rectal exam

[mjl1717]

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

Peter/Prostate

Yes and as L2D mentioned we anticipated comic relief.. [ I guess we need it]

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[Bananas Foster]

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

horror stories?

what, didja strike oil once you got past the bedrock?

 

[felipe5]

a friend of mine pulled out a decent sized nugget on his finger after doing one of his first DRE's at our VA...😀 it was absolutely freaking hilarous and a bit nauseating at the same time.... skip ahead a few months and I matched in to urology

 

[-Goose-]

horror stories?

what, didja strike oil once you got past the bedrock?

Exactly. If you want the whole story, read this book: http://www.amazon.com/gp/product/15...ref=sr_1_1/104-0287391-7996756?_encoding=UTF8

Basically, the author is called in as a 3rd year to do a fecal dys-impaction. After some serious work (several attempted enemas), he was successful. Turns out he got more than he bargained for and was covered up to his shoulder. Even sprayed it on an innocent bystander (nurse). I'm doing the story zero justice. Buy the book, its great just for that story alone (and many others)...


(actually its a great book by a legend in medical education from the nation's finest university 😉 )

 

[ClockworkDoc]

Exactly. If you want the whole story, read this book: http://www.amazon.com/gp/product/15...ref=sr_1_1/104-0287391-7996756?_encoding=UTF8

Basically, the author is called in as a 3rd year to do a fecal dys-impaction. After some serious work (several attempted enemas), he was successful. Turns out he got more than he bargained for and was covered up to his shoulder. Even sprayed it on an innocent bystander (nurse). I'm doing the story zero justice. Buy the book, its great just for that story alone (and many others)...


(actually its a great book by a legend in medical education from the nation's finest university 😉 )

Sounds like a great book, I'll definitely check it out.

I also wanted to comment about how well your name goes with the thread topic.😀

 

[TheLesPaul]

Sounds like a great book, I'll definitely check it out.

I also wanted to comment about how well your name goes with the thread topic.😀

Not as well as yours does 🙂.

 

[KECKington]

Not as well as yours does 🙂.

Or yours......

 

[TheLesPaul]

I don't get it..?

 

[doctorFred]

I can't help but think that the people who sign up to be standardized patients for rectal exams are getting off on it. Because why the hell else would you bend over so that 15 total strangers could tickle your prostate, conveyer belt style.

 

[KECKington]

I can't help but think that the people who sign up to be standardized patients for rectal exams are getting off on it. Because why the hell else would you bend over so that 15 total strangers could tickle your prostate, conveyer belt style.

It is because they get a free cancer exam, and their insurance wouldnt pay for a second opinion (let alone 14 more)!

 

[Law2Doc]

I can't help but think that the people who sign up to be standardized patients for rectal exams are getting off on it. Because why the hell else would you bend over so that 15 total strangers could tickle your prostate, conveyer belt style.

There are probably a range of motivations, ranging from prurient, to the "easy" money involved (tends to actually be a lot for a single day of "work"), to the motivation to help better educate a profession that perhaps you have had uncomfortable experiences with in the past. I kind of doubt the "free cancer exam" is a motivating factor because 99% of the students wouldn't recognize an enlarged prostate regardless.

 

[-Goose-]

I can't help but think that the people who sign up to be standardized patients for rectal exams are getting off on it. Because why the hell else would you bend over so that 15 total strangers could tickle your prostate, conveyer belt style.

$.

 

[PeepshowJohnny]

I can't help but think that the people who sign up to be standardized patients for rectal exams are getting off on it. Because why the hell else would you bend over so that 15 total strangers could tickle your prostate, conveyer belt style.

It usually is more about the money the school will fork over, but they tend to be...eccentric individuals. Not so much that they're getting sexual pleasure from it but that their manner during the thing can be a little offsetting.

 

[KECKington]

It usually is more about the money the school will fork over, but they tend to be...eccentric individuals. Not so much that they're getting sexual pleasure from it but that their manner during the thing can be a little offsetting.

Wait....they are not moaning during the exam are they?

 

[smq123]

I kind of doubt the "free cancer exam" is a motivating factor because 99% of the students wouldn't recognize an enlarged prostate regardless.

At our school, our clinical instructors (all MD attendings) usually do the exam first, just so they can tell us if there is something in particular that we should be watching for. ("He has a benign nodule," or "She has a cyst in the upper outer quadrant of the right breast," etc.) So I guess it CAN be kind of like a free exam....

Wait....they are not moaning during the exam are they?

We had a standardized patient who would breathe VERY heavily after FEMALE students did an abdominal or a lung exam (particularly while we were percussing his back). He would remain totally quiet for the male students.

Then, after the exam was finished, he'd lean back and say to you, "Well? Was it as good for you as it was for me?"

Needless to say, he got fired the next year.

I wish I was making this up.

 

[45408]

Yeah, my standardized patient for the pelvic exam was maybe 25, and about halfway through our small group session, she commented on the lengths she has to go to pay off her undergrad loans. I also know of a girl who said she did it when she was short on cash, because she got something like $40 an hour for it.

One of my dad's college buddies is an actor for the interviewing class, and he recognized me I had met him once or twice, but it had been 10+ years, but I gave him my real name, and I look a fair amount like my dad, so he figured it out. He's an actor/playwright, and he needs the extra money as well.

The LOL we had for a practice H&P mentioned that she volunteers elsewhere, so this is probably just something she does to keep herself busy.

