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 that 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 conducting breast and prostate examinations, obtaining Papanicolaou smears, and obtaining a sexual history from men and women and to compare ratings of comfort and skill of internists with those of family physicians. Methods: We surveyed 389 internists and family physicians from a large health plan in Minnesota. All female physicians and a random sample of male physicians were surveyed. Respondents rated their level of skill and comfort in conducting breast and prostate examinations, obtaining 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 physicians. Results: Compared with male physicians, female physicians were more likely to report being "very comfortable" performing breast examinations (OR, 7.55; 95% confidence interval [CT], 3.06-18.65), obtaining 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 obtaining 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 excellent compared with 49% and 37% of male family physicians and internists, respectively (OR, 0.12; 95% CI, 0.06-0.22). Conclusions: Internal medicine and family practice physicians report significantly less comfort and lower levels of skill when performing sex-related examinations obtaining a sexual history from patients of the opposite sex. Interventions to improve skill and comfort level should be considered.