1. The importance of a healthy diet and exercise
2. Major risk factors for substance abuse
3. Health problems associated with substance abuse
4. Contraception
5. Prevention of STDs
6. Interventions to prevent accidents in the home and workplace
7. Interventions for preserving good dental health, such as regular tooth brushing and flossing and regular dental appointments
8. Psychosocial issues, such as:
a. Depressive disorders/suicidal impulses
b. Anxiety disorders
c. Physical/sexual abuse
d. Family interaction and relationships
e. Psychologic and sexual identity
f. Personal goals and career development
2. Perform initial assessment
To gain the patient’s confidence and cooperation in obtaining the history and performing the physical examination, the resident should appreciate the effects of age; racial, ethnic, and cultural backgrounds; sexual orientation; personality; mental status; and the patient’s level of comfort and modesty.
1. Obtain a complete medical history, including a history of genetic diseases.
2. Perform an appropriate general and focused physical examination.
3. Perform routine screening for selected diseases
The content and frequency of routine health examinations for screening and counseling should be tailored to risk factors (Table 1) and the patient’s age (see Periodic Assessment). Major causes of morbidity and mortality by age can point to areas that warrant special attention.
a. Ages 12 and younger
For the preadolescent patient, the obstetrician-gynecologist usually serves as a consultant. All primary care can be performed by a pediatrician or family physician after assessment of the specific problem for which the patient was referred. Specific objectives for the obstetrician-gynecologist in this role are found in Unit 5 under “Pediatric gynecology (birth to menarche).”
b. Ages 13-18 years
For adolescents, the obstetrician-gynecologist serves either as a consultant or as a primary health care provider, depending on the nature of his or her practice and level of expertise in the spectrum of reproductive tract disorders. (These disorders are described in Unit 5 under “Adolescent gynecology.”) The following areas warrant special attention in this age group.
a. Assess patients for evidence of substance use (tobacco, alcohol, and other drugs).
b. Perform a Pap test for sexually active adolescents.
c. Discuss contraception and “safe sex” with all patients and provide contraception for those who are sexually active.
d. Test sexually active adolescents for sexually transmitted diseases (STDs), such as:
(1) Gonorrhea
(2) Chlamydia
(3) Syphilis
(4) Hepatitis B and C
(5) Human immunodeficiency virus (HIV) infection
e. Counsel adolescents about the use of automobile safety belts and bicycle helmets.
f. Evaluate social and family well-being (eg, psychologic and learning inventory).
g. Assess nutritional and growth status.
h. Evaluate the ability to perform in physical and competitive sports activities.
c. Ages 19-39 years
The obstetrician-gynecologist usually is the chief care provider for women ages 19-39 and provides both specialist care in obstetrics and gynecology and primary preventive health care. The following areas warrant special attention in this age group:
a. Describe normal reproductive physiology, including issues such as fecundity and sexuality.
b. Assess reproductive concerns, such as:
(1) Family planning
(2) Prevention of STDs
(3) Pregnancy care
(4) Infertility
c. Treat menstrual disorders, such as:
(1) Amenorrhea
(2) Oligomenorrhea
(3) Dysfunctional uterine bleeding
d. Manage breast disorders, such as:
(1) Mastitis
(2) Galactorrhea
(3) Mastodynia
d. Ages 40-64 years
Women ages 40-64 are in a time of transition and may face reproductive and perimenopausal concerns, medical conditions, and psychosocial problems. The following areas warrant special attention in this age group:
a. Assess and manage reproductive concerns, such as:
(1) Family planning until menopause
(2) Pregnancy care (eg, offering genetic counseling/prenatal diagnosis with amniocentesis or chorionic villus sampling)
(3) Infertility
b. Evaluate and treat perimenopause/menopause concerns:
(1) Describe normal aging, lifestyle modifications, and hormone replacement therapy.
(2) Describe risk factors for osteoporosis.
c. Assess risks for cancer (eg, lung, breast, endometrium, ovary, colon, and skin).
d. Evaluate psychosocial risks:
(1) Suicide
(2) Depression
(3) Physical and emotional abuse/neglect
e. Ages 65 years and older
The goal of health maintenance in older women is improvement of the quality of life and prolongation of a disease-free state (see “Care of the Geriatric Patient."). The following areas warrant special attention in these patients:
a. Describe the biology of aging.
b. Describe the psychologic problems that may be associated with aging, such as:
(1) Depression
(2) Emotional abuse or neglect
(3) Change in sexual function
c. Describe the appropriate interventions to prevent fractures in older women, such as:
(1) Administration of hormone replacement therapy
(2) Calcium supplementation
(3) Exercise
(4) Administration of substances that inhibit bone resorption, eg, the bisphosphonates
d. Describe appropriate interventions to prevent injuries that are due to falls.
e. Describe the assessment for urinary and fecal incontinence.
f. List the major risk factors for cardiovascular disease.
g. Describe the altered pharmacokinetics of drugs in the elderly population and the likelihood of drug interactions with medications commonly prescribed in this age group.
h. List the frequent and at least partially preventable hazards of hospitalization and surgery in the older age group, such as:
(1) Acute renal failure
(2) Adverse drug events
(3) Inappropriate bladder catheterization
(4) Deconditioning and immobility
(5) Dehydration
(6) Delirium
(7) Electrolyte disturbances
(8) Functional decline
(9) Incontinence
(10) Infection
(11) Malnutrition
(12) Pressure ulcers
(13) Stress-induced gastrointestinal ulceration
(14) Thromboembolism
(15) Untreated pain
4. Provide immunizations
Describe the appropriate indications for selective immunizations such as rubella, measles, varicella, hepatitis A and B, influenza, pneumococcal infection, tetanus, and diphtheria.
| 
