Diagnostic and Therapeutic Challenges - Dissertation Example

?Thematic Analysis There are different themes identified from the interviews which are relevant to the matter. These are themes which relate to the aims and objectives as identified in the earlier chapters of this dissertation. Views on STD testing All but one of the interviewees mentioned that they felt very much confident in taking throat and rectal swabs. One of the interviewees declared that he did not have much training in carrying out these swabs, and so he did not have much confidence in the procedure. The rest of the interviewees were confident in carrying out the swabs, which mostly included proctoscopy and blind swabs (Friedman and Bloodgood, 2011). They were especially confident in carrying out throat swabs more than rectal swabs because of the uncomfortable and embarrassing nature of the rectal swabs. Interviewee 3 mentioned however that he needed more confidence in proctoscopy because he mostly participated in blind rectal swabs. Most of the interviewees also mentioned that they were able to gain confidence through experience and this experience also taught them how they could make the patient more comfortable during the rectal swabs. Interviewee 4 mentioned that by exuding confidence during the procedure, the patient could be more comfortable. This interviewee also points out the importance of carrying out the swabs as quickly as possible in order to lessen the discomfort. These views emphasize the importance of confidence and the fact that the respondents placed primary importance on its impact in the successful administration of tests. Attitudes Where there may be genital site testing missed by other health professionals, majority of the respondents indicated that they would just ask the patient why the genital testing was not carried out. The respondents point out that most times, the patient may have been the one to refuse the swab. If it is the patient who has refused the test, their reasons for refusing would be asked and the respondents said they would try to talk the patient into submitting to the genital swabbing. Majority of the respondents also mentioned that they would not challenge the previous medical examiner, instead, they would clarify or ask why the test was not carried out. Interviewee 6 mentioned that sometimes, it may be a simple case of omission on the part of the previous examiner. Majority of the interviewees mention that challenging the previous medical examiner would not be appropriate and they would be uncomfortable doing it. However, clarifying the situation with the previous examiner would be the more professional option (Wedemeyer and Manns, 2009). The interviewees also mention the importance of communicating with the previous examiner regarding the patient’s genital swab. The term “liaise” with the medical examiner was mentioned by interviewee 7. Knowledge: The themes indicated below reveal the extent of the knowledge that the respondents have on the management of MSM patients, especially in relation to patient testing, demographic data, guidelines, sexual history, as well as training. 1. Patient testing The clinical staff performs varied functions in relation to MSM patients seeking medical care in their clinics. Most of the interviewees mention that their most common and current responsibilities in relation to MSM patients include patient testing for sexually transmitted diseases. Interviewee 1 mentions that patients approach them ‘requesting testing for sexually transmitted infections.’ Interviewee 2 also mentions a syphilis test, and a swab as well as blood test he most recently carried out on an MSM patient. Another interviewee mentioned carrying out bacterial and genital testing on an MSM. These interviewees also mention having to carry out routine assessments and tests on their MSM patients. Two of the interviewees (2 and 4) mentioned that they usually carry out vaccinations or antibacterial injections for their clients. All in all, the importance of functions which relate to the prevention and the management of sexually-transmitted diseases is a common theme seen among MSM patients. Testing has been mentioned as one of the main considerations for MSM patients, especially because of the fact that they are most vulnerable to sexually-transmissible diseases (Wang, et.al., 2009). All the interviewees mention that genital site testing is very much important among MSMs because this test helps establish whether or not the patients already have STDs or any other infections, including AIDS. Genital site testing helps rule out the presence of these infections among high-risk MSM patients, hopefully with the end goal of implementing early treatment and management. These interviewees also note that this type of testing can be awkward for patients and that they may often refuse these tests because of the embarrassment and awkwardness attached to it (Richardson, et.al., 2009). The interviewees also mention that most of these tests include oral, anal and genital swabbing. 2. Younger population In terms of age, the interviewees declare that majority of their MSM patient seeking medical care for STDs and HIV/AIDS belong to the younger generation, those in their late teens or early adulthood (20-40 years old). Older MSM patients however are also seeking medical attention and testing, however, majority of the patients are still in the younger age set. Moreover, in terms of number, there is almost always at least one MSM patient seeking some form of medical care in the clinic, with most common interventions being STD testing. 3. Minor ethnicity In terms of ethnicity, majority of the interviewees mention that most of their MSM patients are Afro-Caribbean and Asians. This is already the trend established in other studies (Low, 2004). However, not too far behind in terms of number are the white Caucasian/Europeans. These whites seem to have increased in number in relation to health concerns and MSM sexual activities. It is also important to note that some of these patients are not openly homosexual, with some of them hiding their sexuality from their friends and family. 4. Guidelines on MSM All of the interviewees are aware of the guidelines in their area on MSM testing. They are aware of the need to conduct routine tests on asymptomatic patients, especially those which include routine throat and rectal swabs. For symptomatic patients, more specific tests are often recommended. The interviewees declare that they do follow and apply these guidelines in their practice. 