Gynecologists' perception of the patient-physician relationship in pelvic examinations in Taiwan.

OBJECTIVE: To explore the gynecologists' physical contact and their interaction with patients, as well as the patient-physicians relationship during the pelvic examination (PE). STUDY DESIGN: This qualitative study uses face-to-face, in-depth interviews with 20 gynecologists from three hospitals in central Taiwan. RESULTS: The results revealed two main categories: adopting non-gendered and desexualised strategies and acknowledging a patient's situation. The majority of gynecologists adopted strategies to reduce their embarrassment during a PE, such as the use of a PE curtain, having a nurse in attendance, the tendency to depend on an ultrasound scan and the use of minimal verbal communication. CONCLUSION: Within the social context in Taiwan, male gynecologists tend to adopt a non-gendered and desexualised attitude to lessen the embarrassment and to protect them from accusations of sexual misconduct by patients during the PE. Acknowledging a patient's situation can benefit the gynecologists and allowed them to conduct the PE more easily. The results could possibly provide the medical student with an awareness and reflection of how social interaction plays a role for the gynecologists and their patients during a PE.

Decision-making tree for women considering hysterectomy.

AIMS: This paper reports on a study carried out to establish a decision tree model to describe how women in Taiwan make the decision whether or not to have a hysterectomy. In addition, we examined the predictability of the decision-tree model. BACKGROUND: Hysterectomy is the second most common surgical procedure performed worldwide. Medical professionals believe that the operation can relieve pain and prevent cervical cancer, thus improving a woman's quality of life. While most physicians advise hysterectomy even for benign uterine conditions, feminists decry the belief that the uterus has no purpose, believing that it is an important symbol of womanhood. METHODS: The study was conducted in two phases. Phase I, the model development phase, was carried out to generalize data from a qualitative study of 14 women and to establish a tree model outlining their decision to proceed with hysterectomy. The second phase was the model prediction phase that applied inductive and deductive methods to data analysis and development of the decision-tree model. The model tree was then tested with 18 women who were deciding whether or not to undergo hysterectomy. Using the decision-making tree, we studied the women's thought processes and analysed their primary concerns. The study was carried out in 1999-2001. RESULTS: The study determined 13 criteria that Taiwanese women use when deciding about having a hysterectomy. Developed in accordance with Gladwin's methodology, the model tree successfully predicted 90% of decisions whether or not to have a hysterectomy. CONCLUSIONS: Nurses working in gynaecological services should understand how women decide to undergo hysterectomy so that the proper counselling and follow-up can be provided. With further testing, our decision tree may help in this process.