Patients' perceptions and experiences of family medicine residents in the office.

OBJECTIVE: To examine patients' perceptions and experiences of having family medicine residents in the office. DESIGN: Descriptive survey; questionnaire completed by patients. SETTING: Outpatient office of 4 family physicians in the greater Vancouver area, affiliated with the Department of Family Medicine at the University of British Columbia. PARTICIPANTS: A total of 265 English-speaking adult patients attending the office. MAIN OUTCOME MEASURES: Patients' self-reported perceptions and experiences of having family medicine residents in the office. RESULTS: Response rate was 94.7% (251 of 265 patients completed the questionnaire). Although 81% of respondents had seen residents in the office, 59% did not understand a resident's training or thought residents were medical students. The 3 main reasons participants gave for choosing to have residents involved in their care were the following: to contribute to training future doctors (61.8%); to obtain 2 opinions instead of 1 (20%); and residents are most up-to-date (11.2%). The most common reasons for choosing not to see residents were the following: to continue relationships with their own doctors (54.2%); to avoid the need to repeat history (18.6%); and the perception that residents are less experienced (16.9%). Having a resident involved in their care was perceived as a positive experience by 95.5% of respondents who had seen residents. Overall satisfaction with care and overall comfort in dealing with residents were ranked good to excellent by 91.8% and 90.8% of respondents, respectively. About 71% of patients said they would choose to have residents involved in their care. CONCLUSION: Respondents reported very positive experiences with having family medicine residents in the office. Overall comfort and satisfaction with seeing family medicine residents was reported to be extremely high, and most patients surveyed would choose to have family medicine residents involved in their care. Patients needed to know more about the resident's level of training and the role of residents in patient-resident interactions.

Follow-up of infertile couples who dropped out of a specialist fertility clinic.

Lack of commitment to infertility investigations and treatment was not the reason for patient dropout.

Should we try to understand the high rate of dropout from fertility treatment?

Failure to adhere to therapy is common in couples with fertility problems. Explaining why is difficult and worthy of further investigation without stigmatizing assumptions.

Does anovulation exist in eumenorrheic women?

OBJECTIVE: To determine whether anovulation exists in normally menstruating women. METHODS: In a database of 550 consecutive couples seeking pregnancy, results of the midluteal serum progesterone level analysis planned for 7 days before the onset of the next menses were examined in women with predictable cycles shorter than 35 days. RESULTS: Of the 550 couples seeking pregnancy, 410 of the female partners (74.5%) were eumenorrheic. Fifteen of these women (3.7%) had apparently anovulatory cycles with a progesterone lower than the normal ovulatory value of 15 nmol/L. Further examination showed that four of the 15 women (26.7%) had an isolated prolonged cycle, whereas an additional four (26.7%) failed to have their sample taken at an appropriate time. One (6.7%) had a low progesterone level that was normal in the subsequent cycle. Two patients (13.3%) were older than 40, both having elevated early follicular follicle-stimulating hormone levels. One patient (6.7%) conceived in the following menstrual cycle without further evaluation. The three remaining women (20%) showed consistently apparently anovulatory cycles. However, the levels were exclusively above the follicular range. CONCLUSION: Our findings cast doubt on the concept of anovulatory cycles in eumenorrheic women and suggest that further examination of the lower level of ovulatory progesterone may indeed be necessary.