CARE OF THE YOUNGER PATIENT – THE METHOD CHOSEN (FAMILY AND MENSTRUAL HISTORY)
History-taking will not be regarded as an interrogation or intrusion if its relevance is explained. To facilitate rapport during history-taking and to avoid misunderstandings, the doctor needs to be specific and wherever possible avoid medical terminology. Thus the words ‘clotted or inflamed blood vessels’ may replace ‘thrombophlebitis’. It is important that words such as ‘migraine’ should be understood and the details of the symptom explored. It is easier for both patient and doctor to face the idea that the COC is out of the question now and forever if there is a history of focal or crescendo migraine, at the first consultation (Guillebaud, 1985).
Having shared their medical, family and menstrual history with the doctor they are not surprised to be asked, ‘How long have you been sexually active?’ and ‘Any problems with sex itself?’ Additionally, they see the taking of routine smears as a positive health check. If the sexual history is known and recorded then it is unlikely that a smear will be suggested to a virgin. When the offer of a smear test is refused, it is worth spending sometime looking for the reason behind the refusal. Reasons given can include the rather vague ‘I can’t be bothered’, which may be a sign of a general lack of esteem and self-care, but is more likely to be a way of voicing embarrassment, or even a sign of a phobia of any clinical procedure. An open-ended nonjudgemental enquiry into the difficulty can usually allow the patient to express her fears.
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