Sex matters difficult for docs

DEAR DR. ROACH: As a physician, with the advent of electronic health records, I can see a reluctance of both the educated patient and the physician to be forthcoming about sexually related matters. Do you have any suggestions on how to circumvent this problem?

R.V., M.D.

DR. ROACH: My advice to colleagues is to be aware of any discomfort in your patient in discussing intimate details.

If a patient seems reluctant to discuss them, you can offer not to write the information into the chart.

Personally, I tell my patients in these situations that although their information is kept confidential, there are limits to that confidentiality (including disclosure by mistake, which unfortunately has happened), and anything that they don't want in the chart will be left out.

In the case of sexual matters, I will write something like "I discussed issues of sexual health and gave suggestions on reducing risk" in the chart. There are other areas in which I act similarly on request: Illicit drug use is one

My advice to readers is that you should discuss these matters with your clinician. If concerns about it being in your medical record are keeping you from bringing it up, ask that it not be put in. There are limits to patient confidentiality.

However, some sexually transmitted infections must be reported to the local health department, which may pursue (anonymous) partner notification. Physicians also must disclose records in case of a subpoena. There are a few other exceptions to patient confidentiality.

In an ideal world, patient medical records would be used only for communication among health care professionals, and sexual health, drug use and many other personal details may be important for the entire team to know about.

However, for those people who are very concerned about confidentiality, I feel it's better to get the information, even if I have to promise not to write it in the chart. (I solicit permission to tell consultants the information verbally, if necessary).