinez; Seth Zissette; Thesla Palanee-Philips; Florence Mathebula; Siyanda Tenza; Miriam Hartmann; et al et al
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    Maternal alcohol use and childrens emotional and cognitive outcomes in rural South Africa
    Tamsen Rochat; Brian Houle; Alan Stein; J Mitchell; Ruth Bland
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    Sexual history taking: perspectives on doctor-patient interactions during routine consultations in rural primary care in South Africa
    (Elsevier Inc., 2021-05-03) Pretorius, Deidre; Couper, Ian; Mlambo, Motlatso
    Background: Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken. Aim: To describe the optimal consultation process, as well as associated factors and skills required to improve disclosure of sexual health issues during a clinical encounter with a doctor in primary health care settings in North West province, South Africa. Methods: This qualitative study, based on grounded theory, involved the video-recording of 151 consultations of adult patients living primarily with hypertension and diabetes. This article reports on the 5 consultations where some form of sexual history taking was observed. Patient consultations were analyzed thematically, which entailed open coding, followed by focused and verbatim coding using MaxQDA 2018 software. Confirmability was ensured by 2 generalist doctors, a public health specialist and the study supervisors. Main outcome measure: Sexual history was not taken and patients living with sexual dysfunction were missed. If patients understand how disease and medication contribute to their sexual wellbeing, this may change their perceptions of the illness and adherence patterns. Results: Sexual history was taken in 5 (3%) out of 151 consultations. Three themes emerged from these 5 consultations. In the patient-doctor relationship theme, patients experienced paternalism and a lack of warmth and respect. The consultation context theme included the seating arrangements, ineffective use of time, and privacy challenges due to interruptions and translators. Theme 3, consultation content, dealt with poor coverage of the components of the sexual health history. Conclusion: Overall, sexual dysfunction in patients was totally overlooked and risk for HIV was not explored, which had a negative effect on patients' quality of life and long-term health outcomes. The study provided detailed information on the complexity of sexual history taking during a routine consultation and is relevant to primary health care in a rural setting. Pretorius D, Couper I, Mlambo M. Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa. Sex Med 2021;9:100389.
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    Sexual history taking: doctors’ clinical decision-making in primary care in the North West province, South Africa
    (AOSIS, 2021-09-29) Pretorius, Deidre; Couper, Ian D; Mlambo, Motlatso G.
    Background: Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire. Aim: The aim of this research study was to assess doctors’ clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios. Setting: This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district. Methods: This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors’ clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group. Results: One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p < 0.001). The participating doctors did not meet the expectations of the reference group. Conclusion: Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.