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Destigmatizing sex, mental health, substance abuse in clinical settings: we’re not there yet

Meghan Oates-Zalesky

Post By Meghan Oates-Zalesky

February 5, 2020

Healthcare providers want their patients to share any and all concerns about their health during clinical sessions—removing the barriers to open communication on what are often readily treatable conditions.

However, when it comes to sexual health, mental health, and substance abuse, patients in the US remain embarrassed by discussing these topics with primary care physicians (PCPs) and nurses. For physicians, the discomfort can run both ways.

InCrowd asked PCPs and nurses to rank eight topics that they wished their patients would be more comfortable discussing during appointments. Sexual health topped the list, with 52% of PCPs, and 55% of registered nurses (RNs) noting they wishes their patients were less uncomfortable discussing these matters.

Mental health (15%) followed for PCPs, and gastrointestinal and gastro-urinary (GI/GU) issues ranked second (also at 15%) for RNs.

Substance abuse ranked third, at 13% for PCPs and 7% for nurses.

Verbatim PCP remarks revealed added layers to the interpersonal dimensions of broaching these subjects with patients in an open, non-judgmental manner.

“As a male physician, I wish female patients were more open about their sexual health or gynecological issues, and male patients were more open to discussing their mental health,” said one male PCPs participating in the six-minute MicroSurvey with responses sourced in October 2019.

While 63% of physicians claim they are comfortable discussing all topics with patients, nearly a quarter—23%—of PCPs said they are sometimes embarrassed to discuss certain topics with their patients.[1]

“I’m often hesitant to ask about sexual encounters outside a patient’s stated orientation,” said a female PCP.

“I never want patients to feel judged, however substance abuse questions can be very delicate,” said another female PCP. Weight/diet issues, domestic issues or finances, aging and death concerns, and physical abuse or trauma ranked lowest among what clinicians saw as stigmatized subjects for patients.

Sexual health including sexually transmitted diseases (STDs), sexual dysfunction, PreP and infections also ranked number one among easily treatable conditions that patients are too embarrassed to discuss, according to PCPs, with mental health issues (12%) and GI/GU issues (10%) also often cited.

Respondents in InCrowd’s MicroSurvey indicated that destigmatizing difficult discussions has a clear patient health impact. Nearly 30% of PCPs believe that both major STDs and serious chronic disease progressions including GI and GU cancers and inflammatory disease could be avoided by patients simply having upfront conversations with their doctors.

As to fixing what patients believe are the biggest barriers to communications with their healthcare professionals (HCPs), InCrowd’s data showed time constraints were a dominating factor, followed by patients fear of judgment or shame. Patients’ fear of judgement/shame ranked as the number one barrier for patients as perceived by respondents at 33% and time constraints second at 31%.

Interestingly, 14% of nurses said that poor HCP listening is something patients believe is a barrier to communication—an issue ranked third by nurses yet ranked next to last among PCPs, where only 3% cited listening to patients as a communication barrier.

InCrowd’s six-minute MicroSurvey on difficult discussions between healthcare professionals and patients was sourced on October 2-4, 2019 and included n=239 respondents—155 US PCPs and 84 US RNs. The clinicians see an average of around 250 patients per month.


[1] For methodological reasons the MicroSurvey did not include a question to RNs about their own embarrassment in patient discussions.

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