If You Don't Know The Thing You're Dealing...

[autographedcat]

So here's a question I put out there to my friends who have expertise with sexual health. (Or even just an opinion on the matter.)

A friend of mine is recently starting to become socially active, having become single a couple of years ago. He's already involved in a casual friends-with-benefits relationship, and there's something on his horizon that may be developing.

At some point, I recommended to him that as long as he's dating, he should get an STD test periodically. Particularly if he's going to be involved with more than one person at one time, I consider it an ethical responsibility. He agreed, and said that since he was already due for his annual physical, he'd ask them to run it at the same time.

Yesterday, he told me that he'd had that appointment, and that his doctor had refused to order the panel:

His rationale, insofar as I could read it, was "They aren't reliable past the first ten minutes after you have them, so wait until you have a stable partner and then get tested together.

To which I said: "You should fire your doctor. That's not only wrong, it's completely irresponsible."

This goes beyond my usual insistence that as the consumer, you have the right to have a say in setting your own health priorities. I'm flabbergasted that a doctor would, in 2012, tell a sexually active person that there's no point in getting STD screening as a preventing measure.

Am I overreacting, or is this utterly bizarre?

Comments

[kshandra]

Report his ass. That is utterly irresponsible.

[anaisdjuna.livejournal.com]

That's mucked up!

[osewalrus.livejournal.com]

Your reaction is correct.

[eeyorerin]

wtf?

When I see my doctor, she asks if I am sexually active and then offers STD screening as a matter of course -- she doesn't ask if I have a "stable partner" or any crap like that.

He'd probably be better off trying to find a sexual health clinic to get the testing done if his doctor is that backward.

[autographedcat.livejournal.com]

He's going to go to the local health department, which offers screenings. But he shouldn't HAVE to.

[umbran.livejournal.com]

It is ridiculous for a doctor to refuse to run tests that the patient requests, yes.

However, there's a third option: there was some miscommunication, and the doctor didn't actually refuse, so much as recommend against. I mean, the doctor is correct - as soon as you have relations with someone who wasn't also tested, your test is unreliable. If the doctor pressed that point hard (because, really, it is important for you to get it), your friend might have heard it as an outright refusal, when that wasn't really what happened from the doctor's point of view.

This is not a slight against your friend - but most folks would be astonished by how frequently what the doctor said/meant, and what the patient remembers/reports don't really match up. And rare indeed is the person who will accept that their own eyewitness testimony isn't 100% accurate.

You know, everyone's above average, and all that.

[autographedcat.livejournal.com]

That's possible, and I know that if you're not used to pushing back against authority figures (which doctors are typically viewed as for obvious reasons), it's easy to just take what they say as an absolute rather than advisement.

Even so, I don't agree with it as a recommendation, let alone an outright refusal.

[umbran.livejournal.com]

Yeah, I'm only talking about the refusal here. I'm by no means saying it is a good recommendation.

[johnpalmer.livejournal.com]

I'll note that I have seen people report conversations that (to me) clearly said X, and to the person reporting it, clearly said Y. So, yes, I could easily believe it could be a wild miscommunication.

Also, IIRC (and I may not!) STD testing without overt symptoms is less accurate. That might be playing a role.

[aiela.livejournal.com]

It's two pronged, and the doctor is ignoring one of the prongs.

Yes, you could test clean this afternoon and pick something up tonight. There's always that chance. You would, however, at least have a baseline understanding of what your STI status is right now. If there's something you needed treated, you can have that done; if there's something you need to warn potential partners about, you can do that. If you do not currently have any STI's, congratulations.

In addition, if you have multiple partners you should be practicing extremely safe sex _anyway_, so you should be lowering your chances of picking something up tonight by taking good precautions. One of those precautions is getting yourself tested periodically.

It sounds like his doctor was speaking from a point of monogamy. With a monogamous person, yes, that's the best way to do things. But with someone who isn't monogamous, it's a more, uh, fluid situation and you need to test periodically regardless of when you are adding new partners.

[cellio]

This.

[autographedcat.livejournal.com]

I suppose that's true, but in the case of someone who is starting to "date", even if they tend to be monogamous there's an expectation that they're going to be encountering a variety of potential sexual situations.

It's not just about protecting your OWN health, but the healthy of the people you're going to be interacting with. Knowing going into the dating scene that you've got a clean bill of health is important.

[aiela.livejournal.com]

Oh, I totally agree with you, I'm just trying to figure out what the doctor's thought process was.

[hsifyppah.livejournal.com]

With you on the bafflement. Even if it's not valid ten minutes later, what if one of the tests right now was POSITIVE? Ten minutes later, I would still want to know that I should be treated for chlamydia, y'know?

(Although I'm with umbran too on wondering if there was some miscommunication, because wow it sounds so very off that you have to wonder. I have certainly unwittingly confused patients many times.)

[autographedcat.livejournal.com]

Perhaps people don't expect, after being asked if they want a flu shot, for the next question to be "And which sort of flu would you like?" :)

[hsifyppah.livejournal.com]

I have had a few of my darling smart-ass patients ask what kind of flus I had on the menu! One of them always says "Oh, no, I'll eat them here." when I ask if he'd like me to put his prescriptions in a bag. I have the best patients ever.

[redbird]

Best case, if umbran is correct, the doctor should have ordered the test panel and explained why it's of limited value. As given, it comes close to implying that if someone is having casual sex, there's no point in trying to protect their partners. That's separate from the possibility that your friend might have an infection that he'd benefit from treating whether or not he has sex with other people.

