There is still a lot of stigma surrounding a diagnosis of hepatitis C, so the most important thing you can do is to be non-judgemental, compassionate and respectful. Give yourself adequate time to answer questions - consider arranging an extended consultation in the near future.
Taking a drug and alcohol history, and asking about sexual health issues should become routine. The Australian STI management guidelines for use in primary care (history taking and contact tracing) can be found here. For screening and assessment tools for health professions and for self-reporting, see the Drug and Alcohol Clinical Advisory Service website. For information on alcohol and other drugs (AOD) support nationally, see DirectLine.
Questions about acquisition can be very uncomfortable for patients and difficult to answer. They can also be difficult questions for clinicians to ask. It is not necessary to ask as your first question or at all. If you are not engaged in notification or treatment, then you may not need to know and your patients are entitled not to say. It is not a priority to ask about how someone got hepatitis C if if there are other complex issues to address first.
Some suggested phrases are:
It is important to explain risk of transmission to others, if relevant. Departments of Health in different states and territories collect confidential information on this to better understand how transmission has occurred or is occurring in Australia. It is important to know if transmission has possibly occurred in health facilities or from health or other procedures, such as tattooing.
If someone identifies intravenous drug use as the risk, bear in mind that it may have been in recent years or decades ago. So to address any possible ongoing risk of transmission, perhaps say "Would you like me to discuss safe injecting?"
To know how long someone has been infected, say "How long have you had Hep C?" or "When were you first diagnosed?" Finally, provide a take-home information pack, including pamphlets on general health, liver health and safe injecting. Explain that you provide these to all your patients in case there is information that may be useful to them.