1: Patient Care
5 Topics
2: Normal Obstetrics
7 Topics
3: Abnormal Obstetrics
13 Topics
4: General Gynecology
8 Topics
7: Neoplasia
6 Topics
History
Duration = 8:40
00:00
APGO educational topic number one
00:01
history welcome to the obstetrics and
00:04
gynecology clerkship in this video we
00:06
will introduce you medical student
00:08
extraordinaire
00:09
two important aspects of women’s
00:11
healthcare we will discuss unique
00:13
history questions and risk assessments
00:15
that we hope you will continue to
00:16
utilize with your female patients in
00:18
your future medical careers the
00:20
objectives of this video are to complete
00:22
a comprehensive Women’s Medical
00:23
interview that includes menstrual
00:25
obstetric ‘el gynecologic contraceptive
00:27
sexual family and social histories to
00:31
assess risk for unintended pregnancy
00:33
sexually transmitted infection cervical
00:35
pathology breast malignancy gynecologic
00:38
malignancy nutrition obesity domestic
00:40
violence and eating disorders to assess
00:42
the patient’s adherence to the
00:44
recommended screening measures
00:45
demonstrate interpersonal and
00:47
communication skills that build trust by
00:49
addressing relevant factors including
00:51
culture ethnicity language literacy
00:53
socioeconomic status spirituality
00:56
religion age sexual orientation and
00:58
disability to produce well-organized
01:00
written and oral reports to communicate
01:02
the results of the OB gen and general
01:04
medical interview here is your patient
01:06
Romina health of which you are about to
01:09
take a comprehensive women’s health
01:10
history of WA Mina what are the
01:12
important elements the physical
01:14
environment is very important in order
01:16
to enhance the quality of the interview
01:17
the interview should take place in a
01:19
quiet private well-lit room and whenever
01:21
possible with the patient dressed
01:22
possibly intimidating instruments should
01:24
be covered remember how important it is
01:27
to greet the patient by title and name
01:29
to make eye contact to shake hands and
01:31
to be welcoming be aware that the
01:33
presence of family members may be an
01:35
impediment to an honest interview
01:36
especially in cases of intimate partner
01:38
violence the help of a medically trained
01:41
interpreter should be sought for
01:42
patients who need those services family
01:44
members should ideally not be used for
01:46
translation because of privacy
01:47
confidentiality bias and the sensitive
01:50
nature of many women’s health issues
01:51
let’s start with the menstrual history
01:53
find out her menarche
01:55
or the age at which she started
01:57
menstruating find out how regular her
01:59
periods are find out how heavy her
02:02
periods are and what was the date of her
02:03
last menstrual period why is this
02:05
important let’s take a quick trip to the
02:08
land of primary care what if WA Mina was
02:11
seeing you for headaches and you
02:12
neglected to ask her
02:13
our periods would this be relevant if
02:15
her periods were extremely heavy to the
02:16
point that she was very anemic from her
02:18
bleeding or what if Amina had very light
02:21
very infrequent periods this would
02:23
suggest that an evaluation for a
02:25
prolactin oma should be included or what
02:27
if you were seeing an obese young woman
02:29
who had a borderline fasting blood
02:30
glucose and you discovered that her
02:32
periods are extremely irregular this
02:34
constellation of symptoms should make
02:35
you think of polycystic ovarian syndrome
02:38
let’s move now to gynecologic history
02:40
ask if she has any known gynecologic
02:43
illnesses the gynecologic history
02:46
includes the sexual history it is
02:47
important to use open-ended questions
02:49
such as please tell me about your sexual
02:52
partner or partners why is this so
02:54
important to ask open-ended questions
02:56
let us imagine a few possible scenarios
02:58
what if Amina was a lesbian who was
03:01
seeing a gynecologist for the first time
03:02
on her intake form she marked that she
03:04
was sexually active and not married
03:06
if you immediately asked her what birth
03:09
control she is using and then spend time
03:11
counseling her about contraception
03:12
options without first asking an
03:14
open-ended question this could be
03:16
perceived as culturally insensitive
03:18
asking open-ended questions also allows
03:20
well Mena to feel that she can be opened
03:22
so you can better assess her risk of
03:24
sexually transmitted infections
03:26
contraceptive history what is your risk
03:28
of unintended pregnancy and you went
03:30
sexually active with men without a
03:32
contraceptive plan is basically at risk
03:34
for unintended pregnancy remember that
03:36
the United States has the highest rate
03:38
of unintended pregnancy in the developed
03:40
world with approximately one-half of all
03:41
pregnancies being unintended also
03:44
remember to ask about prolapse and
03:45
incontinence many women may be
03:48
embarrassed by these conditions and may
03:50
not mention them unless you specifically
