PRACTICE PEARLS

 

Fam Pract Manag. 2020 Jan-Feb;27(1):34.

NAVIGATE PATIENTS’ ANXIETY ABOUT PELVIC EXAMS

I recently worked with a 31-year-old patient who had a history of sexual trauma. She was motivated to have a pelvic exam and Pap test, but also anxious. Our first attempt was stopped because of her physical and emotional discomfort. I sent her home with a small, disposable speculum so that she could familiarize herself with the pelvic exam equipment at her own pace. On the second try, she was again unable to go through with the exam. She felt defeated and self-critical. I suggested that she bring her partner and premedicate with a low dose of lorazepam. She bravely returned to the exam room, feeling more relaxed but still anxious.

Then I decided to try a mirror. I had not used this strategy before, but it did the trick. She held the mirror in place and was able to see everything I was doing as I talked her through the process and her partner held her hand. She was very proud of herself and relieved that my nurse and I did not judge her or lose patience. There were big hugs and relief all around when her Pap test came back normal.

ASK OLDER PATIENTS THESE QUESTIONS TO ASSESS DEMENTIA RISK

By asking older patients one question about subjective memory complaints, you can begin to assess their risk of dementia, according to research published in the September/October 2019 issue of the Annals of Family Medicine.

The query, “Do you feel you have more problems with memory than most?” is from the 15-item Geriatric Depression Scale. When administered at baseline and two-year intervals thereafter, this assessment of subjective memory complaints was a predictor of which community-dwelling older adults were likely to develop dementia.

Based on the results, the researchers suggest a three-step process for assessing dementia risk:

  1. Ask the subjective memory

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Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to fpmedit@aafp.org, or add your comments below.

 
 

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