rectal exam

[coolioyo]

Is there anyway you can get by medical school without having to do one?
Are there schools that do not do this or at least not on standardized patients?

Thanks.

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[PeepshowJohnny]

No chance on not doing one.

Some schools may not have standardized patients, but most do.

 

[Shah_Patel_PT]

Is there anyway you can get by medical school without having to do one?
Are there schools that do not do this or at least not on standardized patients?

Thanks.

Nice try. you cant graduate without doing a few Guiacs.

 

[SocialistMD]

Out of curiosity, what do you plan to do for a living? Is is being a physician? Because I can only think of maybe two specialties (nuclear medicine and pathology) where you won't be doing rectals as an intern at the very least if not during your regular practice.

 

[coffeebythelake]

Is there anyway you can get by medical school without having to do one?
Are there schools that do not do this or at least not on standardized patients?

Thanks.

Do you think it would make you a better doctor?

 

[Doctor Bagel]

We don't do rectal exams on standardized patients at my school. However, I'm sure it will come up with real patients during clinicals. Why the specific concern?

 

[njbmd]

Is there anyway you can get by medical school without having to do one?
Are there schools that do not do this or at least not on standardized patients?

Thanks.

Not a chance as you have to learn how to examine your patients (every part of your patient). If you never perform a rectal exam, what are you going to do when a patient presents with a huge rectal tumor that can be felt digitally and you don't do that exam.

A rectal exam when done properly gives loads of information that is vital to the health of your patients. During your third year, on almost every clinical rotation (except psych perhaps) you, the medical student will be doing most of the history and physical exams. The physical exam isn't complete without a rectal.

Remember the only legit reasons not to do a rectal are that you don't have any fingers or the patient does not have an anal opening. In the case of no anal opening, you can still digitally examine a stoma.

 

[45408]

We don't do rectal exams on standardized patients at my school. However, I'm sure it will come up with real patients during clinicals. Why the specific concern?

Likewise. They said they have a hard enough time getting patients as it is. Throwing in a DRE would make it impossible.

 

[Tiger26]

Likewise. They said they have a hard enough time getting patients as it is. Throwing in a DRE would make it impossible.

Yet they seemed to have plenty of volunteers for paps and pelvics, eh

 

[Team Zissou]

nm

 

[45408]

Yet they seemed to have plenty of volunteers for paps and pelvics, eh

They also said that that's the reason we don't do the rectovag on them...


are you even in med school any more?

 

[Tiger26]

They also said that that's the reason we don't do the rectovag on them...


are you even in med school any more?

If you looked at it from the perspective of my tuition bill, you would say yes.

If you looked at it from the perspective of the time I spend in class or even the building, you would say no

 

[LadyWolverine]

At Maryland, we learn to perform the male rectal digital exam (as well as the female rectovaginal exam) on standardized patients during our second-year physical exam & diagnosis course. I completed this module recently. It honestly wasn't a "big deal," and the actual RDE was actually pretty anti-climactic, compared to all of the other components of the male genital exam. It took about 20 seconds to perform.

I don't understand why some students get so stressed/grossed out by this component of the physcial exam. You're just using the tools you have to examine and diagnose - in this case, there's no better tool than your finger, which happens to be connected (one would hope) to your brain. Personally, I thought cutting open a dead body had a much higher "ick" factor.

 

[MSKalltheway]

Are you joking? That's a basic physical exam skill, if youre gonna be a doc, you need to get down and dirty sometimes.

 

[Law2Doc]

No chance on not doing one.

Some schools may not have standardized patients, but most do.

A standardized patient is the easy one. You usually aren't alone and the patient knows what's coming. When you have to go in alone and do one to an unsuspecting senior citizen complaining of a rectal bleed, because your attending wants one (notwithstanding that the dude is going to get colonoscopied regardless), that is what really tests your mettle. You not only won't get through med school without doing "one", you might not get through med school without doing ten. You have to treat the [w]hole patient in medicine. Sorry.

 

[mjl1717]

Do you think it would make you a better doctor?

Oh boy- one of those threads:

1) Eikenhein, you are being real funny!!!

2)Otherwise, To be Osler- like you would probably do it..

3)Lastly, since Im not going to entertain this guy too much..
A normal prostate should feel like the tip of your nose..
I rest my case.

 

[mjl1717]

A standardized patient is the easy one. You usually aren't alone and the patient knows what's coming. When you have to go in alone and do one to an unsuspecting senior citizen complaining of a rectal bleed, because your attending wants one (notwithstanding that the dude is going to get colonoscopied regardless), that is what really tests your mettle. You not only won't get through med school without doing "one", you might not get through med school without doing ten. You have to treat the [w]hole patient in medicine. Sorry.

