What does good health care look like? Depending on where people are at, their needs, preferences, and who is available, a good experience in a health care setting can look like many things. What makes it good is not necessarily the specific location, specific words used, or what posters are on the walls. Not everyone wants the same thing, has access to the same resources, or faces the same circumstances.
Factors contributing to a positive experience
feeling connected to and in tune with you and their care team
have a say in important decisions related to their body and their health
having the information they need to make important health care decisions
Hard skills and Soft Skills!
When we talk about health care, the hard skills are the hands-on technical skills that someone needs to use to do their job effectively – for example, drawing blood, putting an IV line in, diagnosing or prescribing the right medication and the soft skills are the interpersonal skills one needs to facilitate communication and navigate the patient/care provider relationship successfully. This means, for example, emotional intelligence, reliability, and communication style. Both matter and are crucial to offering the best possible care. Both deserve to be continually honed!
What’s your relationship status?
Many health care providers and the people who support their work receive a limited amount (if any) of training in sexuality. Providing sex positive health care may be less about a perfect script, and more about being able to be trusted to discuss important topics that relate to people’s health, including their sexual and reproductive health.
Relationship Check-up: Are you offering sex positive care?
Sex positivity embraces sexuality with the view that when it comes to a sexual act, practice or experience, the only relevant concerns are the consent, pleasure and well-being of the people engaged in or affected by it. Sex positivity places no moral value on different sexualities or sex acts. It helps us set aside our judgments and makes room for the diversity of human sexuality.
When someone asks a question related to sexual or reproductive health, are you able to handle these questions with ease? Do you feel comfortable in the process? Or do you feel uncomfortable with the topics they bring up, or feel defensive?
Our patients can certainly mirror discomfort. When you ask them or they ask you about sex and you are embarrassed about it, that awkwardness can be transferred to the person you are talking to. The best way to speak to issues related to sexuality is to use plain, everyday language, the same way you would talk about allergies or tension headaches.
TIP: During an appointment, it can often become a waiting game for the other to start talking. Sometimes, you may assume that if a patient has an issue, they will bring it up, while the patient may be waiting for you to ask first, each thinking that it’s the others’ responsibility. Keep that in mind and perhaps review your intake or interview questions to make sure you get important information from all your patients on sexual health, sexual orientation, or sexual behaviors (without making assumptions).
Are you asking simple or open ended questions? Are you working with your patient to create a more complete picture of why they are seeking care or what they may need?
Everyone makes assumptions, which, at times can get in the way of good care. Treatment or diagnosis can sometimes be based on the assumptions you make about a person or their condition. Avoid making assumptions about your patient and their sexual health based on what they look like/act like, about what kind of sex they are (or are not) having, about who can (or cannot) get pregnant, and about who they are partnered with.
When a patient brings up important health related topics, do you follow their lead in terms of the words they use?
If they use the word ‘partner’, mirror what words they are using. Avoid using language that assumes who they are in a relationship like ‘husband’ or ‘wife’ unless they themselves are using those terms.
Are you respectfully honest when you are not familiar with a specific issue? Are you willing to make your patient your partner in exploring the topic or options with you while also doing the work needed to educate yourself on it?
Your patient is wondering if they can get pregnant now that they started injecting testosterone. If you don’t know and don’t feel very familiar with specific Trans health issues, seek out best practices and guidelines to help you care for your patient and if possible, call on colleagues to make sure your patient has the correct information they will need to make a decision about birth control use.
If your patient is already linked to a health care practitioner who works specifically with a community they identify with and/or is engaged in complementary therapies and practices that are important to them, try to explore how care can be integrated.
Do you support your patients in accessing the care they are asking for?
If a patient asks for an HIV test or a full panel of STI tests, support them in getting tested for what they are asking for instead of making assumptions and questioning why they’d need it in the first place. When you fill a requisition for STI tests, never assume which ones may be relevant for them, inquire further.
When you are unable or conflicted about providing certain services, do you do all you can to provide your patients with effective and timely referrals?
If your patient is pregnant and looking to access abortion services, assist them in getting the care they need if you can’t offer it yourself in a timely and sensitive manner. Build your list of colleagues and organizations you can confidently refer to for a range of issues.
Do you feel like you are able to provide a safe space for your patients to explore important health related decisions, free from pressure or fear-based messaging? Are able to provide them with a range of unbiased sexual and reproductive health options so that they can make informed decisions that are right for them?
If your patient is HIV negative and their partner is HIV positive and they want to know what the safer sex methods available to them are, provide them with non-judgmental, evidence-based information for them to decide what they feel comfortable with.
