Clinical Approach to the Patient

Chapter 2 Clinical Approach to the Patient



As is the case in most areas of medicine, a careful history and physical examination should form the basis for patient evaluation and clinical management in obstetrics and gynecology. This chapter outlines the essential details of the clinical approach to, and evaluation of, the obstetric and gynecologic patient. Pediatric and adolescent patients, the geriatric patient, and women with disabilities all have unique gynecologic and reproductive needs, and this chapter concludes with information about their evaluation and management.



image Obstetric and Gynecologic Evaluation


In few areas of medicine is it necessary to be more sensitive to the emotional and psychological needs of the patient than in obstetrics and gynecology. By their very nature, the history and physical examination may cause embarrassment to some patients. The members of the medical care team are individually and collectively responsible for ensuring that each patient’s privacy and modesty are respected while providing the highest level of medical care. Box 2-1 lists the appropriate steps for the clinical approach to the patient.



Although a casual and familiar approach may be acceptable to many younger patients, it may offend others and be quite inappropriate for many older patients. Different circumstances with the same patient may dictate different levels of formality. Entrance to the patient’s room should be announced by a knock and spoken identification. A personal introduction with the stated reason for the visit should occur before any questions are asked or an examination is begun. The placement of the examination table should always be in a position that maximizes privacy for the patient as other health-care professionals enter the room. Finally, any appropriate cultural beliefs and preferences for care and treatment should be recognized and respected.



image Obstetric History


A complete history must be recorded at the time of the prepregnancy evaluation or at the initial antenatal visit. Several detailed standardized forms are available, but this should not negate the need for a detailed chronologic history taken personally by the physician who will be caring for the patient throughout her pregnancy. While taking the history, major opportunities will usually arise to provide counseling and explanations that serve to establish rapport and a supportive patient–physician encounter.



PREVIOUS PREGNANCIES


Each prior pregnancy should be reviewed in chronologic order and the following information recorded:



















image Diagnosis of Pregnancy


The diagnosis of pregnancy and its location, based on physical signs and examination alone, may be quite challenging during the early weeks of amenorrhea. Urine pregnancy tests done in the office are reliable a few days after the first missed period, and office ultrasonography is used increasingly as a routine.




SIGNS OF PREGNANCY


The signs of pregnancy may be divided into presumptive, probable, and positive.





Jun 4, 2016 | Posted by in GYNECOLOGY | Comments Off on Clinical Approach to the Patient

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