Abstract
The aim of this study was to investigate General Practitioners’ (GPs’) collection
and analysis of data on women presenting with lower genitourinary (GU) complaints,
also taking into account patient preferences. For 135 patients seen after nurse triage,
eleven GPs recorded the clinical data they had explored, an evaluation of the patient’s
desire (or not) for medical interventions, a preliminary diagnosis with certainty
estimate, and management actions.
Whether a clinical data item was explored varied between 97% of the patients for fever
to 15% for pelvic examination. Decisions regarding diagnosis followed to a large extent
results from screening laboratory tests. For prescription of antibiotics the patient’s
desire (or not) for medical interventions was a significant discriminant. The GPs
reported the lowest diagnostic certainty for diagnosis of urethritis, the highest
for cystitis. Factors contributing to physicians’ uncertainty in their decisionmaking
were assumed patient reluctance for medical interventions and negative screening tests.
In conclusion, patient requests and preferences significantly influenced the GPs,
even though results from screening laboratory tests were mainly used as the basis
for decisions. The high reliance on screening tests may often cause other clinical
information to be neglected. Thus, the uncertainty regarding patients with negative
laboratory test results may reflect that important information is not included in
the clinical analysis.
Key-Words
Genitourinary Infections - Decision-Making - Patient Participation - Practice Research
- Doctor-Patient Relation
