Discrepancy between physicians' perceptions and practices during pelvic examinations in Taiwan.
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.


METHODS
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).


CONCLUSIONS
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).


CONCLUSIONS
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.
Chen
Shu-Ling
SL
School of Nursing, Hung Kuang University, Taiwan.
Jane
Sui-Whi
SW
Yu
Yu-Mei Chao
YM
Hsieh
Yeu-Sheng
YS
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards* / Q000706:statistics & numerical data; D003142:Communication; D003219:Confidentiality; D005260:Female; D005836:Genitalia, Female; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control; D007258:Informed Consent; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000523:psychology; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology; D009775:Obstetrics and Gynecology Department, Hospital; D010353:Patient Education as Topic; D010808:Physical Examination / Q000451:nursing / Q000592:standards* / Q000706:statistics & numerical data; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D012647:Self-Assessment; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013624:Taiwan