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DOCTORS COMPETENCIES
Communication Standard in moral and ethical conduct Competencies in implementing medical knowledge and technology. Standard in doctor-patient relationship.
PATIENTS SEEK
Respect , courtesy , privacy A provider that understands each patients situation and needs Complete and accurate information Access and continuity of care Fairness (kejujuran) and results
Doctor-patient communication
Good communication is essential to patient assessment and treatment. Foundation of communication is based on key skills: empathy, attentive listening, expert knowledge and rapport.
Two points
Taking history about sex behavior and problem.
Female patient
Unique Vary in sexual and reproductive experience and organ function Fearful of gynecologic examination, she considers private and embarrassing The privacy of all discussion Review past medical history, family history, social history,
continued
Number of pregnancies, deliveries, abortions, contra-ceptions, STD, drug usage, sexual practices, marital status. Current medication, drug allergy Moral standard, religious belief , sexual practices and experience may be different Abnormal practices / lesbian / anal sex etc
The 3 components
The patients
Shy, embarrassed Afraid / scare Sense of painful Inconvenience.
The doctors
Mostly male doctors Non sensitive
Place of examination
The patient
Age : adolescence, young adult, married, divorcee, menopause ? Primi gravida (kehamilan pertama) ? Multiparous woman ? In Happiness or sadness? The first experience or familiar with Alone or accompanied by mother/elder sister etc ?
Place of examination
Opened, not special and no privacy crowded room Uncomfortable room Image of teaching hospital No toilet / rest room
The doctors
Most of them are men Manhood behavior, hard, loud, rough and mostly non sensitive Not catching the unspoken language No respect to patient as a complete human being. in a hurry, lack of time
EXAMINING WOMEN
History taking General Physical examination Examination of Specific area (obgyn) Related supporting examination Making diagnosis / differential diagnosis Working plan of therapy Counseling and informed consent Therapy : medication or surgery Three C (complete, correct, clearness) of medical record Strict Confidential.
Example
Semi-closed room The existence of female nurse The nurse help to put off underwear The nurse help the patient to sit on gynecologic table Vaginal examination : smooth, careful, not forced, the sequence, confidence and not rough, do serious and no joking.
Example (2)
Systematic sequence Only ONCE , NO repetition Eye contact No sexual harassment Ended with conclusion and clear information to the patient
Special condition
From young lady to menopause Infected genital organ. Deviation of sexual behavior : gay, lesbian From gonorrhea --- HIV/AIDS HIV positive in pregnancy Case of criminal rape Case of Unwanted pregnancy etc
conclusion
Female patients need special treatment Doctor should master how to Talk about sex and examining womans body. Doctors should know womans nature and characters. Being respect, courtesy and privacy Smooth, careful, not force and responsible Ended with information to make confidence and trust