Jonathan S. Berek Paula J. Adams Hillard
We are all products of our environment, our background, and our culture. The importance of ascertaining the patient’s general, social, and familial situation cannot be overemphasized. The physician should avoid being judgmental, particularly with respect to questions about sexual practices and sexual orientation.
Good communication is essential to patient assessment and treatment. The foundation of communication is based on key skills: empathy, attentive listening, expert knowledge, and rapport. These skills can be learned and refined.
The Hippocratic Oath demands that physicians be circumspect with all patient-related information. For physician–patient communication to be effective, the patient must feel that she is able to discuss her problems in depth and in confidence.
Different styles of communication may affect the physician’s ability to perceive the patient’s status and to achieve the goal of optimal assessment and successful treatment. The intimate and highly personal nature of many gynecologic conditions requires particular sensitivity to evoke an honest response.
Some patients lack accurate information about their illnesses. Incomplete or inadequate understanding of an illness can produce dissatisfaction with medical care, increased anxiety, distress, coping difficulties, unsuccessful treatment, and poor treatment response.
After a dialogue is established, the patient assessment proceeds with obtaining a complete history and performing a physical examination. Both of these aspects of the assessment rely on good patient–physician interchange and attention to details.
At the completion of the physical examination, the patient should be informed of the findings. When the results of the examination are normal, the patient can be reassured accordingly. When there is a possible abnormality, the patient should be informed immediately; this discussion should take place after the examination, with the patient clothed.
The practice of gynecology requires many skills. In addition to medical knowledge, the gynecologist should develop interpersonal and communication skills that promote patient–physician interaction and trust. The assessment must be of the “whole patient,” not only of her general medical status. It should include any apparent medical condition as well as the psychological, social, and family aspects of her situation. To view the patient in the appropriate context, environmental and cultural issues that affect the patient must be taken into account. This approach is valuable in routine assessments, and in the assessment of specific medical conditions, providing opportunities for preventive care and counseling on an ongoing basis.
Many external variables exert an inﬂuence on the patient and on the care she receives. Some of these factors include the patient’s “significant others”—her family, friends, and personal and intimate relationships (Table 1.1). These external variables include psychological, genetic, biologic, social, and economic issues. Factors that affect a patient’s perception of disease and pain and the means by which she has been taught to cope with illness include her education, attitudes, understanding of human reproduction and sexuality, and family history of disease (1–3). Cultural factors, socioeconomic status, religion, ethnicity, language, age, and sexual orientation are important considerations in understanding the patient’s response to her care.
We are all products of our environment, our background, and our culture. The importance of ascertaining the patient’s general, social, and familial situation cannot be overemphasized (4). Cultural sensitivity may be particularly important in providing reproductive health care (5).
The context of the patient’s family can and should be ascertained directly. The family history should include a careful analysis of those who had significant illnesses, such as cancer or an illness that the patient perceives to be a potential explanation for her own symptoms. The patient’s perspective of her illness can provide important information that informs the physician’s judgment; specific questioning to elicit this perspective can improve satisfaction with the interaction (6).
Table 1.1 Variables that Inﬂuence the Status of the Patient
History of illness
Habits (e.g., use of alcohol, tobacco, and other drugs)
Patient’s status (e.g., married, separated, living with a partner, divorced)
Caregiving (e.g., young children, children with disabilities, aging parents)
Siblings (e.g., number, ages, closeness of relationship)
History (e.g., disease)
Social environment (e.g., community, social connectedness)