Rethinking the Abnormal Uterine Bleeding Consult: Creating a Patient-Centered, See-and-Treat Model of Care

Moving from the multi-visit, several-week evaluations to a patient-centered, technology-enabled approach to the AUB evaluation allows for improved efficiency for all stakeholders—patients, health care professionals, and the health care system—with the potential to improve patient and physician satisfaction. In addition, it allows for more appropriate use of limited health care resources. The potential for fewer visits simplifies the clinical care pathway for the patient: Scheduling, time off, child care, and travel expenses are all decreased with the incorporation of telehealth into the evaluation pathway. By providing evaluation of the uterine cavity in the office, higher level of care resources maybe allocated for more complex procedures when indicated. As several studies have shown, office hysteroscopy with standard 5-French scopes is feasible and reasonable with a 93–94% success rate. 15 , 16 When failures occur, it is typically due to pain or stenosis, which often can be predicted based on discussions and examination. Vaginoscopy and instrument-free approaches have been adopted to decrease discomfort, but no set medication regimen has been found to be preferred. Adaptation of our traditional clinical care pathways 17 allows us to assess and treat patients with AUB more efficiently. In a world evolving into quality metrics, improved patient satisfaction with less time to treatment, improved clinician office efficiency with fewer appointments per patient chief symptom, and optimized and appropriate resource allocation are going to be the keys to success. 1 , 18