The magical mystery land of community health

I don't make this stuff up!…but I do change identifying information.

I think the word you’re looking for is “possible” March 21, 2010

Filed under: Uncategorized — lesbonurse @ 2:34 am

The scene: a 22 year-old female patient, in the office for a school physical.  She mentions that she had an episode of sharp, midline suprapubic pain earlier in the week.  During the questions about the pain, we had this exchange:

Me: “Do you think it’s possible that you could be pregnant?”

Patient: “Oh no, that’s impossible!”

Me: “Impossible because you’re not having sex?  Or impossible because you’re using birth control? Or…?”

Patient: “Well, neither.  I just can’t think about it.”

Me: “Are you having sex with anybody?”

Patient: “Yes, my boyfriend.”

Me: “And are you using any form of birth control, or condoms?” (I ask it this way because a lot of patients seem to think condoms don’t fall into the regular birth control category)

Patient: “Well, sometimes, but not all the time.”

I took this moment to share an important statistic about conception: 8 out of 10 women having unprotected sex (with a man) will be pregnant within a year.  That usually gets a fearful look out of women who don’t desire a pregnancy, which enables me to jump in with a discussion about birth control.  In this case, the patient wasn’t ready to start a hormonal method, but agreed to talk to her boyfriend about more consistent condom use while she considered her options.  I also advised her to return to the clinic for a pregnancy test if she doesn’t get her period by the expected date.

“Impossible,” eh?

 

When your ass is dragging… March 16, 2010

Filed under: Uncategorized — lesbonurse @ 1:03 am

I haven’t been feeling quite up to snuff lately.  So under the weather, in fact, that I took the 3rd sick day of my 3-year NP career.  I never feel so grateful for my general good health as when I feel like shit.  The normal 9-10 hour days start feeling like death marches to the finish, and having GI upset turns every diabetic foot exam into a stomach-clenching, nausea-inducing experience.  Not to mention the ever-growing pile of unfinished progress notes…oh god, the progress notes.  Anyway…I’m feeling better now, but it was a bad week.  Anything funny or remarkable that happened was overshadowed by my general state of crapiness.  So…sorry, readers.  Nuthin’ good to post this time.  But I’m feeling peppier now, so I’m sure things will start being funny again this week.

 

Is it my business? March 2, 2010

Filed under: Uncategorized — lesbonurse @ 4:21 am

Is it my business to counsel patients on what is clearly poor sexual technique?  Here’s the situation: A young male patient came in with a request for std testing.  He reported that a condom had broken during sex last week, and he was worried.  In these situations, I always inquire into the circumstances of the breakage.  Improper use of the condom?  Lack of lubrication?  Oil-based lubrication?  It turns out that this patient’s condom had broken at some point during 90 minutes of sexual intercourse.  I pointed out that condoms can get very dry during extended sexual intercourse, and inquired about whether or not he had used any lubricant.  “No,” he said, “But I think you’re probably right.  She kept saying ‘I”m so dry, I’m so dry.'”  Ok then, we have identified the problem.  I pointed out that using lubricant can prevent dryness and therefore prevent condom breakage, especially during long sexual encounters.  The patient seemed receptive.  I was close to pointing out that his lady friend would have no doubt been happier and more comfortable with some extra lubrication.  I was also close to asking him if he usually has a problem reaching orgasm.  Neither of these things were exactly relevant to the std testing situation, and neither of them are strictly medical (although the orgasm question can be a medical issue).  I settled for reinforcing the proper use of condoms and lubricant, as well as reviewing the different types of std’s and screening.  I decided against dispensing any more sex advice, but I couldn’t shake the feeling that I had passed up an opportunity to help this young man become a better partner.  But really, is that my job?  I don’t want to be inappropriate as a provider, but I also don’t want to encourage what sounded like a relatively unpleasant sexual encounter for his partner.

I’ll be seeing him again for his lab results, so if I can think of a professional-but-rapport-building approach to this issue, I’ll get another stab at it.  No pun intended.  ha.