Guidelines in Flux

Abstract

INTRODUCTION: The American College of Obstetricians and Gynecologists (the College) recommends annual pelvic examination during routine well-woman care. Other organizations, notably the American College of Physicians, advise against screening pelvic examinations in asymptomatic women. We assessed primary care physicians' current practice patterns. METHODS: Internal and family medicine physicians (N=801) electronically were surveyed at all Mayo Clinic sites; 284 (36%) responded. Demographics were recorded. Comparisons between groups utilized Wilcoxon rank-sum tests for scaled survey items (eg, comfort or importance level) using SAS 9. P<.05 was significant. RESULTS: Nearly all (n=276, 97%) primary care physicians routinely perform pelvic examinations. Few (10%) referred patients to obstetrician–gynecologists (ob-gyns) solely for routine examinations, but internal medicine physicians were more likely to refer than family medicine physicians (P<.001). There was no difference in referral for male compared with female primary care physicians. The most common reasons for referral were patient preference for ob-gyns (n=81) and technically difficult examinations (n=66). Family medicine physicians reported more comfort with all components of the examination (P<.001). Internal medicine providers placed less importance on speculum placement (P=.002), identifying the cervix (P=.002), examining vaginal walls (P=.001), and bimanual palpation of the fundus (P=.02). More than half of respondents (n=154, 56%) thought examinations should be performed every 3 years for low-risk women. CONCLUSION: Despite evolving and conflicting guidelines, most primary care physicians currently perform pelvic examinations. Few refer patients to ob-gyns solely for this purpose. Family medicine providers appear more comfortable with examination technique than internal medicine physicians. Most primary care physicians felt pelvic examinations could be performed less frequently than recommended by current College guidelines.