03:51
ask moving next to her obstetric history
03:54
this includes the gravida T which is the
03:57
number of pregnancies and parity which
03:59
are the pregnancy outcomes the parody
04:01
can be further described as a number of
04:03
full-term preterm abortions and living
04:05
children the acronym T pal can be useful
04:09
for remembering these different aspects
04:10
of note abortions refers to both
04:12
terminations and miscarriages next we
04:15
move on to family history you should
04:18
find out which illnesses occur in
04:20
first-degree relatives such as diabetes
04:22
cancer osteoporosis and heart disease
04:25
information gathered here
04:27
may indicate a genetic predisposition
04:28
for hereditary disease such as breast or
04:31
ovarian cancer let’s now move to social
04:34
history it is important to ask about
04:36
tobacco alcohol and illegal drugs in the
04:39
United States approximately 21 percent
04:41
of all women use tobacco products 16
04:44
percent of women older than 12 are binge
04:46
drinkers and 11 percent of non pregnant
04:49
women age 15 to 44 report illicit drug
04:53
use in the past month the social history
04:55
is also an important time to screen for
04:57
sexual abuse and intimate partner
04:59
violence these two issues are
05:01
unfortunately too common in our female
05:03
patients and we as health care providers
05:05
need to improve how well we screen for
05:06
them the radar approach is one way of
05:09
addressing intimate partner violence
05:10
with your patients our remember to ask
05:13
routinely about intimate partner
05:14
violence a asked directly about violence
05:17
with questions such as at any time has a
05:19
partner hit kicked or otherwise hurt or
05:21
frightened you D document information
05:25
about suspected intimate partner
05:26
violence in the patient’s chart and file
05:28
reports when required by law a assess
05:31
your patient safety is it safe to return
05:33
home find out if any weapons are kept in
05:35
the house our review options with your
05:37
patients know about the type of referral
05:39
options that are available such as
05:41
shelters or support groups
05:50
you
06:02
when we discuss a patient’s adherence to
06:05
recommend a screening measures it is
06:07
important to think about health literacy
06:09
this is the ability to understand
06:11
instructions on prescription drug
06:13
bottles appointment slips patient
06:16
education brochures consent forms and
06:18
the ability to negotiate complex
06:21
healthcare systems 10% of Americans are
06:24
estimated to have low health literacy
06:26
and 50% are estimated to have marginal
06:29
to low health literacy skills adults
06:32
with low health literacy are to increase
06:34
risk of hospitalizations encounter more
06:36
barriers to receiving necessary health
06:38
care services and are less likely to
06:41
understand medical advice that can
06:43
affect disease progression it is
06:45
important for health care providers to
06:47
be able to assess a woman’s health
06:49
literacy to provide appropriate
06:50
instructions and explanations about her
06:52
care health literacy is one of the
06:55
important aspects of effective
06:56
communication that should take into
06:58
account culture ethnicity language
07:01
socioeconomic status spirituality and
07:03
religion age sexual orientation and
07:06
disability it is important that you
07:09
produce well-organized written and oral
07:10
reports to communicate the results of
07:12
the OB gen and general medical interview
07:14
we will conclude this video with tips
07:17
and tricks that will help you throughout
07:18
this clerkship and Beyond obstetrics and
07:21
gynecology is a surgical specialty so
07:24
the general expectation will be that
07:25
written and especially oral reports
07:27
should be concise and focused it is
07:30
important to take a complete history
07:32
however remember to focus on the
07:33
pertinent positives and negatives for
07:37
example most of our patients on labor
07:38
and delivery are young reproductive aged
07:40
and generally very healthy in this world
07:43
the Gees and peas and especially the
07:44
mode of delivery of prior pregnancies
07:46
will be important to include so if you
07:49
are presenting someone who is admitted
07:50
with active labor prior contraception
07:53
for example may not be the most
07:54
important point to emphasize in this
07:56
presentation but contraception will be
07:58
an important point to highlight in a
08:00
presentation about a postpartum patient
08:03
remember that the assessment and plan
08:05
are the important aspects of the written
08:07
and oral reports that medical students
08:09
often struggle with get into the habit
08:11
of developing an assessment and plan for
08:13
every patient that you see during your
08:14
clerkships the
08:15
is one of the critical steps in becoming
08:17
a skilled clinician this concludes the
08:20
aapko video on history we hope that you
08:22
feel better prepared to perform a
08:24
comprehensive Women’s Medical interview
08:26
and to demonstrate interpersonal and
08:28
important communication skills