Nussbaum M P, Shenker I R, Feldman J G
Division of Adolescent Medicine, Schneider Children's Hospital of Long Island, Jewish Medical Center, New Hyde Park, NY 11042.
J Adolesc Health Care. 1989 May;10(3):203-8. doi: 10.1016/0197-0070(89)90233-7.
This study ascertained current pediatric attitudes verses performance in caring for adolescent females in private practices in a suburban area. Sixty-seven randomly selected pediatricians were given a confidential questionnaire; 90% responded. Areas assessed were attitudes and practice about sexual history, breast examination, teaching self-breast examination, and vaginal examination. Comparisons were made between the different age groups and between male and female pediatricians. Ninety-two percent of pediatricians felt it was important to take a sexual history by age 16 years, while only 73% actually did. More female than male pediatricians thought it was important to take a sexual history and actually did so. Seventy-five percent stated that a breast examination should be routine, and most performed the examination. However only 60% taught self-breast examination despite the fact that 93% believed it was important. An internal vaginal examination as part of a routine physical was performed by only 7%. For specific gynecologic problems most asked to see the patient but most did not do an internal examination. The most likely indication for a pelvic examination was a vaginal discharge, but only 28% of the pediatricians would examine their patient for this complaint. Of the pediatricians who do the examination, 41% were not sure they had received the proper training. These data suggest that despite the American Academy of Pediatrics' recommendations that pediatricians continue the care of patients until age 21 years, there does not appear to be optimal care provided to female adolescent patients.
本研究确定了郊区私人诊所中儿科医生在照顾青春期女性患者时的当前态度与实际表现。67名随机挑选的儿科医生收到了一份保密问卷，90%进行了回复。评估的领域包括关于性病史、乳房检查、教授自我乳房检查和阴道检查的态度及做法。对不同年龄组以及男女儿科医生之间进行了比较。92%的儿科医生认为在16岁时询问性病史很重要，但实际这样做的只有73%。认为询问性病史很重要且实际这样做的女儿科医生比男儿科医生更多。75%的医生表示乳房检查应作为常规项目，且大多数医生进行了该项检查。然而，尽管93%的医生认为教授自我乳房检查很重要，但只有60%的医生这样做了。只有7%的医生将内部阴道检查作为常规体检的一部分。对于特定的妇科问题，大多数医生要求查看患者，但大多数医生没有进行内部检查。盆腔检查最可能的指征是阴道分泌物，但只有28%的儿科医生会针对这一症状检查患者。在进行检查的儿科医生中，41%不确定自己是否接受过适当的培训。这些数据表明，尽管美国儿科学会建议儿科医生持续照顾患者至21岁，但对青春期女性患者似乎并未提供最佳护理。
