Asperger Syndrome and Patient Interactions (PART 2/2)

ICM taught me about what things were considered taboo and personal to most patients (ie Neurotypicals). I found this quite beneficial as I could also apply this to non-Medical social situations. Previously I openly talked about some of these things while upsetting or offending some NTs without realizing it, but now I know why, and I shall only discuss these topics in the appropriate social groups, whether online or in person.

Here is a basic list of topics from clinical conversations and the ICM booklets that I’ve discovered to be Taboo/ R-rated/Covertly discussed among most NTs:

- Sexual activity, Sexuality, Pornography

- Issues relating to Primary Sexual Characteristics (eg penis, vagina) along with breasts and bottom

- HIV/AIDS and other STIs (Sexually transmitted infections)

- Bowel movements

- Urination

- “Illicit” drug use

- Prescription drug abuse (especially Opioids and Benzodiazepines)

- Drug (including Alcohol) addiction

- Severe/Clinical Depression

- Bipolar Disorder, Schizophrenia and other psychiatric conditions that are (unfortunately) stereotyped by mainstream public and mainstream media to be “crazy” conditions

Engaging in clinical conversations also STRONGLY encouraged me to suppress my impulsivity in saying whatever comes into my head. I have quietly learnt (not from bad experience) that if I automatically say comments that may appear judgmental or not directly relevant to the medical condition, then it’s just going to hinder the conversation, not to mention having a very high chance of offending the patient.

Here’s a segment of me thoroughly censoring myself. I was conducting a sexual interview with a woman who had Bipolar II Disorder (fake name of Cassie). My internal thoughts are in brackets:

Me: (Ok start with the rote “politeness”)

Good morning Cassie, I’m Ken, I’m a third year Medical student from Melbourne Uni. I’ve been told by your GP to conduct a sexual interview on you before you proceed with the main consultation with her. This will involve me asking you about your potential relationships and sexual activity. I’d like to assure you that whatever you tell me will remain entirely confidential between you, me and the doctor. Are you alright with that?

Cassie: Yep that’s fine.

Me: (Ok good.)

Ok Cassie, firstly, are you in any form of intimate relationship?

Cassie: Yeah, I have a boyfriend.

Me: (Just as I expected.)

Ok. Are you sexually active with him?

Cassie: Yes I am.

Me: (I knew it, it appears that practically all of the patients that I’ve spoken to that have a partner or a spouse are sexually active with them! Very few of them seem to be able to cope with no sex life whatsoever.)

Ok, how often do you have sex with him?

Cassie: Um, usually 3 or 4 times a week.

Me: (OMG she’s really horny! I though most adults had sex once a month, or perhaps once a week at the most, but 3 or 4 times a week?! That sounds like heaps! That sounds very tiring and stressful to me! I bet she’s having all that sex when she’s hypomanic , I wonder if she’s even taking her Seroquel?!)

Alright, and how long do your sex sessions go for?

Cassie: With foreplay? Uh about 30 minutes.

Me: (Hmm I wonder what proportion of her sex involves foreplay. From the movies that I see that have sex in it, I estimate the ratio of foreplay:penetrative sex to be around 1:2 or 1:3. But this is probably irrelevant as she’s still doing penetrative sex anyway which has a risk of pregnancy and contracting STIs. I need to focus on any penetrative sex that she engages in.)

What kind of sexual activities do you and your boyfriend engage in?

Cassie: The usual foreplay, feeling each other, and penis-in-vagina.

Me: (hmm I’ll need to ask about contraception/protection now.)

And do you or your boyfriend use any protection when having sex?

Cassie: Well he uses condoms, and I’ve had the Implanon in me for around 3 months so it’s working out pretty well. It’s really cheap, I have a Health Care Card so it was around $5! We only have sex with each other and nobody else, so STIs aren’t an issue, but yeah I really don’t wanna be pregnant.

Me: (That sounds reasonable. Oh wow the Implanon’s that cheap with Concession Health Care Card, I wish I had a Concession Health Care card so I could get my prescription medications for that price! OMG shut up shut up, stop having irrelevant thoughts. What shall I say now? Oh yeah, talk about the Implanon.)

Alright, I can understand that you don’t want to be pregnant, and it’s good that you have very little or no chance of contracting an STI based on what you’ve said. Are you feeling any side effects from the Implanon?

Cassie: Actually no! It’s way better than being on the pill. When I was on the pill, my mood became even worse, and sometimes my face would go all red!

Me: (Ok, now say something good about her Implanon, to show that you heard what she said. I can please her a bit.)

That’s good to hear that the Implanon isn’t giving you any negative side effects, and that it’s doing its intended action.

.

. [further questions regarding Cassie’s partner]

.

Me: (Ok I need to conclude now, I’ve collected all the information and it sounds like she’s horny and she has a very active sex life despite her Bipolar II Disorder. She’s unlikely to get pregnant or contract an STI, so that’s good. I need to thank her for revealing her info, to show that I appreciate her. Don't wanna piss her off.)

Well Cassie, that’s the end of the interview, thank you very much for your patience and cooperation.

Cassie: You’re welcome!

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I’m appreciative and grateful for the theories and explanations that I’ve learnt, and have become slightly more aware of how the things I say impact on NTs, and I often try to use the “clinical communication rules” in non-Medical conversations with them, which has so far been more beneficial for me compared to the stage when I was “socially naïve/innocent” (prior to age 21). I still think that the majority of NTs are overly sensitive (emotionally) and very emotionally demanding, but unfortunately (for me, being that I’m in the minority group) that’s how their brains are wired, just like how AS wires my brain differently, so I can’t fully blame them.

In conclusion, ICM and clinical conversations with patients have been very useful to me as they’ve explained various complexities of communication and the thoughts and emotions that get created in patients who are primarily NT. My AS causes me to have a reduction in emotional complexity, and ICM teaches me how to appear sensitive and empathetic even though my condition causes me to not automatically be like that in regards to NTs. I’m still very inexperienced in Clinical communication despite having noticed a lot of social/psychological theories, so I’ll need to practice more and more when I enter Clinical rotations. As a matter of fact, I enjoyed the majority of clinical conversations that I’ve had with patients, because the conversation appears more structured, and the rules are more spelt out via textbooks and professional guidelines etc, and I get to collect information which is practical within a time limit.

I sincerely hope that the attraction and pleasure that I gain (despite the great stress) from such patient interactions don’t diminish in the future, and that as I gain more skills later on, such interactions in the hospital (and in life in general) will be even more manageable and less painful, like a positive loop.