Confidentiality is an important issue in adolescent health care. A number of medical organizations, including the American Medical Association, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecologists, endorsed adolescents’ rights to confidential medical care. Particularly with regard to issues as sensitive as sexual activity, it is critical that the adolescent be interviewed alone, without a parent in the room. The patient should be asked whether she engaged in sexual intercourse, whether she used any method of contraception, used condoms to minimize the risks of sexually transmitted diseases, or she feels there is any possibility of pregnancy.
Follow-Up Arrangements should be made for the ongoing care of patients, regardless of their health status. Patients with no evidence of disease should be counseled regarding health behaviors and the need for routine care. For those with signs and symptoms of a medical disorder, further assessments and a treatment plan should be discussed. The physician must determine whether she or he is equipped to treat a particular problem or whether the patient should be directed to another health professional, either in obstetrics and gynecology or another specialty, and how that care should be coordinated. If the physician believes it is necessary to refer the patient elsewhere for care, the patient should be reassured that this measure is being undertaken in her best interests and that continuity of care will be ensured. Patients deserve a summary of the findings of the visit, recommendations for preventive care and screening, an opportunity to ask any additional questions, and a recommendation for the frequency of any follow-up or ongoing care visits.
The management of patients’ gynecologic symptoms, and abnormal findings and signs detected during examination, requires the full use of a physician’s skills and knowledge. Physicians are challenged to practice the art of medicine in a manner that leads to effective alliances with their patients. The value of skilled medical history taking cannot be overemphasized. Physicians should listen carefully to what patients are saying about the nature and severity of their symptoms. They should listen to what patients may not be expressing: their fears, anxieties, and personal experiences that lead them to react in a certain manner when faced with what is often, to them, a crisis (such as the diagnosis of an abnormality on examination, laboratory testing, or pelvic imaging).
Physicians should supplement their formal education and clinical experience by constantly seeking valid new information and honing their communication skills. To meet the challenges posed by the complexities of patient care, physicians must learn to practice evidence-based medicine, derived from the very latest data of highest quality. Computers make the world of information management accessible to both physicians and patients. Physicians need to search the medical literature to acquire knowledge that can be applied, using the art of medicine, to patient care that maintains health, prevents disease, alleviates suffering, and manages and cures illness.
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