Health Screening

Question 1

PHQ2

Answer 1

Patient Health Questionnaire 2

Designed to screen for depression. Pertinent questions:

Over the past two weeks, how often have you been bothered by any of the following problems:

• Little interest or pleasure in doing things?

• Feeling down, depressed, or hopeless?

Have you ever thought about or attempted suicide? Ever been treated for other psychiatric or behavioral issues? How has mood been recently?

Question 2

Particular populations at risk for depression

Answer 2

• Adolescents
• Post-partum women
• Geriatric patients
• Patients with chronic medical conditions

Question 3

SIGECAPS (mnemonic for depression symptoms)

Answer 3

Sleep disorders

Interest (anhedonia)

Guilt

Energy deficit

Concentration deficit

Appetite disorder

Psychomotor retardation or agitation

Suicidality

Question 4

Recommendations of the USPSTF on screening for depression

Answer 4

Screen all adults who have not been previously screened, and use clinical judgment in consideration of risk factors, comorbid conditions, and life events to determine if additional screening of high-risk patients is warranted.

Question 5

How one might broache the topic of sexual history

Answer 5

“Sometimes a symptom like this can be related to sexual activity, so I’d like to ask you a few questions about this.”

or

I am going to ask you a few questions about your sexual history. I ask these questions at least once a year of all my patients because they are very important for your overall health. Everything you tell me is confidential. Do you have any questions before we start?

Question 6

10 P’s screening

Answer 6

1. Preferred Name/Pronouns (“he,” “she,” “they,” etc.).
2. Preamble (e.g., explaining that you explore this topic routinely, with everyone. This might be as simple as, “To understand all of the issues that are important for your health, I would like to ask some questions about your sexual history.”)
3. Privacy (asking the questions in a private setting and ensuring confidentiality)
4. Permission (e.g., after explaining what you plan to do, asking “Is that OK?”)
5. Partners
6. Practices
7. Protection from STIs
8. Pregnancy (including protection from unwanted pregnancy, plans for desired pregnancy)
9. Partner abuse (Screen for Intimate Partner Violence here, if not done elsewhere in the history)
10. Pleasure

Question 7

Three basic sexual history screening questions

Answer 7

Always broache these with an introduction

1. Have you been sexually active in the last year?
2. Do you have sex with men, women, or both?
3. How many people have you had sex with in the past year?

Question 8

Helpful tips for taking sexual history

Answer 8

• Acknowledgement of sensitivity “This is often difficult for people to talk about”
• Give rationale! Explain why you need to ask
• Attend to the environment. Patients may not want to talk in certain contexts, like if someone else is in the room
• If, despite your best efforts, it becomes clear that a topic truly is off limits, note it to yourself (and include it in your write-up), thank the patient for being willing to express their discomfort, and go on.

Question 9

Clinical pearls for sexual education

Answer 9

• It is not likely you will get HIV from oral sex. However, giving and receiving oral sex can give you STDs
• Sharing sex toys without condoms or other latex barriers can give you STDs
• Condoms greatly reduce the risk of STDs, but it is still possible to get them through areas not covered by the condom
• Even when both partners are HIV-infected they should still use condoms to avoid STD transmission and the (small) possibility of infection with a second strain of HIV
• Having an STD can make it more likely you will get HIV

Question 10

The ideal screening test

Answer 10

• Prevalent condition (in given population)
• Acceptability of test to patient
• Good sensitivity/specificity
• Modifiable disease course
• Disease in question has consistent characteristics
• Test is affordable
• Impact on QALYs

Question 11

Most issued guidelines in the US come from. . .

Answer 11

. . . the U.S. Preventative Services Task Force (USPSTF)

Question 12

Things to take into consider for individualized screening recommendations for patients

Answer 12

• Likelihood of the disease in this patient
• Testing options (and associated risks/benefits)
• Advice from guidelines
• Outcomes of concern from the patient (morbidity, mortality, anxiety, procedures)
• Cost to patient (financial and time)