中部某醫院骨盆腔檢查：病患使用帳幕意願分析和病患感受不良骨盆腔檢查經驗分析

Pelvic Examination in Central Local Hospital: Analysis of Patients' Attitude about the Use of a Screen and Analysis of Poor Pelvic Examination Experience

許維邦(Wei-Pang Hsu) ； 張瑞月(Rei-Yeuh Chang) ； 周明智(Ming-Chih Chou) ； 許大立(Ta-Li Hsu) ； 蕭培靜(Pei-Ching Hsiao)

《澄清醫護管理雜誌》 10卷2期 (2014/04) Pp. 9-15

摘要

目的以病患為中心為二十一世紀醫療五大核心價值之一，也是畢業後一般醫學訓練的目標。就一位女性而言，沒有骨盆腔檢查就不是一個完整的理學檢查。然而女性因為害羞、恐怖經驗和錯誤觀念，畏懼診查，延誤疾病的早期診治。本研究目的要探討婦女接受骨盆腔檢查時是否同意使用帳幕和分析其以往不愉快檢查經驗。方法描述性觀察型研究，針對民國九十七年六月至民國九十八年五月1,155位台中某醫院家醫科門診病患給予面對面問卷。分析人口學特徵、接受骨盆腔檢查時是否同意使用帳幕及原因、和不愉快檢查經驗比率及情境並探討和六大核心能力之相關。結果在這1,155位病患當中有54人（4.7%）接受骨盆腔檢查時，同意不使用帳幕。理由以直接醫病溝通和監督醫師為主。不愉快檢查經驗分析，至少59人（5.1%）的病患曾有不愉快經驗。其情境包括醫護態度、疼痛、隱私和衛生等。這些不愉快經驗存在於不同性別醫師和不同醫院層級，將其和住院醫師六大核心能力分析，和專業素養及病人照顧最有關。結論總計有54人（4.7%）病患在接受骨盆腔檢查時，同意不使用帳幕和至少有59人（5.1%）的病患曾有不愉快經驗。本著以病人為中心之醫療，無論是在臨床教學或服務時，務必納入病患的價值觀，以專業的態度和技能，提供優質醫療服務，消弭病患抱怨。

關鍵字

骨盆腔檢查 ； 理學檢查 ； 以病人為中心之醫療

並列摘要

PurposesPatient-centered medical care is one of the five core values of 21st century practitioners and also one of the goals of post-graduate year one training. For female patients, complete physical examinations include a pelvic examination, but many women ignore or delay a pelvic examination due to its inherent embarrassing nature, a previous terrible experience, or their own misconceptions, which potentially leads to delayed diagnosis and treatment. The aim of this study was to explore the opinion of setting a screen during pelvic examination and the poor pelvic examination experience in Taiwan.MethodsThis observational convenience-sampling survey used a questionnaire administered face-to-face to women with pelvic examination experiences while they visited the family medicine out-patient department between June 2008 and May 2009 at a regional teaching hospital in Taichung. 1,155 participants were recruited in this study. We analyzed the demographic data, the percentage of agreeing with a screenless pelvic examination and their reasons, and the percentage of those having a poor pelvic examination experience, the scenario and its association with six core competencies.ResultsOf the 1,155 participants, 54 patients(4.7%) agreed with a screenless pelvic examination. Their major reasons were direct patient-doctor communication and concerns about monitoring the doctor's behavior. There were 59 patients(5.1%) who had experienced a poor pelvic examination experience during their course of medical treatment. The scenarios included attitude, pain, privacy and hygiene. The poor pelvic examination experience included physicians of both genders and different levels of hospital. Among the six core competencies, professionism and patient care were most related to a poor pelvic examination experience.ConclusionsThere were 4.7%(54 patients) who agreed a screenless pelvic examination and at least 5.1%(59 patients) with poor pelvic examination experience during their course of medical treatment. Based on patient-centered medical care, either during medical education or enforcement of medical practice, it is advised to incorporate the value of patients and provide excellent medical service by professionism and skills. Thus it is believed to eliminate patients' complaints beforehand.

並列關鍵字

pelvic examination ； physical examination ； patient-centered medical care