Listen to patients for ways to increase business

When I began my last year of family medicine residency in 2008, I was just glad to be at that point. Like everyone else, I had worked hard to get there. At the beginning of that first year, I said to an attending that I had always hated being at the bottom of the pile and having to work my way up. Being an intern was not about being at the bottom, he responded; it was about being lower than an earthworm.

But now, as a third-year resident, I was at the top of the pile and beginning to think about my future. Fortunately, I had a ready-made office to return to; I had been an independent nurse practitioner for several years and owned my office. During my residency, I made great sacrifices to keep it open. Business had dropped off considerably, however, while I was away.

I knew I would have to work very hard to re-establish myself and my business. I spent a lot of time that third year thinking about how I could best take care of my patients while increasing business. My question was answered, as often happens, by my patients.

One day, a 72-year-old widow came in to discuss her sex life-or lack thereof. She explained to me that she still had sexual feelings but experienced no satisfaction, primarily because the gentlemen her age could not make her "old puss pucker." When I asked her to elaborate, she said men did not seem to care as much about making love as she did.

Another patient, a 39-year-old woman, discussed her distress at experiencing a low libido for several months. She was beginning to have some changes in her periods and, other than some stress due to lack of libido, had no evidence of depression.

I started to listen to my patients with a better ear whenever they casually mentioned anything about sexuality. Sometimes (usually while having a pap smear), women would mention that they just didn't care about having sex anymore or that they were glad "those days" (of having sex) were gone. Occasionally, they would bring up the subject because they were bothered by the fact that their desire was not as strong as it used to be.

Of course, men would ask for drugs to treat erectile dysfunction, saying sildenafil, vardenafil, or tadalafil would help them satisfy their partners.

After several months of intently listening to patients and getting better at asking the right questions, I decided to search for seminars and courses about sexuality in patients of all ages, particularly those 50 years old and older. I found a few classes and read as much as possible about sexuality in older adults.

Not long after, I learned about sexuality and hormones in older adults. I read an article suggesting that all men with diabetes, and those with comorbidities such as chronic kidney disease or hypertension, should have their testosterone levels checked. This hormone issue was more common and more important than I had ever dreamed.