Provocative Questions

Abstract

THE RELATIONSHIP CONTEXT AND PATIENT ACCEPTANCE OF RISK-BASED SCREENINGPace' s personal experience in talking with women in his 20-year continuity practice 3 gives him a different perspective than was found in the study by Smith et al. 4 Smith and colleagues found great reluctance to engage in risk-based cervical cancer screening. Women' s stories about their need for self-advocacy seem to be at odds with Dr. Pace' s experience of a high level of patient acceptance of longer screening intervals. How does a trusting relationship with a clinician affect the patient' s personal experience that seems so important in acceptance of risk-based screening? How do the health care system context and trust affect women' s perception of risk-based screening?Harper et al 5 quote recent data showing the benefi t of longer intervals between cervical cancer screenings. They present their own data showing that among women' s ranking of 22 reasons for an annual examination, having a Pap smear ranked number 8-lower than 5 reasons that relate to the clinician-patient relationship. They raise the provocative hypothesis that "interval screening may be limited not by the frequency of the woman' s visit to her provider, but by the physician' s ability to change his/her screening behaviors.

Chaperone use during intimate examinations in primary care: postal survey of family physicians

“…It is clear that same sex preference plays a role in the clinician's decision to employ chaperones; however, this may provide a false sense of security, may be inconsistent with best practice recommendations, and may expose clinicians to potential liability. Further investigation is required on the issue of whether malpractice claims and/or concerns function as a determinant of chaperone use [ 21 ]. Another valuable complement to the present study would be a survey of patient preferences and experiences as a means to assess the concordance of patient and provider views.…”