So true!!

 

[Reimat]

Is there anyway you can get by medical school without having to do one?
Are there schools that do not do this or at least not on standardized patients?

Thanks.

I did about 6 in my first year at my preceptor's primary care office. Honestly, it's not that bad - in, twist, out, and done. Plus, you only have to do it a few times before you're able to ID an enlarged prostate.

 

[Law2Doc]

I did about 6 in my first year at my preceptor's primary care office. Honestly, it's not that bad - in, twist, out, and done. Plus, you only have to do it a few times before you're able to ID an enlarged prostate.

More often than not you are going to be looking for obvious "roids" or other sources of bleeding and then doing the hemocult. It won't take even a few times to do that adequately. If you have a working finger, you are proficient. Finding an enlarged prostate is just icing on the cake.

 

[MrBurns10]

I don't think it's that dumb a question. I'm more than halfway through clinicals and have yet to do one (except on the standardized patient we learned on). So maybe as a sub-I I will, but if I haven't done one on Family Med, Internal Med, or Surgery, I doubt I'll be doing any on peds and ob/gyn (except the pelvic, of which I've already done plenty).

 

[smq123]

I don't think it's that dumb a question. I'm more than halfway through clinicals and have yet to do one (except on the standardized patient we learned on). So maybe as a sub-I I will, but if I haven't done one on Family Med, Internal Med, or Surgery, I doubt I'll be doing any on peds and ob/gyn (except the pelvic, of which I've already done plenty).

You might need to do some kind of DRE-type procedure on OB/gyn. If your patient has an oddly positioned uterus (retroflexed/retroverted), you might need to put one finger in the rectum to do the pelvic. And since there's some primary care associated with OB, you might need to do a DRE then too.

You didn't do a DRE on surgery? Really? Geez. No anemic patients? No trauma patients? No need to assess rectal tone? Wow.

 

[SocialistMD]

I don't think it's that dumb a question. I'm more than halfway through clinicals and have yet to do one (except on the standardized patient we learned on). So maybe as a sub-I I will, but if I haven't done one on Family Med, Internal Med, or Surgery, I doubt I'll be doing any on peds and ob/gyn (except the pelvic, of which I've already done plenty).

How on earth did you do your surgery rotation without doing one? At both my medical school and the program where I am doing my residency, it is required for medical students to do a rectal exam (as in, there is a little book where you have to have a resident or attending sign off that they witnessed you do it).

 

[UCLAstudent]

How on earth did you do your surgery rotation without doing one? At both my medical school and the program where I am doing my residency, it is required for medical students to do a rectal exam (as in, there is a little book where you have to have a resident or attending sign off that they witnessed you do it).

I didn't do any on surgery, either --- unless you count urology.

 

[Law2Doc]

I don't think it's that dumb a question. I'm more than halfway through clinicals and have yet to do one (except on the standardized patient we learned on). So maybe as a sub-I I will, but if I haven't done one on Family Med, Internal Med, or Surgery, I doubt I'll be doing any on peds and ob/gyn (except the pelvic, of which I've already done plenty).

Medicine and OBGYN (ie the DRE) are the two core rotations where you typically do them. If not, then you just push the joy to your sub-I year or internship.

 

[myrtle]

It seems to vary a lot between schools. At Tulane, we do one on a standardized patient in the second year and I've heard from some 3rd/4th years that they do them all of the time and others that they never do, much like the responses on SDN. Maybe it depends on how much the school/rotation focuses on physical exam techniques?

Anyway, from personal experience, I was not all that thrilled to do one, but it worked out just fine. I think it's much better to do one on a standardized patient - ours have done it for 10+ years and know exactly how to teach us, what to say and do and don't mind (as far as I can tell) having it done repeatedly. It's much better than being thrown into the mix with random patients! If it's a fear that you have, I'd actually think you should seek out a school that offers practice with standardized patients first. Don't plan on not doing one at all, I'm sure you will at some point and it's better to have confronted your anxiety about it first.

 

[MossPoh]

Better than the old days when you practiced drawing blood and doing rectals on fellow med students. My dad did say that it increased bonding a bit. A finger up your friend's bum is about as close as you can get.

 

[SocialistMD]

Better than the old days when you practiced drawing blood and doing rectals on fellow med students.

We drew blood from each other. In 2003. When I was a rising third year. Ah, the old days...

 

[Blade28]

More importantly, what's the OP's objection to doing a rectal exam?

We drew blood from each other. In 2003. When I was a rising third year. Ah, the old days...

So did we. Late in my MS-I year (2001-2002).

 

[notdeadyet]

We drew blood from each other. In 2003. When I was a rising third year. Ah, the old days...

