Chapter 2 - PROCEDURE IN
Here follows the procedure which has been developed in one of the
author's clinics in the Netherlands. The aim is to make the total
procedure a smooth one, so that every patient gets the utmost care
and consideration, even if there many patients. Although each
procedure takes roughly the same time which seldom exceeds fifteen
minutes, a complication may arise which disrupts clinic routine.
Ideally a spare treatment room is available and at least two doctors.
While the junior doctor works on the list, the senior doctor keeps
himself available to deal with sudden problems. He may take over the
treatment while the junior continues with the next patient in a free
Dependent on the number of patients the different tasks may be
done by more or less staff. In a small setting the doctor with a
receptionist and an assistant must do the lot, if the number of
patients rises more staff will be necessary. It is a good thing if
all staff are able to do all tasks so that they may alternate tasks,
and absence of a staff member does not impair the routine.
1. Appointing patients. In almost all
cases this will be done by telephone. Appointments should be made in
a way which avoids overcrowding, so that the list can be handled
smoothly with ample time for every patient. Time must be kept
available for unforeseen problems. The exact date of last menstrual
period (LMP) should be asked to schedule the patient according to the
age of the pregnancy. Further advanced pregnancies take more time and
have a greater possibility of complications.
Patients also tend to stay longer in the clinic. Therefore
advanced pregnancies should be scheduled at the end of the session,
young pregnancies in the beginning. If the LMP is unknown or not
certain or if the patient is not sure about her pregnancy she is told
that treatment is subject to the result of the examination in the
clinic. These patients are appointed at the beginning of the day and
While the regular list is started the clinic reception can
schedule them in if they can be treated, or try to find another
solution for them.
The patient should be advised about the price and further
conditions, told to bring a night gown, towel, extra slips and some
hygienic pads, and told not to eat for six hours prior to the
procedure (general anaesthesia) or have a light breakfast only (local
anaesthesia). She should be encouraged to come for examination and
counselling if she is not sure whether she wants to finish her
pregnancy or not. It is a good policy for a clinic to grant this
pre-exam and counselling free of charge and state in advance that a
patient will not be persuaded to have an abortion done. A patient
should feel free to decide at any moment to keep her pregnancy, even
when she is already on the operation table (which occasionally
happens). Patients should be urged to phone if they will not keep
their appointment or if they will be late.
2. Reception. On arrival the patients
name and address and date of birth is taken down and a treatment form
is filled in. Payment is made and the patient is given an outline of
the procedure. The receptionist should already find out if there is a
reason for preliminary examination, for instance if the pregnancy is
not certain or if it may be too far advanced.
one or more counsellors are available who speak with every patient
This topic is discussed in some detail in
4. Preparation of the patient. Here
again to prevent a useless time consuming session, the first thing is
to find out if a preliminary examination is necessary. It is also the
counsellor's task to deal with patients who are not admitted for
treatment after examination.
revised spring 2010