Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: A scoping review of qualitative studies

Abstract

Background: In recent years several reports have found that women do not feel listened to either by clinicians or at the system level when discussing health care concerns. In particular, women perceive that they are treated dismissively and that their symptoms are not taken seriously. This finding is reflected both in reports on health care conditions which specifically affect women, such as endometriosis, heavy menstrual bleeding and menopause, and in reports which explore failures of the health care system to listen and intervene when patients feel they are experiencing harm. A particular issue has been highlighted around women not feeling listened to by primary care clinicians, who are seen as the ‘gatekeepers’ to the more specialist care available in secondary care services. This can lead to patients feeling that their health concerns are being dismissed without due consideration. What is less well-known is why this occurs and in what circumstances, or indeed to what extent primary care clinicians perceive that there are problems around listening to women patients.

In order to better understand this issue from the perspective of primary care clinicians, we were asked to carry out a scoping review of evidence on primary care clinicians’ views on listening to and, more broadly, interacting with women patients, including with specific groups of women patients such as ethnic minority women, LGBTQ+, older/younger and disabled women. Following initial exploratory work, we developed a protocol for a scoping review of the qualitative research evidence with the following aim and research questions.

Aim: To identify and summarise qualitative evidence on primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions. Research questions: 1. What evidence is there about primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions? 2. What key themes have been raised about challenges of interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions?

Findings: Twenty-three papers, from 18 unique studies, were included in the qualitative scoping review. Most papers (n=8) were about clinicians’ experiences with diagnosing and managing endometriosis, with smaller numbers of papers discussing menopause (n=4), menorrhagia (n=3), polycystic ovary syndrome (n=3) and chronic pelvic pain (n=2). Infertility disease, menstrual disorders and premenstrual symptoms each were discussed in one paper. The papers reported data collected in the UK (n=8), Australia (n=7), US (n=3), Netherlands (n=2), Sweden (n=2) and Norway (n=1). Primary care clinicians who participated in the studies included GPs, nurse practitioners, internists/family practitioners, pharmacists and a community gynaecologist. GPs were included in the majority of papers (n=20).

We also identified a selection of themes and subthemes on or related to the challenge of interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions. Subthemes were organised within four thematic ‘levels’: the individual clinician; structural and organisational factors; community and external factors; and factors specific to gynaecological conditions and symptoms.