{"id":140,"date":"2020-08-12T21:09:32","date_gmt":"2020-08-12T21:09:32","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=140"},"modified":"2021-05-05T22:46:07","modified_gmt":"2021-05-05T22:46:07","slug":"1-history","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/1-history\/","title":{"rendered":"1. History"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/Odc5vlgxCpY\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 8:40<\/p>\n<input type='hidden' bg_collapse_expand='69e9b56b00bf57035524958' value='69e9b56b00bf57035524958'><input type='hidden' id='bg-show-more-text-69e9b56b00bf57035524958' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b56b00bf57035524958' value='Hide Transcript'><button id='bg-showmore-action-69e9b56b00bf57035524958' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b56b00bf57035524958' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number one<br \/>\n00:01<br \/>\nhistory welcome to the obstetrics and<br \/>\n00:04<br \/>\ngynecology clerkship in this video we<br \/>\n00:06<br \/>\nwill introduce you medical student<br \/>\n00:08<br \/>\nextraordinaire<br \/>\n00:09<br \/>\ntwo important aspects of women&#8217;s<br \/>\n00:11<br \/>\nhealthcare we will discuss unique<br \/>\n00:13<br \/>\nhistory questions and risk assessments<br \/>\n00:15<br \/>\nthat we hope you will continue to<br \/>\n00:16<br \/>\nutilize with your female patients in<br \/>\n00:18<br \/>\nyour future medical careers the<br \/>\n00:20<br \/>\nobjectives of this video are to complete<br \/>\n00:22<br \/>\na comprehensive Women&#8217;s Medical<br \/>\n00:23<br \/>\ninterview that includes menstrual<br \/>\n00:25<br \/>\nobstetric &#8216;el gynecologic contraceptive<br \/>\n00:27<br \/>\nsexual family and social histories to<br \/>\n00:31<br \/>\nassess risk for unintended pregnancy<br \/>\n00:33<br \/>\nsexually transmitted infection cervical<br \/>\n00:35<br \/>\npathology breast malignancy gynecologic<br \/>\n00:38<br \/>\nmalignancy nutrition obesity domestic<br \/>\n00:40<br \/>\nviolence and eating disorders to assess<br \/>\n00:42<br \/>\nthe patient&#8217;s adherence to the<br \/>\n00:44<br \/>\nrecommended screening measures<br \/>\n00:45<br \/>\ndemonstrate interpersonal and<br \/>\n00:47<br \/>\ncommunication skills that build trust by<br \/>\n00:49<br \/>\naddressing relevant factors including<br \/>\n00:51<br \/>\nculture ethnicity language literacy<br \/>\n00:53<br \/>\nsocioeconomic status spirituality<br \/>\n00:56<br \/>\nreligion age sexual orientation and<br \/>\n00:58<br \/>\ndisability to produce well-organized<br \/>\n01:00<br \/>\nwritten and oral reports to communicate<br \/>\n01:02<br \/>\nthe results of the OB gen and general<br \/>\n01:04<br \/>\nmedical interview here is your patient<br \/>\n01:06<br \/>\nRomina health of which you are about to<br \/>\n01:09<br \/>\ntake a comprehensive women&#8217;s health<br \/>\n01:10<br \/>\nhistory of WA Mina what are the<br \/>\n01:12<br \/>\nimportant elements the physical<br \/>\n01:14<br \/>\nenvironment is very important in order<br \/>\n01:16<br \/>\nto enhance the quality of the interview<br \/>\n01:17<br \/>\nthe interview should take place in a<br \/>\n01:19<br \/>\nquiet private well-lit room and whenever<br \/>\n01:21<br \/>\npossible with the patient dressed<br \/>\n01:22<br \/>\npossibly intimidating instruments should<br \/>\n01:24<br \/>\nbe covered remember how important it is<br \/>\n01:27<br \/>\nto greet the patient by title and name<br \/>\n01:29<br \/>\nto make eye contact to shake hands and<br \/>\n01:31<br \/>\nto be welcoming be aware that the<br \/>\n01:33<br \/>\npresence of family members may be an<br \/>\n01:35<br \/>\nimpediment to an honest interview<br \/>\n01:36<br \/>\nespecially in cases of intimate partner<br \/>\n01:38<br \/>\nviolence the help of a medically