A rookie error: The importance of a good history.

As a female GP obstetrician, I do a LOT of gynaecological examinations and spend a good portion of my day feeling or looking up ladies’ private parts – in a purely professional way! I fancy myself a bit of a gun with a speculum and can confidently locate the cervix pretty much every time.

I was reading Casey Parker’s recent broomedocs.com post about how difficult spec exams are for people who don’t do them all the time and was appreciating the fact that despite my lack of experience in lots of other areas of medicine, at least gynae was something I was pretty comfortable with.

Last week I had a patient in her 50s come in for a pap smear because she “had been really naughty and hadn’t had one for 5 or 6 years”. So, I got her up on the examination table and after a minute realised with horror that I could not for the life of me find her cervix! I tried every repositioning trick in the book and still no sign of it. Realising that she was getting a bit uncomfortable, I said “I”m really sorry I’m going to have to take the speculum out and examine you digitally to find the location of the cervix”. Then she says ” Oh… by the way, I’ve had a hysterectomy.. does that make a difference?” !!!!

*FACEPALM*

It turns out she’d had a total hysterectomy for a non-cancerous cause and so no longer had a cervix to find. So in fact, she didn’t even need a smear at all and I’d just put her through an unneccesary and uncomfortable examination purely because I had failed to take a sufficient gynae history. Ahhh… sometimes you just have to laugh.

In GP we are under a lot of time pressures and rarely have time to take the sort of comprehensive history we were taught at medical school. Have you ever been caught out by inadequate history taking? I’d love to hear your stories in the comments below.