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How to alleviate anxiety before first OB/GYN exam
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A recent national survey revealed that almost 40% of women were at least ‘somewhat concerned’ about what would happen during their first OB/GYN exam.
Christine Greves, MD, an OB/GYN at Orlando Health and one of the investigators behind this research, said a pre-visit can set the foundation for a strong doctor-patient relationship, allay patients’ fears and hesitations and may make patients more likely to return for regular appointments.
“It's important for them to know they can trust us,” she said in an interview. “I like to let them know that whatever they share with me is confidential. This is not going to be discussed with anyone else. I also let them know that I am here for them in a nonjudgmental fashion.”
Greves added that the OB/GYNs need to stress to patients that no topic is off limits.
“Some young female patients may be embarrassed to ask about what to expect with their menstrual cycle, have questions about STD transmission or what can happen after their first sexual experience. I let them know that they can ask whatever questions they have. They don't need to ask Google,” she said, adding that OB/GYN practices that cannot offer pre-visits can ease patients’ fears by “simply talking openly and establishing a relationship” with their patients.
Other researchers have examined the paradox between what patients are comfortable discussing vs. what patients need to know for their well-being.
“Frank and open discussion of reproductive health issues is both crucial and challenging,” Christine Dehlendorf, MD, of the University of California at San Francisco and Ward Rinehart, co-proprietor and manager of Jura Editorial Services wrote in Patient Education Counseling.
“In broader society, encouraging discussion of reproductive issues between partners and within communities has the demonstrated potential to enhance the health and well-being of both individuals and communities,” they added.
The American College of Obstetricians and Gynecologists (ACOG) suggested clinicians use the shared decision-making model in patient discussions when obtaining a patient’s medical history.
Other recommendations in the society’s position statement include the clinician setting the stage for the interview, ascertaining the primary reason for the patient’s visit and setting an agenda, getting the patient to express herself, then moving on to describing symptoms, personal and emotional context of the visit, and then the clinician taking steps to ensure he or she understands the reasons for the patient’s visit.
Greves said that primary care physicians also can play a part in easing patients’ minds by encouraging teenaged patients and their parents to talk with an OB/GYN outside of the clinical setting before the first OB/GYN exam.
ACOG also recommended allowing other office employees, such as advanced practice nurses or physician assistants, to be part of the discussions, as these may improve the patient’s experience and understanding of her visit, as well as using electronic communication with established patients when situations warrant.
Special considerations for ‘underserved’ patients
Previous research has also shown that “populations of color and low-income groups” living in poor environmental conditions have health risks due in part to various social determinants of health including racism, segregation and socioeconomic status, and are often considered ‘underserved patients.’
To that end, ACOG also encourages OB/GYNs to follow the RESPECT model in patient discussions, particularly when talking to female patients who are part of this group:
‘R’ – Rapport, by associating with the patient on a social level; seeing her point of view; consciously trying to suspend judgement; and acknowledging and not making assumptions.
‘E – Empathy, by recalling that the patient has come for help; pursuing and comprehending the patient’s rationale for her behaviors or illness; verbally allowing and validating the patient’s feelings.
S – Support, by querying the patient and trying to comprehend barriers to care and compliance; assisting the patient in overcoming these barriers; using family members if appropriate; and easing the patient’s mind and indicating a willingness to help.
P –Partnership, by being flexible regarding control issues; negotiating roles when needed; and emphasizing working as a team to address the patient’s medical problems.
E – Explanations, by asking often if the patient understands and using verbal clarification techniques.
C – Cultural Competence, by respecting the patient, her beliefs and culture; comprehending that the patient’s view of clinicians may be characterized by cultural or ethnic stereotypes; knowing one’s own personal biases and preconceptions; grasping one’s limitations in addressing medical issues across cultures; and comprehending one’s own personal style and recognize when it may not be working with a given patient.
T – Trust, by noting that self-disclosure may be an issue for some patients who are not accustomed to Western medical approaches; and taking the needed time and consciously work to establish trust.
Data suggest the RESPECT model may becoming increasingly relevant to clinicians. At least one report suggests that “people of color” will comprise the majority of U.S. residents in the year 2043, and another report indicates that almost half of all Americans are considered low income. – by Janel Miller
References:
ACOG.org. Effective Patient–Physician Communication. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Effective-Patient-Physician-Communication. Accessed July 25, 2018.
CBSNews.com. Census data: Half of U.S. poor or low income. https://www.cbsnews.com/news/census-data-half-of-us-poor-or-low-income/. Accessed July 25, 2018.
Dehlendorf C, Rinehart W. Patient Educ Couns. 2016;doi: 10.1016/j.pec.2010.11.001.
EPI.org. People of color will be a majority of the American working class in 2032.
https://www.epi.org/publication/the-changing-demographics-of-americas-working-class/. Accessed July 25, 2018.
Orlando Health. Meeting with OBGYN prior to first exam empowers young women in medical settings.
Wilson S, et al. Environmental Health. 2014;doi:10.1186/1476-069X-13-26.
Disclosure: Greves reports no relevant financial disclosures.