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
- 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
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.
"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
- 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
- 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.