Discrepancy between physicians’ perceptions and practices during pelvic examinations in Taiwan
Resource
Patient Education and Counseling 74 (1): 124-129
Journal
Patient Education and Counseling
Journal Volume
74
Journal Issue
1
Pages
124-129
Date Issued
2009
Date
2009
Author(s)
Abstract
Objective: This study explored (1) physicians' perceptions of pelvic examination (PE) procedures and (2) the discrepancy between physicians' perceptions and their practices as observed by their attending nurses. Method: Data were collected from 20 physician-completed questionnaires on the perceived importance of 23 PE procedures. Each physician's practice of the same 23 PE procedures was assessed by 4-6 attending nurses (100 nurse observations). Physicians and nurses were sampled by convenience from the obstetrics/gynecology outpatient departments of 3 teaching hospitals in central Taiwan. Discrepancies between physicians' perceptions and their practices as assessed by attending nurses were examined by the Mann-Whitney U test. Results: Physicians' mean scores ranged from 3.15 to 4.00, indicating that PE procedures were generally perceived as important. The procedures were rank ordered according to the mean scores from highest to lowest. Physicians' 5 top-ranking procedures were wearing gloves during the PE, asking agreement for the examination, paying attention to privacy during the PE, protecting the woman's personal information, and protecting the woman's medical records. Physicians' 5 lowest ranking procedures were telling the woman before inserting the speculum that she will feel some pressure, explaining the procedure before the PE, proactively providing information, asking the woman how she feels during the PE, asking a woman's permission to examine prior to commencing the PE, and describing observations to the woman during the PE (the last two procedures were tied for 5th rank). For 15 of the 23 PE procedures, physicians' perceptions did not differ significantly from their practices as assessed by attending nurses. The remaining 8 procedures were statistically significant between physicians' perception and their practices, and were rated higher by physicians (perception) than by attending nurses (practice). Conclusion: The 5 top-ranking PE procedures in terms of perceived importance were related to procedural behaviors, whereas the 5 lowest ranking procedures were verbal statements with explicit affective content. During nurse-observed PEs, Taiwanese physicians consistently practiced the procedural aspects of PEs they perceived as important (e.g., communication and consultation, protection and skilled technique, and confidentiality). However, physicians' practices were less consistent in affective aspects (e.g., explanation and consent, information and instruction, and sensitivity). Practice implications: Our results suggest that physicians should concentrate not only on procedural behaviors, but also on affective behaviors. These findings could be incorporated in medical education, particularly for medical students training to become obstetric and gynecological physicians. ? 2008 Elsevier Ireland Ltd. All rights reserved.
Subjects
Nurse; Obstetrics and gynecology; Pelvic examination; Perception; Physician; Practice
Other Subjects
article; clinical practice; information processing; medical record; outpatient department; pelvis; perception; physician; priority journal; questionnaire; rank sum test; statistical significance; Taiwan; teaching hospital; Adult; Attitude of Health Personnel; Clinical Competence; Communication; Confidentiality; Female; Genitalia, Female; Hospitals, Teaching; Humans; Infection Control; Informed Consent; Male; Medical Staff, Hospital; Middle Aged; Nursing Staff, Hospital; Obstetrics and Gynecology Department, Hospital; Patient Education as Topic; Physical Examination; Physician's Practice Patterns; Physician's Role; Physician-Patient Relations; Questionnaires; Self Assessment (Psychology); Statistics, Nonparametric; Taiwan
Type
journal article
File(s)![Thumbnail Image]()
Loading...
Name
05.pdf
Size
24.16 KB
Format
Adobe PDF
Checksum
(MD5):3bf1c62d56db579b9ba0de941b08a8d4