Still do that in some schools. Did that in workshops as an MSI this year for me.

Not the DREs, thankfully.

 

[angry energy]

alas, you have uncovered the secret. medicine makes you a homosexual and you learn to love sticking appendages into anuses for fun. when u feel the tingling in your pants, you know youre on your way to earning an md.

if youre a woman, you learn to love the freaky side of anal sex. we doctors are a different breed that the lay public can't even begin to fathom.

congrats on your discovery, may your newfound knowledge make you the most homosexual and freaky of us all!



.....seriously, grow up. you have to do vaginals, handle penises, insert foleys, do breast exams, disimpact a lotta stool, deal with rectovaginal fistulas, etc. i trade DRE's for rectovaginal fistula exams all the time.

 

[GoofyDoc]

Don't forget the therapeutic role of the DRE - disimpaction.

 

[-Goose-]

We just did DREs on standardized patients. It really wasn't that bad.

I've heard horror stories about dis-impactions, though.

 

[MrBurns10]

You didn't do a DRE on surgery? Really? Geez. No anemic patients? No trauma patients? No need to assess rectal tone? Wow.

haha nope, and to think I was actually on urology for two weeks. Of course the only clinic day I had was in peds uro where I pretty much just saw hypospadias all day.

I'm not sure if you all had to do H&Ps on surgery, but we didn't. We had to carry our own patients, but only once or twice during that rotation did I do an H&P and they didn't require a rectal. And now on medicine, if the patient calls for a rectal then the EM docs do it before we admit them and it's just plain mean to do two when one will suffice. Hence, no DREs. Unless you count the ones I do for fun on Saturday nights when I go out.

 

[SocialistMD]

I'm not sure if you all had to do H&Ps on surgery, but we didn't.

This is really a disservice bestowed upon you by your medical school. Unfortunately, this is how the medical school where I am currently doing my residency is, too. I try to get the med students on call with me to do an H&P, but most seem disinterested. Very frustrating.

We had to carry our own patients, but only once or twice during that rotation did I do an H&P and they didn't require a rectal. And now on medicine, if the patient calls for a rectal then the EM docs do it before we admit them and it's just plain mean to do two when one will suffice.

You are really doing yourself a disservice.
(1) Rectal exams are not that painful for the patient (more embarrassing than anything) and they aren't painful at all for you.
(2) How are you going to recognize something mildly yet significantly abnormal unless you have done them before. Do you really want to be an intern in charge of that exam, think it is normal, and then find out you were wrong.
(3) You will learn to not trust other people as your career progresses. I can think of two instances since January 1, in which I have been involved in the care of patients where the ED residents have either (a) been incorrect in their diagnosis on rectal or (b)have lied about doing it and it was never done. One was on a patient with a perirectal abscess (a freaking perirectal abscess!) where they didn't feel the massive fluctuance in the horseshoe abscess. The second was a massive fungating rectal cancer causing obstruction. Sure, the guy had an obstructive series and a CT that both showed obstruction (thus the surgical consult), but no rectal exam to at least try and figure out why. Bear in mind that I am in the lab and only interact with patients in the ED once a month, so God only knows how often it has happened total. I guess these guys went to a medical school where they didn't have to do rectal exams, either...

 

[MrBurns10]

This is really a disservice bestowed upon you by your medical school. Unfortunately, this is how the medical school where I am currently doing my residency is, too. I try to get the med students on call with me to do an H&P, but most seem disinterested. Very frustrating.

Well, we definitely have to do plenty of H&Ps on internal medicine. And if you can do an H&P on medicine, you can do one on surgery (which is half as detailed).

I can see where you're coming from as far as getting better at things, but to be honest, the most that we would be asked to do is to get enough sample to test for hemoccult rather than to diagnose prostate cancer or the (relatively rare) rectal abscess. This sort of skill will be learned at some point regardless, and I've had attendings tell me flat out that it's not necessary to do two rectals unless it becomes necessary. I don't doubt the quality of my clinical education thus far if that's what you're wondering, DRE or not...

I'm sure my streak will end come ob/gyn.

 

[smq123]

I'm not sure if you all had to do H&Ps on surgery, but we didn't. We had to carry our own patients, but only once or twice during that rotation did I do an H&P and they didn't require a rectal.

This is really a disservice bestowed upon you by your medical school. Unfortunately, this is how the medical school where I am currently doing my residency is, too. I try to get the med students on call with me to do an H&P, but most seem disinterested. Very frustrating.

That's true - there aren't very many chances to do H&Ps during surgery, which is the ONE thing that I appreciate about internal med. I don't like doing H&Ps, but I try to do as many as I can. If I don't do the initial H&P on the patient, then I canNOT remember a single damn thing about the patient, besides chief complaint. If I do the initial work up, though, I can almost effortlessly remember a lot of info about the patient - PMHx, HPI, how old they are, what meds they're on, pertinent family hx, etc.

