V2 Berek & Novaks 9781496380333

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2 C H A P T E R

Section I • Principles of Practice

Initial Assessment and Communication

Jonathan S. Berek, Paula J. Adams Hillard

Variables That Affect Patient Status Communication Communication Skills Physician–Patient Interaction Style Laughter and Humor Strategies for Improving Communication History and Physical Examination History

Physical Examination Abdominal Examination Pelvic Examination Pediatric Patients Adolescent Patients Follow-Up

Summary

K E Y P O I N T S

1 We are all products of our environment, our background, and our culture. The importance of ascertaining the patient’s general, social, and familial situation cannot be overemphasized. The physician should avoid being judgmental, particularly with respect to questions about sexual practices, gender identity, and sexual orientation. 2 Good communication is essential to patient assess- ment and treatment. The foundation of communication is based on key skills: empathy, attentive listening, expert knowledge, and rapport. These skills can be learned and refined. 3 The concepts of medical professionalism initially codi- fied in the Hippocratic Oath demand that physicians be circumspect with all patient-related information. For physician–patient communication to be effective, the patient must feel that she is able to discuss her problems in depth and in confidence. 4 Different styles of communication may affect the phy- sician’s ability to perceive the patient’s status and achieve the goal of optimal assessment and successful The practice of gynecology requires many skills. In addi- tion to medical knowledge, the gynecologist should develop interpersonal and communication skills that promote patient– physician interaction and trust. The assessment must be of the “whole patient,” rather than confined to her general med- ical status. It should include any apparent medical conditions and the psychological, social, and family aspects of her sit- uation. To view the patient in the appropriate context, environmental and cultural issues that affect the patient must be taken into account. This approach is valuable in routine assessments, and in the evaluation of specific medical

treatment. The intimate and highly personal nature of many gynecologic conditions requires particular sensi- tivity to evoke an honest response. 5 Some patients lack accurate information about their ill- nesses. Incomplete or inadequate understanding of an illness can produce increased anxiety, dissatisfaction with medical care, distress, coping difficulties, unsuc- cessful treatment, and poor treatment response. 6 After a dialogue is established, the patient assessment proceeds with obtaining a complete history and typically, performing a physical examination. Both of these aspects of the assessment rely on good patient–physician inter- change and attention to details. 7 At the completion of the physical examination, the patient should be informed of the findings. When the results of the examination are normal, the patient can be reassured accordingly. When there is a possible abnormality, the patient should be informed immediately; this discussion should take place after the examination, with the patient clothed.

conditions, providing opportunities for preventive care and counseling on an ongoing basis.

VARIABLES THAT AFFECT PATIENT STATUS

Many external variables exert an influence on the patient and on the care she receives. Some of these factors include the patient’s “significant others”—her family, friends, and personal and intimate relationships (Table 1-1) . These

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