BARRIERS TO BULGARIAN PRIMARY CARE PHYSICIANS TO ADDRESS AND DISCUSS THE ERECTILE DYSFUNCTION PROBLEM WITH THEIR PATIENTS

Abstract

Introduction: Several factors play the role of barriers to GP-s and most of them avoid discussing the erectile dysfunction (ED) problem with their patients, even though a part of the patients hope the doctor would initiate such a discussion. Taking into account the relationship of ED with a number of socially significant diseases, these barriers impede the diagnostic process. Objective: To identify possible barriers to Bulgarian primary care physicians to address and discuss the ED problem with their patients. Materials and methods: The opinions of 12 GP-s from the town of Plovdiv, randomly selected, were studied using qualitative research methods, interview with standard open-ended questions, asked by the research investigator. An audio recording was made and transcribed by the interviewer and by two other research investigators. The obtained data are the result of a consensus. Results: Even though the majority of participants point out that doctors do not avoid and should not avoid commenting on problems, related to the sex life of their patients, only one participant declared to always raise this issue before them. Constraining factors (barriers), pointed out by the colleagues, are lack of training in this aspect of health, also lack of training in asking intimate questions, the perception that sex problems of patients are not among "essential" diseases, associated with "survival", refusal of the patient, lack of time, waiting for the patient to raise this issue first and "personal taboos" of the doctor himself. The respondents point that doctors share the same inhibitions as their patients, as they are a part of the same society and are influenced by various cultural factors. Other factors, that play role of a barrier, are patient – physician gender discordance, lack of confidence and lack of experience with the patients with ED, physician personal sexual experience, when doctors do not apply holistic approach and when physicians do not percept ED as a disease. Conclusion: This survey is the first of its kind in Bulgaria. The results of the survey show that a variety of factors, including factors, related to doctor's personality, acts as barriers that impede doctors from proactively asking about and discussing sexuality issues and ED in particular. The overcoming of these barriers would present an opportunity to improve the therapeutic result.