Screening for sexually transmitted diseases by primary care physicians.

The acquired immunodeficiency syndrome epidemic has drawn attention to screening for sexually transmitted diseases by primary care physicians. A telephone survey of primary care physicians in an area with a high incidence of STDs (Washington, DC) to ascertain the determinants and the extent of screening and counseling for STDs was completed in 1987. Ninety-nine physicians (33 internists, 38 obstetrician/gynecologists, and 28 family/general practitioners), representing 61% of those eligible, completed the interview. One third (39.4%) were screening for gonorrhea, more than one half (57.5%) for syphilis, and almost all (94%) had tested at least one individual for human immunodeficiency virus infection. Analysis suggested that concomitant screening for hepatitis B was significantly and positively associated with screening for gonorrhea and syphilis. Less than half (45.9%) of the physicians asked new patients about their sexual practices. Physicians should take histories of sexual practices and do more preventive counseling.

Primary care physicians' assessment and prevention of HIV infection.

The degree and depth to which primary care physicians counsel patients at risk for human immunodeficiency virus (HIV) infection is a major concern. To determine which factors influence whether physicians counsel patients at risk for HIV, primary care physicians's clinical experience, knowledge, attitudes, and preventive counseling advice in hypothetical case scenarios were assessed. Ninety-nine adult primary care physicians in the Washington, D.C., metropolitan area were interviewed by telephone from May through November 1987. Ninety-one physicians had tested or referred patients for HIV antibody tests. However, 58% could not name the ELISA or Western blot as the tests. The most frequent HIV prevention recommendations were using condoms (67.7%), abstaining from sexual activity (36.4%), getting tested for HIV (30.3%), and safe sex (23.2%). Naming the HIV antibody tests was the most significant predictor of preventive counseling advice; other significant predictors included physicians' personal comfort with counseling homosexual patients and various physician practice and demographic characteristics. Previous studies showed that homophobia was the main inhibitor of effective AIDS counseling. These results suggest that physicians' lack of knowledge and general discomfort in counseling patients about sexual risk factors, rather than homophobia alone, are important barriers to preventive counseling about HIV infection.

Continuing medical education for flexible sigmoidoscopy--toward a conceptual model for procedural skills training.

Participants in two one-day continuing medical education courses on flexible sigmoidoscopy were surveyed before, immediately after and ten months after the courses. 52 (29.5% of 176) participants completed all three survey forms. Before the course 32 (61.5%) expected to immediately use the flexible sigmoidoscope without further training. Ten months after the course 33 (63.4%) were using the flexible sigmoidoscope; four additional respondents were expecting to begin using the instrument. Twenty three of these (69.7%) had only attended the course without additional training. Those who found the instrument more difficult to use, or decided immediately after the course that more education was necessary, were less likely to use the instrument. Those not using the instrument also were older, more likely to be in solo practice and more likely to be surgeons. The course altered the educational plans of 23.1% of the respondents. This one-day format combining didactic and laboratory work with the instrument proved to be an efficient and effective means of education for using the instrument.