ANALYSIS OF THE FAMILY PLANNING CONSULTATION – DOCTOR’S AGENDA (FOLLOWING ROUTINE)
Doctors will need to follow their routine medical procedures before starting a woman on the Pill or inserting an IUD. Once the method is being used, the doctor will want to monitor progress. Medical supervision obviously includes physical examination and investigations.
Much ado has recently been made about taking a sexual history. A process akin to contact tracing has no place in the family planning consultation. Open-ended questions such as, ‘Do you think you could be at risk of HIV infection?’ are usually more revealing than closed questions such as ‘How many sexual partners have you had?’ If a doctor is very worried about the possibility of a sexually transmitted disease then the patient should clearly be referred to the genitourinary medicine clinic. Raising the subject of HIV in the consultation is relevant these days even if the patient does not feel so. A simple introduction is to mention that contraception can protect against pregnancy and infection. Methods such as barriers may do both jobs but patients and their partners will need to consider whether they need a highly effective contraceptive method combined with a barrier for protection against infection. With so much media coverage about HIV it is becoming easier to raise this subject but many patients will still feel they are not at risk.
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