Department of Obstetrics and Gynecology, the MacLean Center for Clinical Medical Ethics, and the Department of Family Medicine, the University of Chicago, and the Department of Obstetrics and Gynecology, the University of Illinois at Chicago, Chicago, Illinois.
Obstet Gynecol. 2019 Apr;133(4):810-814. doi: 10.1097/AOG.0000000000003166.
Controversy exists regarding whether to perform pelvic examinations for asymptomatic, nonpregnant patients. However, several professional organizations support the notion that health care providers should no longer recommend that asymptomatic patients receive a yearly pelvic examination. At minimum, health care providers must respect patients' autonomy in decision making around this examination and initiate a joint discussion about whether to proceed with a pelvic examination. Shared decision making is a model used in other aspects of medicine that can aid such discussions. This model recognizes two experts in these clinical encounters-the health care provider is the expert regarding medical information and the patient is the expert regarding their values, preferences, and lived experiences. When shared decision making is used, not only is each expert valued for their knowledge, but the power differential shifts to a shared power model. This commentary aims to educate about shared decision making, explain why shared decision making is appropriate to use when discussing whether to perform a pelvic examination, and provide a framework for using shared decision making in discussing whether to proceed with a pelvic examination with asymptomatic, nonpregnant patients.
对于无症状、非妊娠患者是否进行盆腔检查存在争议。然而，一些专业组织支持这样的观点，即医疗保健提供者不应再建议无症状患者每年进行一次盆腔检查。至少，医疗保健提供者必须尊重患者在决定是否进行盆腔检查方面的自主权，并发起关于是否进行盆腔检查的联合讨论。共同决策是在医学的其他方面使用的一种模式，可以帮助进行此类讨论。该模式承认这两种临床相遇中的两个专家——医疗保健提供者是关于医疗信息的专家，而患者是关于其价值观、偏好和生活经验的专家。当使用共同决策时，不仅每位专家的知识都受到重视，而且权力差异也转移到共享权力模式。本评论旨在教育关于共同决策，解释为什么在讨论是否进行盆腔检查时使用共同决策是合适的，并提供一个框架，用于在与无症状、非妊娠患者讨论是否进行盆腔检查时使用共同决策。
