Annual gynecological exams are generally thought to be a time for health maintenance and prevention. Routine screening tests like pap smears and clinical breast exams are the essential parts of the annual, but it is also an opportunity to discuss menstrual, sexual or hormonal issues.

I make it a priority at each yearly exam to discuss contraception as well as offering anticipatory guidance for important upcoming changes like menopause or planning conception.

Unfortunately, for many of my patients, this is the only time they see a healthcare provider all year. Often, these patients arrive armed with a mile-long list of problems, issues and complaints. They fully expect me to address and solve those problems in the brief time allotted for an annual exam.

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As a brand new midwife, I often tried to solve each and every problem a patient mentioned during their annual. I quickly learned that this was a recipe for being hours behind schedule with a waiting room full of irate women.

One of my physician partners taught me the magic of the follow-up visit, and I quickly learned how to make this work for me, as well my patients.

Now when patients start listing multiple issues during an annual, I make a list. Once the annual exam is complete, I reiterate their complaints, and ask them which issues are most important or concerning. This helps me prioritize when making a plan of care. 

Next, while scheduling their follow-up appointments, I usually give the patient some “homework” which most often consists of labs or imaging, but can also include keeping a journal, exercises or specific books to read.

This is the first step is making the patient a partner in her care and helps me see how motivated she is to find a solution to her complaints.  

I have found that many patients expect their provider to have all the answers and a cure for what ails them. It is as if the white coat brings some supernatural knowledge and ability to treat any ailment. Although I appreciate the trust in my skill, this belief sets up unrealistic expectations and can lead to frustration on both sides.

I try to encourage every woman to partner with me in making decisions and planning her care. I prefer that patients feel empowered and knowledgeable about their health and understand the options and treatments available.  

My vision of efficient health care is less paternalistic than in times past.  Modern medical care must be a partnership between patient and provider in order to create the best outcomes.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.