Medrx

THE INTERVIEW

Recording a patient's medical history
When I record a patient's history, my intentions are to find out:
1.what the symptoms are
2.how severe the condition is
3.what the possible causes are
4.whether there has been a psychological impact.

Finding out what the symptoms are
My approach to all patients at our initial meeting is blunt. I get straight to the point. I usually begin with a brief introduction, such as, 'Hi, Mr Jones, nice day, isn't it? Now, is your problem more getting and sustaining an erection or premature ejaculation?'
Sometimes I am even more blunt: 'Hi, Mr Jones. So your problem is getting and sustaining an erection. How long have you had this problem?'
Usually, the patient is extremely relieved to hear the problem stated so directly and simply. It's as if a great weight has been suddenly lifted from their shoulders. In most instances they are thinking, 'How does he know that I have this problem?'
The direct approach has proven to be the most effective for my consultations. I have tried other more circuitous questioning in the past, such as: 'So, Mr Jones, what seems to be the problem?' This is usually followed by evasive answers with spluttering and stuttering and long drawn-out descriptions of what he thinks may be the problem. What's more the response is often a rehearsed one that has been memorised and gone over in his head for days in anticipation of my question.
Once the initial formality between doctor and patient is broken, there's no stopping the patient from expanding on the problem. They want to get it all out—months and months and sometimes even years of anguish. When I relate the experiences of a previous patient, the reaction is instant recognition of their own problem and an even greater release of anxiety.
Some of my patients have already approached their general practitioners or a psychologist before they come to the clinic. They are sometimes misinformed with comments such as, 'You're too old to be thinking about that sort of thing', or 'It's all in your mind', or 'You've been with the same woman for thirty years now, so how do you expect to remain attracted to her?' This kind of consultation can have very negative results and sometimes produces even greater depression for patients. Some men may simply give up, making no further effort to overcome their problem. Those few who do eventually seek a second opinion and are given more reassuring advice will respond very positively.

*23\4*

ZINC

CAUTIONARY NOTE ON HERBS

Natural medecine

News

TAKING ESTROGEN

With the onset of menopause, many women suffer from hot flashes and night sweats. Arlene March, 56, a Los Angeles psychotherapist, says she started getting hot flashes 5 years ago. “I’d be working,” she recalls, “and suddenly feel intense heat all over my body. I’d break out in a sweat. I’d have to stop work. Then Dr. Mishell prescribed estrogen pills, and I’ve not had a day of discomfort.”
Some women experience a drying and thinning of vaginal tissues in the absence of estrogen, making sex painful. They also might suffer urinary tract infections and incontinence. Estrogen therapy often helps.
Among the physicians consulted, the most cautious was Dr. Morris Notelovitz, founder of the nation’s first Menopause Center, at the University of Florida, and head of the Women’s Medical and Diagnostic Center in Gainesville, Florida. He says each symptom needs a different treatment and advises that genital tract problems be given estrogen treatment for a couple of years at most. He also urges special measurements of the bones before prescribing estrogen therapy for osteoporosis.
*11/266/5*
WOMEN’S HEALTH

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