中部某醫院骨盆腔檢查: (1)病患使用帳幕意願分析,
(2)不良骨盆腔檢查經驗分析

研究背景和目的:以病患為中心之醫療為二十一世紀醫療從業人員五大核心價值之一，也是台灣地區畢業後一般醫學訓練的目標之一。就一位女性病患而言，沒有接受骨盆腔檢查就不算是一個完整的理學檢查。然而女性同胞往往因為害怕疼痛、心理害羞、錯誤觀念誤導、不友善檢查環境﹙隱私、衛生、無法面對疾病、醫師專業技能、病患的價值觀、人格特質和醫護人員態度等﹚和以往不愉快骨盆腔檢查處置經驗，而將骨盆腔和外陰部診查視為畏途，因而干擾了疾病的早期診斷、治療、追蹤與預防保健、健康促進之執行。本研究主要目的想要探討婦女接受骨盆腔檢查時是否同意使用帳幕和不愉快骨盆腔檢查經驗之分析並謀求對策，以避免不愉快骨盆腔檢查經驗歷史一再重覆發生，並藉由了解婦女是否同意使用帳幕切入，得以達到提供以病患為中心之醫療。研究方法:本研究運用描述性觀察型研究方法，針對民國九十七年六月至民國九十八年五月總計一千一百五十五人台灣台中某教學醫院家醫科門診病患給予面對面問卷調查。分析其人口學特徵、接受骨盆腔檢查時是否同意或堅持要使用帳幕之比率及原因、和曾經有不愉快骨盆腔檢查經驗比率及情境並探討其和六大核心能力之相關性。研究結果: 在這一千一百五十五位家醫科門診病患當中有54人( 4.7 %)病患在接受骨盆腔檢查時，同意或堅持不使用帳幕。不使用帳幕的理由以直接醫病溝通和監督醫師作為為主。不愉快骨盆腔檢查經驗之分析，其結果顯示至少59人(5.1%)的病患曾有不愉快骨盆腔檢查經驗。分析其情境包括態度、疼痛、隱私和衛生等項目。這些不愉快骨盆腔檢查經驗和醫師性別、醫院層級的相關性則無法統計，和住院醫師所須具備六大核心能力相關性分析，發現和專業素養和病人照顧最有所關聯。結論: 總計有4.7 %(54人)病患在接受骨盆腔檢查時，同意或堅持不使用帳幕和至少有5.1%(59人)的病患曾有不愉快骨盆腔檢查經驗。本著以病人為中心之醫療的理念，無論是在從事於醫學教學或是執行臨床服務時，務必納入病患的價值觀，同時以專業的態度和技能，提供優質醫療服務，消弭病患的抱怨於無形。

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

Background and Objectives: Patient-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 in Taiwan. 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. Methods: This observational convenience-sampling survey used a questionnaire administered face-to-face to women 20-64 years of age 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, Taiwan. 1155 participants were recruited in this study. We analyzed the demographic data, the percentage of agreeing or insisting on screenless pelvic examination and the reason, and the percentage of having poor pelvic examination experience and the scenario and its association with six core competencies. Results: In the 1155 participants, there were 54 patients(4.7%) who agreed or insisted on screenless pelvic examination. The major reasons for screenless pelvic examination were direct patient-doctor communication and concerns for monitoring doctor behavior. At least, there were 59 patients(5.1%) with poor pelvic examination experience during their course of medical treatment. The scenario of poor pelvic examination included attitude, pain, privacy and hygiene. The poor pelvic examination experience was distributed among both gender physician and different hospital level. Among the six core competencies, professionism and patient care were most related to the poor pelvic examination experience. Conclusions: There were 4.7%(54 patients) who agreed or insisted on a screenless pelvic examination and at least 5.1%(59 patients) with poor pelvic examination experience during their course of medical treatmen. 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

參考文獻

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中部某醫院骨盆腔檢查: (1)病患使用帳幕意願分析, (2)不良骨盆腔檢查經驗分析

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