STD risk assessment and risk-reduction counseling by recently trained family physicians

Abstract

To survey recently trained family physicians about their practices and perceptions regarding sexual history taking, drug-use history taking, and safe-sex counseling. The study was conducted with all 1991 graduates from the four family practice residency programs in Quebec, Canada. Data were collected in 1992 by using a mailed questionnaire. A total of 148 (80%) of the 186 contacted physicians responded. The physicians reported taking a sexual history less frequently than a drug-use history when seeing patients for a general medical examination (42% versus 71%) or a first pregnancy visit (75% versus 91%). When taken, the sexual history was often too superficial to detect risk behaviors. Consequently, safe-sex counseling was infrequent. Over 20% of the physicians worried about patients' discomfort, were uneasy discussing sexual matters, and did not feel properly trained in sexual history taking. Graduates from the family practice residency at the school that offered training in human sexuality performed better sexual history taking than did graduates from the residencies at the other schools. Although infections from sexually transmitted diseases and the human immunodeficiency virus are important causes of morbidity and mortality, family physicians are still not actively involved in their prevention. The study suggests that medical education might be deficient in this area and that more training in human sexuality should be provided for family physicians.