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APGO educational topic number one
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history welcome to the obstetrics and
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gynecology clerkship in this video we
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will introduce you medical student
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extraordinaire
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two important aspects of women’s
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healthcare we will discuss unique
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history questions and risk assessments
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that we hope you will continue to
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utilize with your female patients in
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your future medical careers the
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objectives of this video are to complete
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a comprehensive Women’s Medical
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interview that includes menstrual
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obstetric ‘el gynecologic contraceptive
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sexual family and social histories to
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assess risk for unintended pregnancy
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sexually transmitted infection cervical
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pathology breast malignancy gynecologic
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malignancy nutrition obesity domestic
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violence and eating disorders to assess
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the patient’s adherence to the
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recommended screening measures
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demonstrate interpersonal and
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communication skills that build trust by
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addressing relevant factors including
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culture ethnicity language literacy
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socioeconomic status spirituality
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religion age sexual orientation and
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disability to produce well-organized
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written and oral reports to communicate
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the results of the OB gen and general
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medical interview here is your patient
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Romina health of which you are about to
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take a comprehensive women’s health
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history of WA Mina what are the
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important elements the physical
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environment is very important in order
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to enhance the quality of the interview
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the interview should take place in a
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quiet private well-lit room and whenever
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possible with the patient dressed
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possibly intimidating instruments should
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be covered remember how important it is
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to greet the patient by title and name
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to make eye contact to shake hands and
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to be welcoming be aware that the
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presence of family members may be an
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impediment to an honest interview
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especially in cases of intimate partner
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violence the help of a medically trained
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interpreter should be sought for
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patients who need those services family
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members should ideally not be used for
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translation because of privacy
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confidentiality bias and the sensitive
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nature of many women’s health issues
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let’s start with the menstrual history
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find out her menarche
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or the age at which she started
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menstruating find out how regular her
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periods are find out how heavy her
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periods are and what was the date of her
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last menstrual period why is this
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important let’s take a quick trip to the
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land of primary care what if WA Mina was
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seeing you for headaches and you
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neglected to ask her
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our periods would this be relevant if
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her periods were extremely heavy to the
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point that she was very anemic from her
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bleeding or what if Amina had very light
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very infrequent periods this would
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suggest that an evaluation for a
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prolactin oma should be included or what
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if you were seeing an obese young woman
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who had a borderline fasting blood
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glucose and you discovered that her
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periods are extremely irregular this
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constellation of symptoms should make
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you think of polycystic ovarian syndrome
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let’s move now to gynecologic history
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ask if she has any known gynecologic
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illnesses the gynecologic history
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includes the sexual history it is
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important to use open-ended questions
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such as please tell me about your sexual
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partner or partners why is this so
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important to ask open-ended questions
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let us imagine a few possible scenarios
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what if Amina was a lesbian who was
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seeing a gynecologist for the first time
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on her intake form she marked that she
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was sexually active and not married
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if you immediately asked her what birth
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control she is using and then spend time
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counseling her about contraception
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options without first asking an
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open-ended question this could be
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perceived as culturally insensitive
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asking open-ended questions also allows
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well Mena to feel that she can be opened
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so you can better assess her risk of
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sexually transmitted infections
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contraceptive history what is your risk
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of unintended pregnancy and you went
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sexually active with men without a
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contraceptive plan is basically at risk
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for unintended pregnancy remember that
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the United States has the highest rate
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of unintended pregnancy in the developed
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world with approximately one-half of all
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pregnancies being unintended also
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remember to ask about prolapse and
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incontinence many women may be
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embarrassed by these conditions and may
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not mention them unless you specifically
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ask moving next to her obstetric history
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this includes the gravida T which is the
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number of pregnancies and parity which
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are the pregnancy outcomes the parody
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can be further described as a number of
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full-term preterm abortions and living
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children the acronym T pal can be useful
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for remembering these different aspects
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of note abortions refers to both
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terminations and miscarriages next we
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move on to family history you should
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find out which illnesses occur in
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first-degree relatives such as diabetes
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cancer osteoporosis and heart disease
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information gathered here
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may indicate a genetic predisposition
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for hereditary disease such as breast or
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ovarian cancer let’s now move to social
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history it is important to ask about
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tobacco alcohol and illegal drugs in the
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United States approximately 21 percent
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of all women use tobacco products 16
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percent of women older than 12 are binge
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drinkers and 11 percent of non pregnant
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women age 15 to 44 report illicit drug
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use in the past month the social history
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is also an important time to screen for
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sexual abuse and intimate partner
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violence these two issues are
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unfortunately too common in our female
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patients and we as health care providers
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need to improve how well we screen for
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them the radar approach is one way of
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addressing intimate partner violence
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with your patients our remember to ask
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routinely about intimate partner
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violence a asked directly about violence
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with questions such as at any time has a
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partner hit kicked or otherwise hurt or
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frightened you D document information
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about suspected intimate partner
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violence in the patient’s chart and file
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reports when required by law a assess
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your patient safety is it safe to return
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home find out if any weapons are kept in
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the house our review options with your
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patients know about the type of referral
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options that are available such as
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shelters or support groups
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you
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when we discuss a patient’s adherence to
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recommend a screening measures it is
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important to think about health literacy
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this is the ability to understand
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instructions on prescription drug
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bottles appointment slips patient
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education brochures consent forms and
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the ability to negotiate complex
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healthcare systems 10% of Americans are
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estimated to have low health literacy
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and 50% are estimated to have marginal
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to low health literacy skills adults
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with low health literacy are to increase
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risk of hospitalizations encounter more
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barriers to receiving necessary health
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care services and are less likely to
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understand medical advice that can
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affect disease progression it is
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important for health care providers to
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be able to assess a woman’s health
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literacy to provide appropriate
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instructions and explanations about her
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care health literacy is one of the
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important aspects of effective
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communication that should take into
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account culture ethnicity language
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socioeconomic status spirituality and
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religion age sexual orientation and
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disability it is important that you
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produce well-organized written and oral
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reports to communicate the results of
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the OB gen and general medical interview
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we will conclude this video with tips
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and tricks that will help you throughout
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this clerkship and Beyond obstetrics and
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gynecology is a surgical specialty so
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the general expectation will be that
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written and especially oral reports
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should be concise and focused it is
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important to take a complete history
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however remember to focus on the
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pertinent positives and negatives for
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example most of our patients on labor
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and delivery are young reproductive aged
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and generally very healthy in this world
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the Gees and peas and especially the
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mode of delivery of prior pregnancies
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will be important to include so if you
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are presenting someone who is admitted
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with active labor prior contraception
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for example may not be the most
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important point to emphasize in this
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presentation but contraception will be
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an important point to highlight in a
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presentation about a postpartum patient
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remember that the assessment and plan
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are the important aspects of the written
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and oral reports that medical students
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often struggle with get into the habit
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of developing an assessment and plan for
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every patient that you see during your
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clerkships the
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is one of the critical steps in becoming
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a skilled clinician this concludes the
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aapko video on history we hope that you
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feel better prepared to perform a
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comprehensive Women’s Medical interview
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and to demonstrate interpersonal and
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important communication skills