Found it!

Yes, friends. I found my wal-mart receipt, upon which I've scribbled some notes.

I had the pleasure of working with a 21-year-old young man during my pediatrics rotation. He was not my patient, but we developed a friendship nonetheless. M has down's syndrome, also known as trisomy 21, which is a chromosomal disorder that is caused by an extra chromosome 21. As many know, individuals with Down's have a lower than average cognitive ability, which can range from developmental delays to profound mental retardation. Physiologically, those with Down's tend to suffer from congenital heart defects, short stature, thyroid disorders, among other health issues. There is also a greater tendency towards infertility, whereas men very rarely father children, and females have significantly lower rates of conception than those unaffected.

M had a congenital heart defect, causing him to have various open heart surgeries throughout his lifetime to date. He was in the hospital on this occasion because of a sternal wound that had healed but reopened, due mostly in part to his scab-picking tendencies. He was consulted by both the wound team and dermatology. During these consults, his mother mentioned that he had a rash in his genital area, and that he had been scratching for the past week or so. The wound team checked it out, and sure enough poor M had a rash on his inner thighs and his genital area was red and inflamed due to his scratching. The team said this was probably due to the spread of infection from his sternal wound via M's hands, prescribed some hydrocortisone, and that was that.

Now, I don't know if it was my sexual health interests flicking me in the head, but for some reason, I was not comfortable with the way the situation was handled. Yes, M had a rash that needed attention, but I felt as though unfair assumptions were made. I brought this up to my preceptor in post-conference. "I know this may be a silly question," I asked, "but why was no mention made or questions asked about M's sexual history?" My preceptor hesitated, and explained that since the floor 'knows' M and his family (especially the overbearing tendencies of his mother), that there was probably never any time where he was alone with anyone else.
I couldn't help but feel that unfair assumptions and judgments were made about Ms lifestyle. Was there a subliminal statement made by the wound team that individuals with Down's syndrome aren't or can't be intimate with others? This boy was 21-years-old, and I can't help but think that had he not been mentally retarded, one of the first questions would have been about a sexual history. He may have been at a lower cognitive ability than other 21 year old men, but that does not mean he has not reached his physiological age.

I realize that it would have been equally unfair to assume that his issue was due to sexual contact, but in my opinion, the question should have been asked (not in front of his mother). These questions are difficult to ask, and must be asked in the correct manner, even to individuals who are not disabled. How does a health professional then adapt to this situation when someone of low cognitive ability is the patient? There's no more beating around the bush (no pun intended), no euphamisms allowed. This cannot be easy for either party, but when we decide that it's easier for us to just ignore the question all together, we are doing a disservice to our profession.

I'm curious to get some input from others on this topic, which may seem controversial. In my opinion, there is no controversy when it comes to treating all citizens with equal and fair health care.

thoughts?