Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
Afr J Prim Health Care Fam Med. 2021 Sep 29;13(1):e1-e9. doi: 10.4102/phcfm.v13i1.2985.
Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire.
The aim of this research study was to assess doctors' clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios.
This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district.
This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors' clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group.
One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p 0.001). The participating doctors did not meet the expectations of the reference group.
Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.
临床推理是为患者提供护理时进行诊断的一个重要方面。性功能障碍可能是患者患有慢性疾病的心血管或神经系统并发症的结果，如果患者没有提出性功能方面的挑战，那么医生应该知道可能存在这种情况，并进行询问。
本研究旨在评估医生在基于两个假设患者情景的情况下，对西北省初级保健设施中慢性疾病患者的性功能障碍风险和管理的临床决策过程。
本研究在西北省肯尼思·卡翁达卫生区的 10 个初级保健设施中进行，这是一个农村卫生区。
本病例研究使用两个假设患者情景作为更广泛的扎根理论研究的一部分，以确定性功能障碍作为合并症是否构成医生临床推理和决策的一部分。对答案进行编码后，进行定量内容分析。然后将问题和答案与参考组的标准答案进行比较。
其中一位医生（5%）考虑到了性功能障碍，但没有进一步探索、检查或管理。对于患有糖尿病的女性患者的情景，参考组认为宫颈健康问题（p=0.001）和依从性问题（p=0.004）是标准询问，但西北省的医生没有考虑这些问题。对于患有高血压和前吸烟者的男性患者的情景，参考组期望对心理健康和视力进行筛查（均 p=0.001），以及对 HIV 进行筛查（p<0.001），这与医生的期望有显著差异。参与研究的医生没有达到参考组的期望。
良好的临床推理和决策不仅基于知识、直觉和经验，还基于对人类福祉的复杂和多维的认识，包括性福祉。
