10. Pearls for the Clinical Encounter

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affective preceptor series
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Perls for the clinical encounter
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as obstetrician-gynecologist our
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patients share sensitive information and
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expect to be treated competently with
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dignity and without judgment your role
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is to show students how to elicit a
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thorough history despite potential
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discomfort embarrassment or concern
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about offending a patient this video is
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designed to help you effectively model
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this process to your students
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using the information on the door
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to prepare for the patient encounter
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encourage your students to use all
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available patient information the age of
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the patient chief complaint and any
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additional information such as a
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patient’s preference to stay dressed for
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the interview is readily available from
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the staff a staff member should ask
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permission for a student to be present
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prior to their entry
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teaching the student how to read between
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the lines
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the patient appear hesitant during
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discussion does the patient appear
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tearful or sad does she fidget laughs
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nervously or avert her eyes when certain
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questions are asked
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does she look to her companion to answer
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questions does this person answer for
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the patient or if used to leave the room
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for the exam
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getting the needed information
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respecting a patient’s culture and
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societal norms is important but so is
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providing comprehensive care the student
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should begin the interview with
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open-ended questions it is important to
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ask medical GYN and social histories
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both in the presence and absence of a
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minor’s parent proceeding from the least
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to most sensitive topic will allow the
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questioning to become as routine as when
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was the last time you had a physical
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exam
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a student asking about quantity of
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alcohol or tobacco use will communicate
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openness to the idea that a team drinks
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alcohol and this may result in a more
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honest response
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handling the oh by the way sometimes
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teenage patients don’t share the real
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reason for a visit until they’ve
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assessed their health care providers
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competence and approach ability if it’s
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possible to repeat a portion of the exam
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or add another test the patient will be
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most appreciative and you will model
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your commitment to excellent patient
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care when this is not possible reassure
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the patient that her concerns will be
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addressed thoroughly at a later date
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this will keep you and your student on
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time
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documenting confidential information
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after the patient encounter it is often
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valuable to discuss with your student
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what’s sensitive information to include
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in the clinical record in general any
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information pertinent to the patient’s
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ongoing care should be thoroughly
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documented
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debriefing students after a patient
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encounter
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a great teaching opportunity lies in
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discussing your thought process while
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gathering sensitive information is there
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another more comfortable way to have
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asked that question is there another way
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to react what would you do next time in
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a similar situation remember the best
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advice is a good example
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helpful questioning strategies to share
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with your students
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teaching students to follow certain
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strategies while asking sensitive
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questions will make them more
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comfortable obtaining the necessary
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history here are a few examples you can
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share with your students
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a young woman who presents for an annual
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GYN exam how was your general health are
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you in an intimate relationship do you
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have sex with men women are both
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do you or your partner have any concerns
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about your sexual health remember to use
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inclusive language with all patients and
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neutral terms such as partner when a
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patient’s partner status is unknown
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your king patient is concerned about a
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lump on her vulva
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ask the same questions you would for a
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general sexual history but also include
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the following some sexually transmitted
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infections do not have obvious symptoms
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and screening is a good idea do you have
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any concerns about sexually transmitted
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infections do you use condoms
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consistently use of condoms for sexual
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intercourse can protect against some
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infections but unfortunately not against
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HSV or HPV
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a pregnant patient has bruising on her
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abdomen and upper arm
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who lives at home with you do you feel
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safe at home many women from all walks
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of life are hurt by someone close to
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them have you ever been physically or
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sexually hurt by someone abuse is never
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right and it’s never the victims fault
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would you like to talk with a counselor
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about getting some help is it safe for
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you to return home today
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an elderly patient blushes when telling
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you that sometimes she can’t make it to
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the bathroom
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here are some ways to phrase questions
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about incontinence are you able to
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urinate and have bowel movements without
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difficulty many women experience a
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bladder leak when coughing laughing or
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hurrying to the bathroom or during sex
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does that ever happen to you what
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precipitates a leak what type of
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protection do you require what treatment
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if any have you tried for this
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don’t forget preceptors model behavior
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to students
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of how many times you heard a former
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student use those exact words you used
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to use when questioning a patient
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sharing some of the pearls that we
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mentioned with your learners will help
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them become better providers and will
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help all of us deliver a higher quality
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care to our patients