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Chapter 4 - After the Exam

A. The Uncompleted Exam

® If a woman is unable to complete the exam, wait a few months and try again, unless there are urgent medical reasons to do the exam immediately.

  • An external or partial exam is better than no exam.
  • Consider providing an external or partial exam combined with a sonogram.
  • General anesthetic is a last resort. The relative risks of deferring the exam and using general anesthetic should be assessed before proceeding with general anesthetic.
  • It may be helpful to work with an occupational therapist or behavior specialist. These specialists can help develop behavior modification plans or adaptations of the exam environment.

B. Medical Records

People with developmental disabilities are often involved with multiple service delivery systems, such as case management, residential care and day programs. Parents and care providers for adults as well as minors often expect medical practitioners to share confidential information, including, for example, HIV status or pregnancy related decisions. Medical practitioners must be vigilant in obtaining the appropriate consent for both formal and informal sharing of information.

It is helpful for the practitioner to keep a record of how accessibility issues were addressed, in order to provide appropriate care during the next visit. Practitioners who document their efforts and successes in dealing with access issues will be rewarded with greater comfort and efficiency during subsequent contacts, both with the current patient with a disability and with those who come after her.

C. Follow-Up

"Will my patient be able to do breast self-exam, or watch for possible side effects of her new hormonal birth control method? Is she able to notice and report possible symptoms of menopause?" These are common concerns of providers.

There are several things providers can do to enhance follow-up.

  • Provide simple take-home patient or care provider materials:
    • There are many brochures available that illustrate BSE with simple pictures.
  • If your patient lives at home or in residential care, you can ask her permission to involve a relative or care giver in her follow-up. With that permission, the care giver or relative could
    • Remind the woman when it is time for BSE and, if useful, provide a shower card or even a videotape to remind the woman how to do self-exam.
    • Help monitor side effects and symptoms through observation or through private conversations with the woman.
    • For a list of reminders for care givers see Appendix V,
  • The practitioner can also provide written instructions on side effects to look for, or the frequency of a follow-up activity such as BSE. These written instructions will help care givers as well as patients.
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