Vaginal Bleeding

How I Practice Video Series
Abraham Lichtmacher, MD, FACOG

HIP: Vaginal Bleeding from ACOG on Vimeo.

HIP: Vaginal Bleeding from ACOG on Vimeo.

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Whenever a patient comes to my office complaining of abnormal vaginal bleeding, it is important for me to explain to her what it is that I'm concerned about and how it is that I'm going to evaluate her problem. In that regard, using common or layman's terminology has often been recommended to help the patient understand the nature of her problem. Unfortunately for many of us we are used to using technical terminology or medical jargon that the patient may not be familiar with. And in that regard when we're asked to make it simpler for the patient often that means that we leave out parts of our discussion. I am a firm believer that you need to really properly educate the patient so that she can give you a good informed and proper informed consent for the treatment that you are going to undertake. In that regard I use common concepts that all of us are familiar with. In describing the endometrium or the lining of the uterus to the patient, I use the analogy of one of those dried out sponges that we all may buy in a supermarket that comes flattened out and dried out and when you put water into it, it suddenly expands. And I use that analogy of the endometrium being the sponge and the water being the hormone or the stimulation that her body is usually putting into that particular sponge. In that regard, I can describe easily the concepts of hyperplasia of the endometrium by excess amounts of water being pumped into that particular sponge to the point that it can no longer hold that fluid and starts to leak, which would obviously describe the abnormal bleeding. Additionally the other concept that I try to get across to the patient is that when I'm discussing a post-menopausal bleeding, once again I can use that same analogy in evaluating the endometrium as being like that dried out, thin sponge and if it's anything over that than obviously needs evaluation. Using that type of a description helps me to describe to the patient what I'm going to be doing and how I'm going to evaluate her particular problem and it helps her understand the nature of the problem a little bit better. In that regard, when I've given her all the descriptions of what the nature of the problem is and how I'm going to evaluate it, it allows for the patient to give me true informed consent. And this is how I practice.


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