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Sex Transm Infect. 2007 December; 83(7): 594.
PMCID: PMC2598647

Letters from beyond: do patients attending Genitourinary Medicine clinics want their general practitioner to know?

Communication standards between physicians in Genito‐urinary Medicine (GUM) and general practitioners (GPs) remain a vital but largely neglected area of study.1 As a result of historical statutes many clinics still communicate with GPs only when patients are formally referred from general practice, but this policy may not reflect current patient or GP preferences.2

All patients attending the GUM clinic in the Scottish Borders complete a registration form that includes a section concerning communication with their GP; therefore, a retrospective analysis was performed on a random sample of 630 case notes (43% male and 57% female) from patients attending between 2002 and 2006.

Overall, 54% of patients requested no contact be made with their GP, but 36% of patients expressed a definite preference for communication with their GP. Patient age did not influence the wish for communication with their GP as patients younger than 20 years old were no more likely to refuse GP contact than those over 20 (57% vs 53%, p = 0.52). Similarly, gender had no significant effect (females 53% vs males 56% p = 0.43).

Patient sexual preference, however, did influence whether patients wished communication between GUM and their GP with patients being significantly more likely to decline GP contact if self‐identified as homo‐ or bisexual (table 11).). Reason for attendance at the GUM clinic was also an important factor, with patients more likely to decline GP contact if they attended for an asymptomatic STI screen or as a contact of infection than if they had symptoms (table 11).

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Table 1 Factors affecting GUM attendees' preference regarding GP contact

Forty‐two per cent (262/630) of patients were referred by their GP, and 35% of patients self‐referred to the GU Medicine clinic (215/630). Self‐referred patients were more likely to decline GU Medicine contact with their GP than those initially referred by a GP (65% vs 36%) (p[less-than-or-eq, slant]0.001). Of those referred by a GP, patients were more likely to consent to contact between the GU clinic and their GP if referred to the clinic with a GP letter (table 11).). Finally, patients who undertook HIV testing were significantly less likely to agree to contact with their GP (table 11).

There is an unwritten assumption that most patients attending GUM clinics would not wish their GP to be made aware, but evidence from this large study refutes this. Providing GP letters for patients may be an addition to the workload for already overstretched GU services but is consistent with other disciplines and may reduce stigma attached to sexual health. Standard letters and electronic systems may reduce the work involved.1 Many patients initially attend GPs for sexual‐health‐related issues3; therefore GUM physicians must be aware of the importance of correspondence with colleagues in primary care. Future possibilities include the adoption of an “opt out” clause for patients regarding communication with their GP. Previous work has also highlighted the difficulties both GPs and patients face concerning life‐insurance considerations with reference to STIs, and further education is needed in this area.4,5

The potential benefits of increased communication between GUM and GPs include better relationships between primary care and GU medicine, and more importantly improved overall patient care, a common goal for both community and hospital practitioners.

Footnotes

Funding body: Not applicable.

Competing interests: None.

References

1. Winceslaus J, Blount J, Cryer C. Sexually transmitted diseases and communications with general practitioners. Sex Transm Inf 1999. 7545–48.48 [PMC free article] [PubMed]
2. Venereal Diseases Act 1917
3. Cassell J A, Brook M G, Mercer C H. et al Treating sexually transmitted infections in primary care: a missed opportunity? Sex Transm Inf 2003. 79(2)134–136.136 [PMC free article] [PubMed]
4. Keane F E, Young S M. GPs, STDs and life insurance. Int J STD AIDS 1994. 5318–321.321 [PubMed]
5. Sankar P, Jones N L. To tell or not to tell: primary care patients' disclosure deliberations. Arch Intern Med 2005. 1652378–2383.2383 [PubMed]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group