5. Sexual history All of the respondents mention that an accurate sexual history is needed for throat and genital swabbing of MSM patients. This sexual history would provide a foundation in identifying body sites which are at risk for exposure to infections (Zenilman and Shahmanesh, 2011), Being active in oral and anal sex is also important information to establish. Interviewee 2 also mentions that he would want to know: if the MSM is using condoms during his sexual activities and the number of sexual partners the MSM has had. The interviewees also mention the importance of knowing the following: ejaculation in the oropharynx, frequency of sexual encounters in a day or in a week, history of sexually-transmitted diseases, last check-up/genital swab, presence of possible symptoms of STDs, use of sex toys, multiple sexual partners at different sites or same sites, anonymous sexual partners, and other high risk sexual activities. 6. Training In terms of formal training on carrying out throat and rectal swabs, most of the respondents mentioned that they have not had formal training on how to carry out these exams. Throat and rectal swabbing was a necessary part of their medical training and they learned the basic techniques of swabbing while in medical school. They gained more practical skills in the process by observing how the other doctors, consultants, and other experienced nurses carried out the swabs. With time, and with more experience, they were able to gain the necessary expertise in carrying out throat and rectal swabbing. Interviewee 3 also mentioned that he was initially supervised by his superior medical officer when he was first carrying out the swabs. But in general, there was no full practical training on how to carry out swabs. The guidance of their more senior colleagues was the main source of whatever training and expertise they gained throughout the years. Interviewee 8 also mentions having gone through a BASH STI course as a junior doctor where throat and rectal swabbing was discussed and related techniques were demonstrated. Apart from that however, interviewee 8 declares that most of his training and experience came from his observations, not from any formal training. Interviewee 5 mentioned that he did not have any formal training in carrying out swabs because it has not been a part of his job; nevertheless, he has had some experience in these tests. Barriers and obstacles All of the respondents indicated that the primary obstacle they face in swabbing MSMs is embarrassment. This embarrassment is also the primary reason for patients refusing to submit to rectal and genital swabs. In relation to the embarrassment factor in the tests, the respondents also mentioned that their patients often found the tests uncomfortable. Another challenge being faced by the respondents is the fact that some of their MSM patients are not openly homosexual or that some are still in denial or are hiding their sexual orientation (Imrie and Macdonald, 2009). These patients more often than not, refuse to submit to the swabs. Some of the patients also prefer to be swabbed by male nurses, but these nurses may not always be available. Some MSM patients may also not be adequately informed about their sexual health and the importance of the swabs. Where the MSM patients refuse genital swabbing, all the respondents mention that they then discuss with the patient the importance and the need for genital swabbing. Interviewee 1 even mentions having to be “explicit” about the reason for the swabbing in order for the patient to understand the need for the test (Klein, et.al., 2012). The interviewees also mentioned about explaining to the patients that although they may be asymptomatic for any STDs, they may still be already suffering from some infection. Interviewer 2 also mentions that if the patient still refuses the genital swabbing, he would then refer the patient back to his doctor, indicating that the genital swab was refused. Interviewee 5 also mentioned that he would explain to the patient that the test is only a routine test in order to rule out any STDs or related infections. Interviewee 6 mentions that where the patients refuse the test, they cannot force the patients to agree because it is their right to refuse. However, all possible means to inform the patient about the implications of his decision shall have to be carried out (Zablotska, et.al., 2011). Interviewee 8 expressed that he would also find out why the patient is refusing the test and then try to correct any wrong information the patient has about the test and about his current risks. Health Education In order to ensure genital testing for MSM patients are carried out, the interviewees recommend various strategies, mainly those which involve health education: informing the patients about the risks they are exposed to, the vaccinations they can have, advancements in the care of MSM and STD patients, and documentation. Documentation was highlighted by the respondents, declaring that accurate and up-to-date records of the MSM patients will provide an accurate history of the patients, including the tests that have already been carried out (or not carried out). A protocol or standard practice in managing MSM patients was also mentioned as an important aspect of caring for these patients (Channa, et.al., 2009). The importance of professionalism, confidence, effective skills, effective communication, and body language was also mentioned as a strategy in ensuring genital swabs for MSM patients. References Channa, R., Khurana, R., Speicher, M., Shah, S., et.al., 2009. Diagnostic and therapeutic challenges. Retina, 29(7), 1045-1051 Friedman, A., and Bloodgood, B., 2011.exploring the feasibility of alternative std-testing venues and results delivery channels for a national screening campaign. Health Promot Pract. Imrie, J. and Macdonald, N., 2009. HIV testing in men who have sex with men: are we ready to take the next HIV testing test? Sex Transm Infect, 85:487-488 Klein, M., Rollet, K., Saeed, S., and Cox, J., et.al., 2012. HIV and hepatitis C virus coinfection in Canada: challenges and opportunities for reducing preventable morbidity and mortality. HIV Medicine, 14(8)-1293. Low, N., 2004. HIV infection in black Caribbeans in the United Kingdom. Sex Transm Infect, 80, 2-3. Richardson, D., Maple, K., Perry, N., and Ambler, E., et.al., 2010.A pilot qualitative analysis of the psychosocial factors which drive young people to decline chlamydia testing in the UK: implications for health promotion and screening. Int J STD AIDS, 21(3), 187-190. 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