Consultant physicians working with patients - Royal College of ...

Consultant physicians working with patientsservices to other providers and training for healthcareworkers. These functions require accessible, confidentialservices staffed by appropriately trained multidisciplinaryteams.Secondary careGUM specialists provide a service for the community indesignated departments. There should be facilities foroutpatients, and any service with HIV-infected patientsshould have access to day care and beds. Althoughconsultants work primarily in outpatient clinics, theyare on call for urgent problems and provide support forother specialists. It is essential that single-handedconsultants have regular meetings with GUM colleaguesfor audit and continuing professional development(CPD). GUM services are usually key stakeholders inthe local chlamydia screening service.Tertiary careExamples of conditions managed in tertiary careinclude complex HIV disease, sexual problems andvulval disorders.Community models of careWhile historically GUM clinics were based in acutehospital sites, an increasing number are now providedwithin community settings. Some services areco-located with other sexual health providers or provideintegrated services to variable degrees. The DH’snational sexual health strategy for England and Walesoutlined the increasing role that primary care isexpected to take in screening for STIs. 1 The strategy setstandards for those providing care at this level andGUM collaborates in developing protocols, training andclinical governance. There is evidence in primary careservices of both increased screening for Chlamydiatrachomatis and referral to GUM clinics.Complementary servicesComplementary medicine services are valued bypatients with HIV and are usually supplied by voluntaryservices.3 Working with patients: patient-centredcareWhat you do with patientsInvolving patients in decisions abouttheir treatmentIt is essential that patients are involved in treatmentdecisions, especially for successful antiretroviraltherapy where it has been shown that thedoctor–patient relationship and understanding oftreatment are key components for the long-termadherence and success of therapy. To preventonward transmission of STIs, patients need aclear understanding of the aims of therapy andthe importance of partner notification.The specialty sets great store by theseprinciples.Patient choice: ethnic and religiousconsiderationsCultural sensitivity is essential in sexual health.Information for patients is published in manylanguages. Intimate examinations need to be carefullyexplained and understood by patients, especially thosewho may have cultural taboos in respect of femaleexamination. Patients with HIV from developingcountries will often have beliefs in traditional medicineor disease causation that need to be addressed.Sensitivity to patients’ sexual orientation is an integralpart of care.Opportunities for education and promotingself careEducation is a cornerstone of GUM for the preventionof transmission of infection. Verbal explanations andwritten materials are provided for all patients withSTIs/HIV during consultations. Health advisers providean extra level of education for those with serious orrecurrent disease, eg syphilis, gonorrhoea and HIV.Emphasis is placed on prevention (using condoms,number of sexual partners, healthcare-seekingbehaviour). The relatively low incidence of HIV in theUK has been partly attributed to these interventions.MSM are routinely advised to have hepatitis Bvaccination.Patients with chronic conditionsThe main groups are patients with HIV, hepatitis B andC, recurrent herpes, warts and the sequelae of pelvicinflammatory disease. Many patients opt for continuingcare in GUM. Psychological services are required but areunderprovided in the majority of clinics.The role of the carerApartnersittinginontheconsultationcanhelptoensure that information and advice are understood, aslong as issues of confidentiality are considered. Carersfrequently accompany patients with HIV disease andcan be vital to adherence to HAART.112 C○ Royal College of Physicians 2013