A careful detailed history is essential before the examination of any patient In addition to a good general history, focusing on the history of the presenting complaint will allow you to customize the examination to elicit the appropriate signs and make an accurate diagnosis. | Chapter 1 The gynaecological history and examination History 1 Investigations 5 Examination OVERVIEW A careful detailed history is essential before the examination of any patient In addition to a good general history focusing on the history of the presenting complaint will allow you to customize the examination to elicit the appropriate signs and make an accurate diagnosis. History When interviewing a patient to obtain her history the consultation should ideally be held in a closed room with no one else present. Enough time should be allowed for the patient to express herself and the doctor s manner should be one of interest and understanding. It is important that a template is used for history taking as this prevents the omission ofimport-ant points. A sample template is given on page 2. Examination It is important that the examiner smiles introduces her himself by name and if appropriate asks the patient s name. A handshake often helps to put the patient at ease. Important information about patients can be obtained by watching them walk into the examination room poor mobility may affect decisions regarding surgery. While obtaining a history it is possible to assess the patient s affect. A history that is taken with sensitivity will often encourage the patient to reveal more details that are relevant to future management. Before proceeding to abdominal examination a general examination should be performed. This includes examining the hands and mucous membranes for evidence of anaemia. The supraclavicular node should always be examined particularly on the left side where in cases of abdominal malignancy one might palpate the enlarged Virchow s node this is also known as Troissier s sign . The thyroid gland should be palpated. The chest and breasts should always be examined this is particularly relevant ifthere is a suspected ovarian mass as there may be a breast rumour with secondaries 2 The gynaecological history and examination I Symptoms History-taking template
