Initial Assessment and Communication in Gynecology Flashcards
promote patient–physician interaction and trust
interpersonal and communication skills
Variables that Influence the Status of the Patient:
Patient
• Age
• History of illness
• Attitudes and perceptions
• Sexual orientation
• Habits (e.g., use of alcohol, tobacco, and other drugs)
Variables that Influence the Status of the Patient:
Family
• Patient’s status (e.g., married, separated, living with a partner, divorced)
• Caregiving (e.g., young children, children with disabilities, aging parents)
• Siblings (e.g., number, ages, closeness of relationship)
• History (e.g., disease)
Variables that Influence the Status of the Patient:
Environment
• Social environment (e.g., community, social connectedness)
• Economic status (e.g., poverty, insuredness)
• Religion (e.g., religiosity, spirituality)
• Culture and ethnic background (e.g., first language, community)
• Career (e.g., work environment, satisfaction, responsibilities, stress)
essential to patient assessment and treatment
Good communication
The foundation of communication is based on key skills:
empathy, attentive listening, expert knowledge, and rapport
AERE
the fundamental element that encourages open communication of the patient’s feelings, concerns, and thoughts, rather than withholding information
Trust
the fundamental element that encourages open communication
Trust me
very basic element of communication
sharing a common language and culture
traditional role of the physician was
paternalistic
can influence interactions with the patient
pattern of the physician’s speech
Important Components of Communication between the Patient and Physician:
Physician Is:
The Physician Is Not:
Physician is:
GGFF
CHER
essential to the maintenance of a relationship between the patient and physician that will foster ongoing care
Good communication
Female physicians
Less talkative
Tends to listen
Less assertive
Speech is characterized by, silence, questions and proposals
L
A
T
S - SPQ
The art of communication and persuasion
Style
Following are techniques to help achieve rapport with patients:
• Use positive language (e.g., agreement, approval, and humor).
• Build a partnership (e.g., acknowledgment of understanding, asking for opinions, paraphrasing, and interpreting the patient’s words).
• Ask rephrased questions.
• Give complete responses to the patient’s questions
suggests that the patient will follow the physician’s recommendations or
“orders.”
Compliance
an essential component that promotes open communication
Humor
can be used as an appropriate means of relaxing the patient and making her feel better.
Laughter
a “metaphor for the full range of the positive emotions.”
Laughter
the response of human beings to incongruities
Laughter
characterize good medical interviewing techniques.
Attentiveness, rapport, and collaboration
A R C
Gynecologic History
• Menstrual history
• Contraceptive use
• Sexual history
• Coitarche/ with whom
• Number of partners
• Last sexual contact
• History of Sexually transmitted infection
are considered to be essential parts of the gynecologic examination
examination of the breasts and abdomen and a complete examination of the pelvis
P B A
The abdomen should be inspected for signs of an intra-abdominal mass, organomegaly, or distention that would suggest ascites or intestinal obstruction.
OK
A fullness in the upper abdomen could be consistent with an __
“omental cake.”
The instrument should be warmed with tap water—not lubricated—if vaginal or cervical smears are to be obtained for the test or if cultures are to be performed.
OK
Discharge - should be studied to detect trichomoniasis, monilia, and clue cells and to obtain cultures, primarily for gonococci and chlamydia.
OK
Unusual bleeding from the cervical canal, except during menstruation, merits an evaluation for __
cervical or uterine neoplasia
Hot to do Bimanual palpation
PPT pg 60
Smear the stool to test for occult blood
guaiac
Ulcerative or purulent lesions of the vulva should be evaluated and __ as outlined in subsequent chapters, and __ should be performed on any lesions.
cultured
biopsy
Sexually active adult:
__ speculum is typically used
Pederson speculum i
women who have
- lax vaginal walls,
- are pregnant,
- will be undergoing cervical or
- endometrial biopsies or procedures:
__ speculum may be required
larger Graves speculum
“Virginal” speculum
Huffman
An endometrial biopsy usually is performed with a __ or __
flexible cannula or a Novak curette
Stool testing for occult blood has been found to reduce colon cancer mortality for individuals older than age __
50
Nodularity and tenderness within the rectovaginal septum suggests __;
nodularity may also suggest the spread of an intra-abdominal malignancy such as __
endometriosis
ovarian cancer
•A speculum examination should not be performed in a prepubertal child in the office - __ position
“frog leg” position
very young girls (toddlers or infants) - __ position may also be helpful for the examination
knee-chest position
The keys to a successful examination in an adolescent lie in __
earning the patient’s trust
an important issue in adolescent health care
Confidentiality
Breast examination
• Should be a part of the physical examination of female patients specially those __ years old and above
40 years old and above.