We had to carry our own patients, but only once or twice during that rotation did I do an H&P and they didn't require a rectal.

Did you take trauma call on your rotation, though? A lot of trauma workup involves testing for rectal tone, especially if the patient might have hit his/her head.

 

[MrBurns10]

Did you take trauma call on your rotation, though? A lot of trauma workup involves testing for rectal tone, especially if the patient might have hit his/her head.

Actually, this was probably the most pointless aspect of our surgery rotation. They used to not make people take call but they did starting with my class. So basically, we'd page the gen surg on-call person to page us if anything happened while we were on the floor...but they never did. The only time I actually did anything while on call was when I was on my actual trauma rotation, but that's keeping in mind that trauma surgery is a gen surg fellowship, so we'd only see the patients that had abdominal injuries. And usually after the rectal had already been done by EM and we needed to get them to surgery right away. That's just how it worked...whether or not it makes sense, I have no clue.

 

[Ashers]

We weren't allowed to do rectal exams on OB/gyn -- just pelvics, even then I only did maybe 6 in 6 weeks, with 1 pap smear. I did more pelvic exams and paps on family med.

I just did my first rectal exam on a guy while he was anesthetized before getting a colostomy. The resident was like, "ok, you examine him." He was amazed when I asked what I was supposed to be feeling for, then I had to explain the not allowed to do rectovag exams on OB/gyn.

 

[smq123]

Actually, this was probably the most pointless aspect of our surgery rotation. They used to not make people take call but they did starting with my class. So basically, we'd page the gen surg on-call person to page us if anything happened while we were on the floor...but they never did.

I hated that too. I solved the problem by following the resident around everywhere.

(The chief for trauma call on that particular weekend was also my daytime chief, so he knew who I was. He also had no difficulty in telling me to stop trailing him like a homesick puppy! )

I think that "trauma call" on surgery rotations should be replaced by SICU call. On trauma call, I'd check in with the trauma intern, and then hang out in the SICU all night. That way, I got to do stuff (ABGs, help with a-lines, help with chest tubes), and I'd be nearby for all codes. Plus, I'd hear from the SICU residents whenever a trauma patient DID come in to the ED, so I'd know when something interesting was going back to the OR.

 

[SocialistMD]

I think that "trauma call" on surgery rotations should be replaced by SICU call. On trauma call, I'd check in with the trauma intern, and then hang out in the SICU all night. That way, I got to do stuff (ABGs, help with a-lines, help with chest tubes), and I'd be nearby for all codes. Plus, I'd hear from the SICU residents whenever a trauma patient DID come in to the ED, so I'd know when something interesting was going back to the OR.

I think it would be even better time spent in the ED. You could always find a lac to suture and there is always interesting pathology to see there. Personally, when I'm on call in the ED, I spend my time hanging out with the ED radiologists, learning to better read films. I think you see more diversity there and have more opportunity to do things than you do in the ICU. Plus, when a trauma comes in, you are there and ready to do it.

To get to the point of the trauma rectal, that was the med students' role in every trauma when we were on call (back when I was a student); insert foley and perform DRE. When our med students actually show up for traumas, I get them to do the same.

 

[MadameLULU]

Once, my glove broke while doing a rectal

 

[TRAMD]

Is there anyway you can get by medical school without having to do one?
Are there schools that do not do this or at least not on standardized patients?

Thanks.

Why would you want to avoid them? They are WAY better than doing PAPs/pelvics.

 

[TRAMD]

Once, my glove broke while doing a rectal

If a part of the equation is failing then you must eliminate it. Don't wear gloves . . . problem solved!

 

[Sartorius24]

Maybe the OP is worried about being sued?

Peter/Judge/Exam

 

[Law2Doc]

Maybe the OP is worried about being sued?

Well, comedy aside, once you are a physician, you can absolutely be sued for not doing one and missing something that kills the patient.

 

[NREMTP]

No, the comedy was great!!! Thanks for laugh for this probing question " Do we have to do a rectal digital exam?"
Yes the pun was intended

 

[Sartorius24]

Well, comedy aside, once you are a physician, you can absolutely be sued for not doing one and missing something that kills the patient.

You can also be sued for doing one...check this out

Construction Worker

 

[Sartorius24]

Just for fun...here's another...this one is classic

Peter/Prostate

 

[-Goose-]

Once, my glove broke while doing a rectal

NOOOO!!!

 

[sendwich]

Once, my glove broke while doing a rectal

that's it, imma gonna make sure i always double glove!!