Are you mindful of ways to make your patients feel safe, like they have a feeling of control over their treatment and that they are included in their care and treatment choices?
Your patient is a survivor of sexual abuse and is visibly nervous about getting a pelvic exam. Work with your patient to help find ways to do the examination in a more comfortable way, for example, by suggesting to raise the table, by detailing each step of the process, by stopping if they request a pause.
Do you put effort in providing a space for your patients to safely disclose important information about themselves and their sexual and reproductive health?
Your patient is pregnant and not sure about what to do; Your male patient is married with a woman but has sex with other men; Your patient is Trans and has been trying to find a way to tell you about their gender identity, etc.
Make sure that you provide a safe space for people to talk about important aspects of their lives or who they are in confidence and without judgment.
When a patient tells you something about their identity or circumstance, do you assume that all of their concerns are connected to that identity/circumstance?
If your patient discloses that they work in the sex industry, consider their life and health needs as a whole and avoid focusing your intervention on the work that they perform. Respond to the needs they are identifying. If your patient is overweight, do not assume that all of their health problems relate to their weight.
Do you show respect for your patients’ experiences, beliefs, behaviors and values?
Your patient is seeking care for depression and they want more information on the use of medication. They also bring up the support they get from elders around the use of traditional medicine and practices. Be open to learning more about how to incorporate Indigenous approaches to their care.
Are you ensuring that you offer information that is age-inclusive and are you knowledgeable about the sexual and reproductive health issues relevant to different age groups?
Never assume that some of your patients are not sexually active because of their age. Be sure to have youth-friendly resources at your clinic/office/drop-in.
Are you vigilant about respecting your patient’s confidentiality?
If you do need to report information, let your patients know about the process when possible. Be especially vigilant in guarding the confidential information of patients who may be criminalized for their work (like sex workers) or who may face discrimination and stigma because of their sexual orientation, gender identity, the services they access (i.e. abortion, hormone therapy, etc.).
How comfortable are you? Ask yourself
What are my values around sexual and/or reproductive health issues?
How do I define healthy sexuality?
Am I comfortable talking about sexual/reproductive health?
How have I worked around issues of sexual or reproductive health with patients so far?
Am I comfortable with patients discussing their sexual and/or reproductive health issues or options with me? Does my comfort levels vary depending on the types of sexual activity or sexualities I am discussing?
What is my stance in regards to contraception, abortion and other pregnancy options care? If needed, do I have a list of service providers I can refer patients to?
How informed are you? Ask yourself
Am I able to provide my patients with quality information on a wide range of contraceptive/birth control options, including emergency contraception?
Am I able to provide my patients with quality information on Sexually Transmitted Infections (STIs), on STI testing and on STI treatment?
Am I able to provide my patients with the information they need on how to have safer sex, to provide them with accurate, non-judgmental information about the levels of risk associated with different types of sexual activity, and to discuss the factors that might put them at risk for acquiring different STBBIs?
Am I able to point my patients to reliable sources of information on contraception/STIs/testing, etc. if I don’t have it handy? (written material or online)
Do I support my patients in getting tested regularly for STIs?
When necessary, am I able to provide quality information on a range of reproductive health options, including options related to pregnancy, including adoption and abortion?
Am I able to provide my patients with a range of material on diverse sexual and reproductive health issues that they can read or take home? Is the material age-inclusive and inclusive of different gender identities and sexual orientations?
Am I interested and able to discuss the sexual and reproductive health issues that are of particular importance to my patients?
What is conscientious objection?
In the context of health care, conscientious objection means the refusal by a health professional to perform particular services on the grounds of moral or religious beliefs. The specific sexual and reproductive health services that are most often refused on the basis of conscientious objection are abortion, contraception and assisted reproduction.
It is a case of conscientious objection if a health care provider outright refuses to provide a service, refuses to refer their patients elsewhere to access it, creates barriers for patients to access them (for example, delaying appointments, imposing time to “think it through” etc.), or shaming patients for wanting to access them in the first place (sometimes, this can mean assuming the choice the patient will make and/or belittling them for asking questions about options).
This is a serious problem as it gets in the way of people’s ability to make choices and take charge of their own health, well-being and life in ways that work best for them/in their current circumstances. Some provinces have started to work on policies to define the responsibilities of doctors and health care providers who refuse to provide services.
Please do take a look at these international standards and to the new Ontario Policy to make yourself familiar with the duty and responsibilities of health care providers in cases of conscientious objection.
FOR IMMEDIATE ASSISTANCE:
Click the number to dial on a mobile phone.