Posted by: notdeaddinosaur | July 31, 2012

The Question Not Answered

Dear NP student who rotated through here back over the winter,

You probably don’t remember seeing this particular woman. I sent you in to do a well-woman exam on her; everything was completely normal. There was nothing particularly memorable about her, either clinically or personally. Just another nice lady coming through the office; just another physical.

You asked her a question, though: “How are things in the bedroom?” She was too shocked to answer you. Shocked that anyone would ask her the question; shocked that anyone would be interested; shocked that any kind of answer she could come up with would have anything to do with her life.

I saw her again today, many months later. She told me to thank you.

You see, she and her husband had been sleeping in separate bedrooms for years. She said theirs was more like a brother-sister relationship than husband-wife. She craved the intimacy and missed him terribly. After you had asked the question — that she was too shocked to answer — she’d gone home and mulled over her life. She’d finally worked up the nerve to say something to him. Turns out he was struggling with some issues of his own (cough*ED*cough). His urologist had also astutely recommended couples counseling, and, well, suffice it to say, things are turning around.

After however many decades of feeling swept along by life, at last she feels in control of her own relationship. And all because you asked her a question for which she never did give you an answer.

That’s a wonderful thing about primary care: sometimes you don’t know how great an impact you’ve had on someone’s life for months — sometimes years — after seeing them. You never know when your caring, your insight, your boldness in asking a question gets a patient to thinking, even if they never actually give you an answer at the time.

So even though I’m pretty sure you don’t remember her, know that you made a huge difference in her life, and that she is grateful specifically to you.

Good job.

Best,

Dr. Dino


Responses

  1. Not to play devil’s advocate here, but I do NOT appreciate being asked personal questions such as these during well-woman visits. I am there for my physical health only. I do not want to be “screened” for spousal abuse without my consent, or questioned about my sex life, or asked, “how many fathers” there are for my four children – believe me, that last one left my jaw on the floor.

    An intimate physical exam is more than enough privacy invasion.

  2. “How are things in the bedroom?” is a question I’ve never been asked, and I wish my GP would. It is a major source of stress for me in my marriage, and I’m sure it has affected my health.
    However, that being said, it is a subject which requires extreme tact by the questioner, and alas, communication skills aren’t often taught in medical school.

  3. I get around it by asking on the intake form if a patient has sex and then a simple – “Any problems?” with a blank line afterwards. It elicits a lot of responses, some very funny, most honest and meaningful, and no patient has ever objected to it. Those who don’t want to share simply leave it blank.

    Great post, Dino.

  4. Amazing how such a small question can trigger so much change. I hope the student finds out what an impact they had.

  5. I have never had a physician ask about my sex life. Ever. That’s just none of their business.

  6. To Evelyn and D.Lane – I’m frankly surprised that no one has asked you that, and I’m even more surprised that you’d be offended by such a question.

    Primary care is more than simply taking care of your body – it’s taking care of ALL of you. That includes everything from the head to the toes, and last I checked the brain and genitalia are included in that survey. As a surgeon, I don’t ask my patients these questions, but if your primary care doctor DOESN’T broach that subject during your routine checkups, they are leaving out something very important.

    Well done, NP student. Very well done.

  7. Caregivers can be insensitive to the modesty and privacy concerns of patients (I’m sure it is easy to become desensitized in such professions). When I seek care, I want it limited to the care I’ve requested. And I do not appreciate doctors who are unwilling to respect these limits.

    I’m probably more sensitive on this issue than most, having had an experience where I expressly refused permission for part of an exam to be performed; the “caregiver” went right ahead in spite of my objection, explaining as she did so that it was a necessary part of the exam. No one should have to physically defend themselves against unwanted “care”; that is a violation of the patient’s right to informed consent.

  8. I know I’m really late to this party, but I just have to say that she asked the question because she’s a nurse practitioner. Nurses are trained to be holistic practitioners (meaning taking care of the whole patient, not holistic as in holistic medicine). It’s why I go almost exclusively to NPs for primary care. No offense, Dr. Dino! If you were in my neck of the woods, I’d be your patient in a flash!


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