trained<br \/>\n01:41<br \/>\ninterpreter should be sought for<br \/>\n01:42<br \/>\npatients who need those services family<br \/>\n01:44<br \/>\nmembers should ideally not be used for<br \/>\n01:46<br \/>\ntranslation because of privacy<br \/>\n01:47<br \/>\nconfidentiality bias and the sensitive<br \/>\n01:50<br \/>\nnature of many women&#8217;s health issues<br \/>\n01:51<br \/>\nlet&#8217;s start with the menstrual history<br \/>\n01:53<br \/>\nfind out her menarche<br \/>\n01:55<br \/>\nor the age at which she started<br \/>\n01:57<br \/>\nmenstruating find out how regular her<br \/>\n01:59<br \/>\nperiods are find out how heavy her<br \/>\n02:02<br \/>\nperiods are and what was the date of her<br \/>\n02:03<br \/>\nlast menstrual period why is this<br \/>\n02:05<br \/>\nimportant let&#8217;s take a quick trip to the<br \/>\n02:08<br \/>\nland of primary care what if WA Mina was<br \/>\n02:11<br \/>\nseeing you for headaches and you<br \/>\n02:12<br \/>\nneglected to ask her<br \/>\n02:13<br \/>\nour periods would this be relevant if<br \/>\n02:15<br \/>\nher periods were extremely heavy to the<br \/>\n02:16<br \/>\npoint that she was very anemic from her<br \/>\n02:18<br \/>\nbleeding or what if Amina had very light<br \/>\n02:21<br \/>\nvery infrequent periods this would<br \/>\n02:23<br \/>\nsuggest that an evaluation for a<br \/>\n02:25<br \/>\nprolactin oma should be included or what<br \/>\n02:27<br \/>\nif you were seeing an obese young woman<br \/>\n02:29<br \/>\nwho had a borderline fasting blood<br \/>\n02:30<br \/>\nglucose and you discovered that her<br \/>\n02:32<br \/>\nperiods are extremely irregular this<br \/>\n02:34<br \/>\nconstellation of symptoms should make<br \/>\n02:35<br \/>\nyou think of polycystic ovarian syndrome<br \/>\n02:38<br \/>\nlet&#8217;s move now to gynecologic history<br \/>\n02:40<br \/>\nask if she has any known gynecologic<br \/>\n02:43<br \/>\nillnesses the gynecologic history<br \/>\n02:46<br \/>\nincludes the sexual history it is<br \/>\n02:47<br \/>\nimportant to use open-ended questions<br \/>\n02:49<br \/>\nsuch as please tell me about your sexual<br \/>\n02:52<br \/>\npartner or partners why is this so<br \/>\n02:54<br \/>\nimportant to ask open-ended questions<br \/>\n02:56<br \/>\nlet us imagine a few possible scenarios<br \/>\n02:58<br \/>\nwhat if Amina was a lesbian who was<br \/>\n03:01<br \/>\nseeing a gynecologist for the first time<br \/>\n03:02<br \/>\non her intake form she marked that she<br \/>\n03:04<br \/>\nwas sexually active and not married<br \/>\n03:06<br \/>\nif you immediately asked her what birth<br \/>\n03:09<br \/>\ncontrol she is using and then spend time<br \/>\n03:11<br \/>\ncounseling her about contraception<br \/>\n03:12<br \/>\noptions without first asking an<br \/>\n03:14<br \/>\nopen-ended question this could be<br \/>\n03:16<br \/>\nperceived as culturally insensitive<br \/>\n03:18<br \/>\nasking open-ended questions also allows<br \/>\n03:20<br \/>\nwell Mena to feel that she can be opened<br \/>\n03:22<br \/>\nso you can better assess her risk of<br \/>\n03:24<br \/>\nsexually transmitted infections<br \/>\n03:26<br \/>\ncontraceptive history what is your risk<br \/>\n03:28<br \/>\nof unintended pregnancy and you went<br \/>\n03:30<br \/>\nsexually active with men without a<br \/>\n03:32<br \/>\ncontraceptive plan is basically at risk<br \/>\n03:34<br \/>\nfor unintended pregnancy remember that<br \/>\n03:36<br \/>\nthe United States has the highest rate<br \/>\n03:38<br \/>\nof unintended pregnancy in the developed<br \/>\n03:40<br \/>\nworld with approximately one-half of all<br \/>\n03:41<br \/>\npregnancies being unintended also<br \/>\n03:44<br \/>\nremember to ask about prolapse and<br \/>\n03:45<br \/>\nincontinence many women may be<br \/>\n03:48<br \/>\nembarrassed by these