General comments
- Dress appropriately and conduct yourself in a professional manner. Smile whenever appropriate and try to focus on putting the patient at ease.
- Introduce yourself by name and explain your role. Be welcoming to anyone else who may be with the patient. If you have other members of your team, introduce them as well.
- Begin by taking a brief history and trying to establish rapport before asking the patient to undress for her physical examination. Sit facing her and make direct eye contact.
- Listen carefully and invite questions to foster a trusting relationship. Try to understand the problem from her point of view in order to develop the most effective management plan. Acknowledge important points in the history by verbal or non-verbal cues (nodding).
- Occasionally, sensitivity to cultural expectations will require a change in approach. For example, some cultures discourage shaking hands whereas in others the husband or male family members will answer questions directed at the woman.
History
Taking an effective history involves a complicated interplay of multiple conflicting issues. The physician must create a comfortable environment, not appear rushed, and listen to all concerns, but at the same time stay focused and put limits on his or her time. The interview should be comprehensive, but tailored appropriately.
- Chief complaint. Patients should be encouraged to express, in their own words, the main purpose of the visit.
- Present illness. Pertinent open-ended questions can help clarify the details of the chief complaint and provide additional perspective.
- Past medical and surgical history. All significant health problems should be noted and any recent changes explored in more detail if indicated. Patients should be asked for an updated list of current medications and allergies. Prior surgical procedures, especially any involving the abdomen, pelvis, or reproductive organs, should be documented.
- Gynecologic history. Age-appropriate questions may include a detailed menstrual history (age of menarche or menopause, cycle length and duration, last menstrual period), contraceptive usage, prior vaginal or pelvic infections, and sexual history.
- Obstetric history.
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