[redaxe.livejournal.com]

Sounds like "finding a new physician" might go onto the To Do list. As with so many here, I'm skeptical that the doctor had the facts correct, and if he did, I'd want to know which specific test(s) he was referring to, and if there were other, different, ones available.

In any event, the patient should always have the option to have any tests required run, provided s/he's got the cost covered.

[mneme]

You're absolutely right.

[johno.livejournal.com]

You are correct. He should be tested.

1) It gives a baseline.
2) He can say his current FwB "I was just tested and I'm clean"
3) If he is not uninfected, he knows he is NOT safe.
You may have been "good" all your life, but if any of your partners were not...
then you may have picked up something long term and not know about it.
4) Depending on how active, what activities and how many partners,
he should be talking to his health care provider about getting regular blood tests.

[ladymondegreen.livejournal.com]

Yes, this, with the addendum that there are things that can lie low in the blood for years and not manifest symptoms, so people can be carriers and not know it, so it's crucial to actually get tested (particularly for HPV, yes, there is now a test for men) because you can stay asymptomatic and still be a carrier and it causes, among other things, cancer.

[patoadam]

Everyone has answered your question correctly, but I'm commenting anyway because the doctor is so incredibly wrong. He won't test your friend until he has found someone he loves and has risked exposing her to an incurable, life-threatening disease. How goofy is that?

I want to add that I am surprised that the phrase "safe sex" has only occurred once so far.

[deborah_c]

Given that my sex life's been non-existent for many years, and that neither my ex or I had never slept with anyone else, I'm probably the least-informed person in the world about sexual health, and I'm still appalled by your friend's doctor...

[celticdragonfly.livejournal.com]

Aww, cute icon. My kids have a Rainbow Zebra cloth book that my mother sewed for them years ago.

[filkertom.livejournal.com]

What everybody else said. The doctor is wrong; your friend should get the test and a new doctor.

[asg-qa-s7.livejournal.com]

As reported, this should probably go to the licensing board; or at least to Angie's List Health. That is SO wrong!

Acknowledging _Umbran_, asking for clarification first would only be fair.

[filkerdave.livejournal.com]

I think your reaction is quite correct

[celticdragonfly.livejournal.com]

Oyyyyyyy.

*virtually goes and hugs her own marvelous doctor*

Yeah, I'd be wanting to switch.

[kaffy_r]

I second, third, and fourth everything said here.

If your friend's conversation with the doctor is accurate, and I assume it is, a new doctor is in order. So is a complaint to the local government licensing and regulatory body. Seriously.

[mihrimah.livejournal.com]

Bizarre and irresponsible. Tell him to go to Planned Parenthood if for some reason he can't get a new GP. Heck, have him got to PP anyway.

[hitchhiker.livejournal.com]

that's deeply fucked up

[callibr8]

I'll take utterly bizarre for $500, Alex. :-)

[smoooom.livejournal.com]

seems odd to me. Get tested before you embark on any relationship. Make sure any potential partners have also been tested.

waiting till you have a partner seems like closing the barb door after the horse has run away.

[catsittingstill.livejournal.com]

I completely agree.

Periodic STD testing, even if it's not accurate if you picked something up yesterday, will still tell you if you picked something up six months ago.

And since you're just as primed to infect people if you picked something up six months ago, obviously you need to be treated, and your partners need to be warned to go get treated (I would go "treat for known exposure no matter how the test comes out, because *they* could have picked it up from you yesterday, but test for other things too while they're at the office.")

What kind of moron is this doctor? What other wrong assumptions is this person making, that you don't have the expertise to catch, and that could come back and bite you in the ass? I would change doctors.

[elgecko.livejournal.com]

When I was in GA, I was refused an HIV screening by a county clinic. The doctor asked me if I'd ever had anal sex with another man, I answered no, and she said it was therefore not medically necessary for me to be screened for HIV. Go home now.

In California, I have a self-imposed regimen of screening twice a year for a suite of different things, and my doc backs me up on it.

I agree with your advice to lose the doc. Further, I'd advise your friend to switch to using a provider that has a profit motive in giving him the screenings. For Georgia, the best two are Quest Diagnostics and the little clinics they've put into Wal-Mart Superstores.

[autographedcat.livejournal.com]

I was asked, once, by my doctor¹ if I felt I was at particular risk for STDs when I requested the screening². I said "No, but I do have multiple sexual partners, and so I just consider it a good precaution." She nodded, said "Good idea." and never mentioned it again.<sup>3

1</sup>who is technically a Nurse Practitioner, but screw it, she's *my doctor*
²and even then, only after having asked for it every year at my physical for five or six years straight.
³Among the many reasons I *love* my doctor.

[kitanzi.livejournal.com]

ACat said "I have no words". I replied, "I have a whole thesaurus of words, but they all come down to horrifying." My first thought was that a doctor who thought that was the only way to spread AIDS is a menace and a disaster, and I hoped you talked to her supervisor - then I thought, oh. Georgia. Never mind.

[gingicat]

You are not overreacting.

[batyatoon]

Oh good god, your friend should lose that doctor ASAP and report his ass. That's indefensible advice.

[sweetmusic-27.livejournal.com]

But... Okay, even if there was some kind of wild miscommunication, still, I'm just so CONFUSED.

Because I've moved around a bit in the last ten years, I have had two doctors who looked at my left hand and said something along the lines of "Of course we can run the full battery of STD tests, but... Do you think you're at risk?" With one doctor, it had the air of 'is there a reason I should make time for this', so I just said, "Yes," and the other doctor I think was wondering if she had an anxious housewife on her hands, so I explained a bit more.

But that's the closest I've ever come to any doctor trying to discourage me, ever. This is just... *headshake*