I am a gynecologist. I do not need to manage every part of a patient’s health, and I should not pretend to.
But I cannot make good gynecologic decisions without understanding the person those decisions are being made for.
Hormone therapy is an obvious example. Whether it makes sense cannot be separated from a woman’s bleeding history, breast history, cardiovascular risk, migraines, bone health, medications, sexual health, sleep, metabolic health, family history and what she actually wants from treatment.
The same is true throughout gynecology. Pelvic pain may involve the reproductive organs, but bowel, bladder and musculoskeletal symptoms may completely change how I think about it. Abnormal bleeding has to be considered in the context of age, medications and other risk factors. A technically successful treatment for a vulvar or sexual-health problem is not particularly successful if it ignores how the woman is actually living with the problem.
There is another part of the history that matters just as much: how a person thinks about her own health.
Some patients want to be proactive about everything they reasonably can. Some want the minimum intervention necessary. Some are comfortable taking medication for a relatively small potential benefit; others need the expected benefit to be substantial before treatment feels worthwhile. One woman may prioritize longevity or prevention, another quality of life right now, and another avoiding medication or surgery whenever possible.
Those are not obstacles to arriving at the “right” treatment. They are part of determining what the right treatment is.
Even two women with the same diagnosis, the same test results and similar medical histories may reasonably make different choices. My role is to make sure they understand what we know, what we do not know, the magnitude of the risks and benefits when we can quantify them, and what the alternatives are. Then the recommendation has to make sense for the person receiving it.
That is why my visits often range beyond the immediate complaint. I am not trying to manage every part of someone’s health. I need to know enough about the rest of it—and enough about what matters to her—to know whether what I am recommending actually fits.
