Thank you for an interesting article which highlights the role of cervical visualisation in the timely diagnosis of cervical cancer and suggests that some GPs may forego pelvic examination (PE) despite the presence of abnormal vaginal bleeding.1 A male medical student who had just completed his primary care attachment told me that during a supervised surgery, a patient presented with a gynaecological condition. As he was unable to do the required PE he advised the patient that the supervising female GP would do it instead. The GP responded by stating that no PE was required as the patient would be referred to secondary care regardless of whether an examination took place or not.
I cannot think of any other body system that a GP would not examine prior to referral. Pelvic examination is more difficult than placing a stethoscope on a patient’s chest in terms of time, chaperone requirements, issues of embarrassment for patients, etc, but I find it difficult to accept that the way to deal with these difficulties is to not do it. The history provides the majority of referral information but examination is vitally important in how we determine the nature of referral, routine or urgent, and how it is triaged in secondary care.
The evidence base for PE in primary care is limited, but what we do know is that performing PE does reduce the diagnostic interval in those diagnosed with a gynaecological cancer. Until we have a complete understanding of the role of PE in primary care, it must continue to be an integral component of our practice.
- © British Journal of General Practice 2014
