Initial consultation

• First establish why the patient is presenting 'now' for the test.

• Explore the 'hidden component' of the patient's consultation.

• Take a full sexual, medical and drug-taking history. It is recognised that this can be embarrassing for both the doctor and the patient, but those experienced in this process advise the following approach:

o Establish a supportive, non-judgmental atmosphere. Encourage disclosure of history and patterns of partners and sexual practices in a gender-neutral situation. Make no assumptions about sexual preferences; they will be indicated by the patient as the history evolves, provided you allow this to happen; this will take time.

• Non-judgmental matter-of-fact questions such as 'Have you injected yourself with drugs?' and (to a male patient) 'Do you have sex with men?' may permit honest disclosure.

• Stress the importance of disclosure of prior, known infections with STDs. Assess the patient's risk for an STD.

• Assess the patient's coping strategies and social network.

Back Pain Relief

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