conditions and may<br \/>\n03:50<br \/>\nnot mention them unless you specifically<br \/>\n03:51<br \/>\nask moving next to her obstetric history<br \/>\n03:54<br \/>\nthis includes the gravida T which is the<br \/>\n03:57<br \/>\nnumber of pregnancies and parity which<br \/>\n03:59<br \/>\nare the pregnancy outcomes the parody<br \/>\n04:01<br \/>\ncan be further described as a number of<br \/>\n04:03<br \/>\nfull-term preterm abortions and living<br \/>\n04:05<br \/>\nchildren the acronym T pal can be useful<br \/>\n04:09<br \/>\nfor remembering these different aspects<br \/>\n04:10<br \/>\nof note abortions refers to both<br \/>\n04:12<br \/>\nterminations and miscarriages next we<br \/>\n04:15<br \/>\nmove on to family history you should<br \/>\n04:18<br \/>\nfind out which illnesses occur in<br \/>\n04:20<br \/>\nfirst-degree relatives such as diabetes<br \/>\n04:22<br \/>\ncancer osteoporosis and heart disease<br \/>\n04:25<br \/>\ninformation gathered here<br \/>\n04:27<br \/>\nmay indicate a genetic predisposition<br \/>\n04:28<br \/>\nfor hereditary disease such as breast or<br \/>\n04:31<br \/>\novarian cancer let&#8217;s now move to social<br \/>\n04:34<br \/>\nhistory it is important to ask about<br \/>\n04:36<br \/>\ntobacco alcohol and illegal drugs in the<br \/>\n04:39<br \/>\nUnited States approximately 21 percent<br \/>\n04:41<br \/>\nof all women use tobacco products 16<br \/>\n04:44<br \/>\npercent of women older than 12 are binge<br \/>\n04:46<br \/>\ndrinkers and 11 percent of non pregnant<br \/>\n04:49<br \/>\nwomen age 15 to 44 report illicit drug<br \/>\n04:53<br \/>\nuse in the past month the social history<br \/>\n04:55<br \/>\nis also an important time to screen for<br \/>\n04:57<br \/>\nsexual abuse and intimate partner<br \/>\n04:59<br \/>\nviolence these two issues are<br \/>\n05:01<br \/>\nunfortunately too common in our female<br \/>\n05:03<br \/>\npatients and we as health care providers<br \/>\n05:05<br \/>\nneed to improve how well we screen for<br \/>\n05:06<br \/>\nthem the radar approach is one way of<br \/>\n05:09<br \/>\naddressing intimate partner violence<br \/>\n05:10<br \/>\nwith your patients our remember to ask<br \/>\n05:13<br \/>\nroutinely about intimate partner<br \/>\n05:14<br \/>\nviolence a asked directly about violence<br \/>\n05:17<br \/>\nwith questions such as at any time has a<br \/>\n05:19<br \/>\npartner hit kicked or otherwise hurt or<br \/>\n05:21<br \/>\nfrightened you D document information<br \/>\n05:25<br \/>\nabout suspected intimate partner<br \/>\n05:26<br \/>\nviolence in the patient&#8217;s chart and file<br \/>\n05:28<br \/>\nreports when required by law a assess<br \/>\n05:31<br \/>\nyour patient safety is it safe to return<br \/>\n05:33<br \/>\nhome find out if any weapons are kept in<br \/>\n05:35<br \/>\nthe house our review options with your<br \/>\n05:37<br \/>\npatients know about the type of referral<br \/>\n05:39<br \/>\noptions that are available such as<br \/>\n05:41<br \/>\nshelters or support groups<br \/>\n05:50<br \/>\nyou<br \/>\n06:02<br \/>\nwhen we discuss a patient&#8217;s adherence to<br \/>\n06:05<br \/>\nrecommend a screening measures it is<br \/>\n06:07<br \/>\nimportant to think about health literacy<br \/>\n06:09<br \/>\nthis is the ability to understand<br \/>\n06:11<br \/>\ninstructions on prescription drug<br \/>\n06:13<br \/>\nbottles appointment slips patient<br \/>\n06:16<br \/>\neducation brochures consent forms and<br \/>\n06:18<br \/>\nthe ability to negotiate complex<br \/>\n06:21<br \/>\nhealthcare systems 10% of Americans are<br \/>\n06:24<br \/>\nestimated to have low health literacy<br \/>\n06:26<br \/>\nand 50% are estimated to have marginal<br \/>\n06:29<br \/>\nto low health literacy skills adults<br \/>\n06:32<br \/>\nwith low health literacy are to increase<br \/>\n06:34<br \/>\nrisk of hospitalizations encounter more<br \/>\n06:36<br \/>\nbarriers to receiving necessary health<br \/>\n06:38<br \/>\ncare services and are less likely to<br \/>\n06:41<br \/>\nunderstand medical advice that can<br \/>\n06:43<br \/>\naffect disease progression it is<br \/>\n06:45<br \/>\nimportant for health care providers to<br \/>\n06:47<br \/>\nbe able to assess a woman&#8217;s health<br \/>\n06:49<br \/>\nliteracy to provide appropriate<br \/>\n06:50<br \/>\ninstructions and explanations about her<br \/>\n06:52<br \/>\ncare health literacy is one of the<br \/>\n06:55<br \/>\nimportant aspects of effective<br \/>\n06:56<br \/>\ncommunication that should take into<br \/>\n06:58<br \/>\naccount culture ethnicity language<br \/>\n07:01<br \/>\nsocioeconomic status spirituality and<br \/>\n07:03<br \/>\nreligion age sexual orientation and<br \/>\n07:06<br \/>\ndisability it is important that you<br \/>\n07:09<br \/>\nproduce well-organized written and oral<br \/>\n07:10<br \/>\nreports to communicate the results of<br \/>\n07:12<br \/>\nthe OB gen and general medical interview<br \/>\n07:14<br \/>\nwe will conclude this video with tips<br \/>\n07:17<br \/>\nand tricks that will help you throughout<br \/>\n07:18<br \/>\nthis clerkship and Beyond obstetrics and<br \/>\n07:21<br \/>\ngynecology is a surgical specialty so<br \/>\n07:24<br \/>\nthe general expectation will be that<br \/>\n07:25<br \/>\nwritten and especially oral reports<br \/>\n07:27<br \/>\nshould be concise and focused it is<br \/>\n07:30<br \/>\nimportant to take a complete history<br \/>\n07:32<br \/>\nhowever remember to focus on the<br \/>\n07:33<br \/>\npertinent positives and negatives for<br \/>\n07:37<br \/>\nexample most of our patients on labor<br \/>\n07:38<br \/>\nand delivery are young reproductive aged<br \/>\n07:40<br \/>\nand generally very healthy in this world<br \/>\n07:43<br \/>\nthe Gees and peas and especially the<br \/>\n07:44<br \/>\nmode of delivery of prior pregnancies<br \/>\n07:46<br \/>\nwill be important to include so if you<br \/>\n07:49<br \/>\nare presenting someone who is admitted<br \/>\n07:50<br \/>\nwith active labor prior contraception<br \/>\n07:53<br \/>\nfor example may not be the most<br \/>\n07:54<br \/>\nimportant point to emphasize in this<br \/>\n07:56<br \/>\npresentation but contraception will be<br \/>\n07:58<br \/>\nan important point to highlight in a<br \/>\n08:00<br \/>\npresentation about a postpartum patient<br \/>\n08:03<br \/>\nremember that the assessment and plan<br \/>\n08:05<br \/>\nare the important aspects of the written<br \/>\n08:07<br \/>\nand oral reports that medical students<br \/>\n08:09<br \/>\noften struggle with get into the habit<br \/>\n08:11<br \/>\nof developing an assessment and plan for<br \/>\n08:13<br \/>\nevery patient that you see during your<br \/>\n08:14<br \/>\nclerkships the<br \/>\n08:15<br \/>\nis one of the critical steps in becoming<br \/>\n08:17<br \/>\na skilled clinician this concludes the<br \/>\n08:20<br \/>\naapko video on history we hope that you<br \/>\n08:22<br \/>\nfeel better prepared to perform a<br \/>\n08:24<br \/>\ncomprehensive Women&#8217;s Medical interview<br \/>\n08:26<br \/>\nand to demonstrate interpersonal and<br \/>\n08:28<br \/>\nimportant communication skills<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 8:40<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-140","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/140","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=140"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/140\/revisions"}],"predecessor-version":[{"id":2759,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/140\/revisions\/2759"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=140"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}