Abstract
Introduction: Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs.Methods: In 2015, 70 medical students at the University of Bergen distributed a questionnaire to all 175 GPs in the practices they visited. The questions covered practical routines related to GEs, insertion of intrauterine device, frequency of GEs in different clinical settings and use of assisting personnel. Statistical analyses included chi-square tests and multiple logistic regressions adjusting for age, gender, specialization and localization.Results: Ninety male and 61 female GPs (87% of invited GPs) responded to the questionnaire. A minority (8%) usually had other staff present during GEs. Compared with female colleagues, male GPs performed bimanual palpation significantly less often in connection with routine Pap smear (AOR 0.3 (95% CI 0.1-0.6)). Twenty-eight percent of the GPs stated that they often/always omitted the GE if the patient was anxious about GE and 35% when the patient asked for referral to a gynaecologist. Omission was more frequent among male GPs. When the GP decided to refer to a gynaecologist based on the patient’s symptoms, more male than female GPs omitted GE (AOR 2.5 (95% CI 1.1-5.4)).Conclusion: Male gender of the GP may be associated with barriers to medical evaluation of pelvic symptoms in women, potentially leading to substandard care. Possibly, however, male GPs’ reluctance to perform the GE may also limit unnecessary bimanual palpation in asymptomatic women.
Highlights
Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs
The one-page questionnaire comprised questions about routines related to GEs, including the presence of other staff during GEs, whether bimanual palpation was done when women came for Pap smears, GE in antenatal and postnatal care, and whether the GPs inserted intrauterine devices (IUDs)
40% were female, 57% were certified specialists in general practice, 43% were younger than 40 years, and 76% younger than 55 years, and 41% worked in rural practices
Summary
Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs. While many women have a positive attitude to the medical benefits of GEs [2], they sometimes have adverse expectations when preparing for the procedure, and may experience the procedure negatively [3] This calls for interpersonal sensitivity and rigorous professional judgement on the doctor’s side in determining when and how to perform a GE. GPs and primary care midwifes provide maternity care to most pregnant women, and GPs insert intrauterine devices (IUDs) and take Pap smears These arrangements are in accordance with the primary health care ideal of comprehensiveness which has been championed in Norway and is promoted by the WHO as a core feature of good health care organisation [4]. It is known that GPs’ delivery of services sometimes is subject to undue
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