PHYSICIAN SELF-REPORT OF COMFORT AND SKILL IN PROVIDING PREVENTIVE CARE TO PATIENTS OF THE OPPOSITE SEX

Background: Cancer screening in adults is a fundamental responsibility of primary care physicians. Previous studies have reported that when the patient and the physician are of the same sex, screening rates are higher; previous studies have also reported that trainees believe tha t they are poorly prepared for and are uncomfortable while performing sex-sensitive examinations. Objectives: To compare the level of skill and comfort of male physicians with that of female physicians in condu cting breast and prostate examinations, obtaining Papanicolaou smears, and obtaining a sexual history from men and women and to compare rati ngs of comfort and skill of internists with those of family physicians . Methods: We surveyed 389 internists and family physicians from a lar ge health plan in Minnesota. All female physicians and a random sample of male physicians were surveyed. Respondents rated their level of sk ill and comfort in conducting breast and prostate examinations, obtain ing Papanicolaou smears, and obtaining a sexual history from a man and a woman. We compared the responses of male and female internists with those of male and female family physicians and computed odds ratios ( ORs), adjusting for physician age and specialty. We also compared the ratings of comfort and skill of internists with those of family physic ians. Results: Compared with male physicians, female physicians were m ore likely to report being ''very comfortable'' performing breast exam inations (OR, 7.55; 95% confidence interval [CT], 3.06-18.65), obtaini ng Papanicolaou smears (OR, 13.80; 95% CI, 3.16-60.20), and obtaining sexual histories from women (OR, 3.99; 95% CI, 2.33-6.84). Conversely, female physicians were less likely to report being very comfortable o btaining sexual histories from men (OR, 0.52; 95% CI, 0.33-0.82). Only 6% and 13% of female family physicians and internists, respectively, believed that their skill in performing a prostate examination was exc ellent compared with 49% and 37% of male family physicians and interni sts, respectively (OR, 0.12; 95% CI, 0.06-0.22). Conclusions: Internal medicine and family practice physicians report significantly less com fort and lower levels of skill when performing sex-related examination s obtaining a sexual history from patients of the opposite sex. Interv entions to improve skill and comfort level should be considered.