The Management of Chronic Gynecologic Conditions During COVID and Beyond - Episode 1

Enhancing Patient-Provider Dialogue in Telehealth and Beyond

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Supported by: AbbVie

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Expert gynecologists provide tips to help ensure robust communication with patients in the virtual setting and beyond.

Ayman Al-Hendy, MD, PhD: Welcome to this Contemporary OB/GYN ViewPoint program titled Management of Chronic Gynecologic Conditions During COVID and Beyond. I am Dr Ayman Al-Hendy from the University of Chicago School of Medicine.

I’m really honored to be joined today on this panel by my dear friends and colleagues, Dr Linda Bradley, Cleveland Clinic, Ohio; Dr Stacey Missmer from Michigan State University, College of Human Medicine, and Dr Eric Surrey, Colorado Center for Reproductive Medicine in Lone Tree, Colorado.

Our discussion today will focus on management of women’s health including chronic pelvic pain resulting from endometriosis and heavy menstrual bleeding from uterine fibroids. We shall also discuss ways to help improve patient-provider communications and overcome the normalization associated with these nonmalignant gynecological conditions.

Welcome everyone, and let’s get started. I’m going to start with you, Eric. In your clinical practice, how do you ensure open and informed communication with your patients?

Eric Surrey, MD: This has become even more challenging now with COVID19 and having to do so much virtual health in telecommunication, but we think one of the critical pieces here is to validate patients’ concerns, to know if you as the clinician are there to listen to their needs. It can be a real problem, short visits, and sometimes as we’ll talk a little later, we have to decide to maybe come back a second time to develop more time to a problem. I think it’s critical to validate the patient’s concerns because oftentimes these are patients who have been put off, whose concerns have been ignored. As we know, there’s been a delay of 4 to 10 years in diagnosing endometriosis. Some of that is a physician’s failure to use their most important instrument, which I know Dr Bradley would say is a hysterscope, but I think it’s the ear. I think that it’s absolutely critical. Sometimes physician extenders can be very helpful in this regard as well.

Ayman Al-Hendy, MD, PhD: Excellent. I’m going to go to you, Linda. In this era of rise of TeleHealth to COVID, it really has changed the way we engage our patients. Do you have any tips to help ensure there’s robust communications with our patients in this virtual setting?

Linda Bradley, MD: Yeah, I think it’s really important for patients to be able to tell their story. Story telling in medicine is important, and as I’ve learned, and as we all learned in medical school, probably 70% to 80% of what we need to know the patient tells us. I try to be not like the textbooks and articles that say that doctors interrupt within 2 minutes to less than 3 minutes. I’d like to just start off with an open-ended question. You know, “Tell me your story. What do you want me to know about you?” And then I just listen, and I use those words and other words such as, “Is there anything else I need to know?” I really try not to interrupt, and then when I do speak with the patient, I may jot a few notes, and I re-use her words to rephrase a future question.

“So you say it hurts with intercourse. Tell me what that means to you.” Then you can give the other answers. “Is it all the time? Is it with penetration? Is it with deep thrusting?” I think the biggest thing, briefly, is just listening, and the patient is a great storyteller if we let them do that. I found myself, I must confess, interrupting, as most articles say, within 7 seconds sometimes to within a minute. We never let patients finish their complete sentence. I think we’re here to ask those questions, and then just briefly to then move on to how does this affect what you and I call, QOL, quality of life? First it’s storytelling, listening, and then it’s impact on what their problem is.

Ayman Al-Hendy, MD, PhD: Thank you. They’re excellent remarks

Transcript edited for clarity.

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