Challenges in Sexual Health Assessment · Clinical Exercise

Over, Under, or Not Yet

Seven presentations and three verdicts. The third verdict is the one this exercise is built around, because a two-way forced choice would reward whichever error you already lean towards.

What this exercise practises

Holding both directional errors at once rather than defending against one, recognising when the honest verdict is that a specific question has not been asked yet, and noticing a presentation that warrants attention in a domain the client has not named.

One of the seven meets no diagnostic threshold and warrants clinical attention anyway. A clinician organised around desire and function will file it under neither error and simply not see it.

Estimated time to complete this exercise: 25 minutes

1Seven verdicts
2The balance
3Close

Before you begin

How this one works

Seven presentations and three verdicts. Within normal range, warrants clinical attention, or not enough information yet.
The third verdict is the one the exercise is built around. It is the correct answer for two of the seven, and a two-way forced choice would reward whichever error you already lean towards.
One of the seven warrants clinical attention in a domain the client has not named, and a clinician organised around desire and function will file it under neither error and simply not see it.
Part 2 is the balance itself, which is the hardest thing in this section to state without turning it into a policy.
Nothing is graded and nothing is recorded. Reloading starts it again.

Over-pathologising and under-pathologising are equally consequential. A clinician who has decided which of the two errors to prefer has stopped assessing and started applying a default, and the default will be wrong at a predictable rate.

References

  1. Bancroft, J. (2009). Human sexuality and its problems (3rd ed.). Elsevier.
  2. Croskerry, P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78(8), 775–780. https://doi.org/10.1097/00001888-200308000-00003
  3. Hays, P. A. (2016). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy (3rd ed.). American Psychological Association.
  4. McCabe, M. P., Sharlip, I. D., Atalla, E., Balon, R., Fisher, A. D., Laumann, E., Lee, S. W., Lewis, R., & Segraves, R. T. (2016). Definitions of sexual dysfunctions in women and men: A consensus statement from the Fourth International Consultation on Sexual Medicine 2015. Journal of Sexual Medicine, 13(2), 135–143. https://doi.org/10.1016/j.jsxm.2015.12.019
  5. Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.). John Wiley & Sons.