TP 147 Using Narrative Medicine Techniques to Support the Development of a New Protocol for Evaluating and Treating Patients with Persistent and Recurrent Non-Gonococcal Urethritis, New York City, 2013

Tuesday, June 10, 2014
Exhibit Hall
Anne Lifflander, MD, MPH, Bureau of Sexually Transmitted Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY

Background:  A subset of patients with non-gonococcal urethritis (NGU) has repeated visits with recurrent or persistent symptoms. Narrative medicine is used to improve understanding of the experiential aspects of illness. In addition to reviewing the medical literature and quantitative data from our clinics, a group composed of the seven Physicians in Charge (PICs) of the New York City STD clinics used narrative techniques to improve our understanding of this subset of patients.

Methods:  Men with frequent use of STD services for NGU were defined as those with >2 visits in 2012 for NGU and ≥10 visits to the STD clinic for any reason since 2005.  The STD Clinics’ Medical Director reviewed the entire electronic medical record of a random sample of ten men meeting these criteria. For each visit, the following was abstracted:  demographics, chief complaint, interval since last visit, interval since last sex, number and sex of partners in the previous three months, type of sex (anal-oral-vaginal), exchange of money for sex , urethral discharge, laboratory results and treatment.  A single case was selected, based on the biomedical and psychosocial information extracted. The PICs used abstracted information to invent a biography of the patient that included a description of his daily life and his sex life.

Results:  The characteristics ascribed to the patient by the PICs were similar when they described his living situation; all PICs concluded that the patient had an anxiety disorder.  However they differed in the elaboration of his sex partners and the circumstances under which the sex took place.

Conclusions:  We concluded that the diversity in the descriptions of his sexual partners, and of the circumstances under which sex occurred identified an important deficiency in the data we routinely collect as part of the sexual history.  This deficiency may contribute to difficulties in differentiating persistent from recurrent NGU.