The practice of obstetrics and gynecology encompasses a broad spectrum of care directed to many aspects of a woman’s health (see also Appendix J).
During the reproductive years, the obstetric-gynecologic provider often serves as a woman’s point of entry into the health care system, a source of continuity in her health care, and her provider of routine screening and preventive care.
Routine visits are opportunities for health care providers to educate and counsel patients regarding risk factors and lifestyle issues, identified by the screening history or physical examination, that place them at risk of illness or injury.The scope of services provided by obstetric-gynecologic providers in the ambulatory setting will vary from practice to practice (see Box 3-1). For example, a practitioner may feel comfortable in providing preventive screening for healthy asymptomatic women, but not in treating chronic diseases. Therefore, it is important to clarify with the patient whether she has a primary care physician who will be providing medical care, preventive health services, and subspecialty referrals for issues that are outside the purview of her obstetrician-gynecologist. The scope of services provided in inpatient settings also varies depending on the obstetrician-gynecologist’s training and experience. For example, in some hospitals a hospitalist may provide care for inpatients, or the gynecologic surgeon may not have privileges for a procedure that the patient requires.
The following sections review the broad range of women’s health care needs addressed by obstetrician-gynecologists, including reproductive, medical, surgical, psychosocial, and preventive care. Also addressed are issues that play an important role in the delivery of women’s health care, including access to health care and awareness of—and responsiveness to— women with diverse needs, such as women with disabilities. The clinical recommendations presented are based on the best available evidence (see also Appendix K).
Information about U.S. organizations concerned with gynecology and women’s health care is provided in Appendix L.Box 3-1. Scope of Ambulatory Women's Health Care Services ^
Well-Woman Care
• Age-specific routine assessment (asymptomatic women)
• Immunizations
• Health status evaluation and counseling
— Weight
— Nutrition
— Exercise
• Routine detection and prevention of disease
— Cardiovascular disorders
— Diabetes mellitus
— Osteoporosis
— Sexually transmitted infections
— Substance use and abuse
• Psychosocial issues: early detection and management
— Sexuality and sexual dysfunction
— Depression and mood disorders; eating disorders
— Intimate partner violence
— Child abuse and neglect
— Elder abuse and neglect
• Family planning
• Preconception care
• Menopausal management
(continued)
Box 3-1. Scope of Ambulatory Women's Health Care Services
(continued)
Obstetrics
• Obstetric care: high and low risk
Gynecologic Services
• Initial and periodic evaluation and treatment of gynecologic conditions (including breast conditions)
• Abortion-related services
• Evaluation and treatment of incontinence
• Gynecologic ultrasonography
• Evaluation and treatment of endocrine dysfunction and infertility