 

[KECKington]

At our school, our clinical instructors (all MD attendings) usually do the exam first, just so they can tell us if there is something in particular that we should be watching for. ("He has a benign nodule," or "She has a cyst in the upper outer quadrant of the right breast," etc.) So I guess it CAN be kind of like a free exam....



We had a standardized patient who would breathe VERY heavily after FEMALE students did an abdominal or a lung exam (particularly while we were percussing his back). He would remain totally quiet for the male students.

Then, after the exam was finished, he'd lean back and say to you, "Well? Was it as good for you as it was for me?"

Needless to say, he got fired the next year.

I wish I was making this up.

😆

 

[PeepshowJohnny]

Wait....they are not moaning during the exam are they?

Nothing that base. It's hard to describe, you just get a sense of...."There's something different about this guy"

 

[CigarTragic]

I can't help but think that the people who sign up to be standardized patients for rectal exams are getting off on it. Because why the hell else would you bend over so that 15 total strangers could tickle your prostate, conveyer belt style.

 

[praying4MD]

Once, my glove broke while doing a rectal 🙁

It's times like these when I love that I am in Pediatrics and not in Surgery.

 

[TRAMD]

It's times like these when I love that I am in Pediatrics and not in Surgery.

The gloves don't break when you do pediatric rectal exams?

 

[TRAMD]

I remember the standardized patient we had for pelvic exams. She was very helpful. When I was doing it wrong she said, "Not there, more to the left." I moved to the left and she said, "There THERE; OH GOD THERE!!!"

I told this joke to some other medical students later that day and one of them reported me to the dean. 🙁

 

[praying4MD]

The gloves don't break when you do pediatric rectal exams?

I think I'd get shot if I did a rectal on an infant, or 5 year old for that matter. Highly, highly contraindicated. Probably lose my license or something. Same thing for pelvic exams (Obviously.) Even in suspected cases of abuse, if it is a younger (less than 11 or so) female, only an external genital exam is necessary (unless of course, there is bleeding or some other indication for it.)

Really, only adolescents get rectals and only if there is a real reason to do it (Same with pelvics.) Also, kids are just less dirty and less smelly than the 80 year old men I remember having to do rectals on at the VA (for example.) Not always, but mostly.

 

[TMP-SMX]

I think I'd get shot if I did a rectal on an infant, or 5 year old for that matter. Highly, highly contraindicated. Probably lose my license or something. Same thing for pelvic exams (Obviously.) Even in suspected cases of abuse, if it is a younger (less than 11 or so) female, only an external genital exam is necessary (unless of course, there is bleeding or some other indication for it.)

Really, only adolescents get rectals and only if there is a real reason to do it (Same with pelvics.) Also, kids are just less dirty and less smelly than the 80 year old men I remember having to do rectals on at the VA (for example.) Not always, but mostly.

You'll be sticking thermometers in their anus all the time.

 

[ladynice]

I remember the standardized patient we had for pelvic exams. She was very helpful. When I was doing it wrong she said, "Not there, more to the left." I moved to the left and she said, "There THERE; OH GOD THERE!!!"

I told this joke to some other medical students later that day and one of them reported me to the dean. 🙁

Why would they report you for hitting an ovary 😕

 

[TRAMD]

I think I'd get shot if I did a rectal on an infant, or 5 year old for that matter. Highly, highly contraindicated. Probably lose my license or something. Same thing for pelvic exams (Obviously.) Even in suspected cases of abuse, if it is a younger (less than 11 or so) female, only an external genital exam is necessary (unless of course, there is bleeding or some other indication for it.)

Really, only adolescents get rectals and only if there is a real reason to do it (Same with pelvics.) Also, kids are just less dirty and less smelly than the 80 year old men I remember having to do rectals on at the VA (for example.) Not always, but mostly.

I apologize for not making the sarcastic nature of my post more obvious.

 

[SocialistMD]

I think I'd get shot if I did a rectal on an infant, or 5 year old for that matter.

Did one on a four-month old this weekend. Perhaps another reason to enjoy not being in surgery.

 

[praying4MD]

You'll be sticking thermometers in their anus all the time.

While this, in my opinion, *should* be standard practice -- you would be surprised that at my institution (and at many others,) the thermometer in the anus technique is no longer used on the newborn exam to test for a perforate anus.

I discovered this, when, on my first night on call as an Intern, I had a pt with a small bowel obstruction (YIKES!) who had been examined many times by many upper levels and fellows, but all had missed the imperforate anus. No kidding. This equalled an emergent ex lap and small bowel resection for the kid on day of life #2. Yikes.

And anyway, thermometer does not equal my finger. Big difference to the germaphobes out there like me.

If you're talking about thermometer in the anus for taking the temperature -- I believe that is in the nurses' job description, not mine. 😉 (Although, truthfully, I wouldn't care either way - We're just usually too pressed for time to actually get our own vitals -- the nurses do that for us...)

 

[praying4MD]

Did one on a four-month old this weekend. Perhaps another reason to enjoy not being in surgery.

Please tell me they were under some sort of conscious sedation or something.

Please? 😱

I guess if it is warranted, then by all means... All I'm saying is that it is, in general, less warranted in Peds than in Medicine or Surgery, and for that, I'm happy. 🙂

 

[Dr. McDreamy]

I actually got all the way thru internal medicine without having to do a rectal. every time the resident would say "hey did you do a hemmacult test?" i would look in the chart and low and behold the kind folks in the ER had already done it for me.

unfortunately on family medicine i did about 1000 rectals. 🙁

 

[Law2Doc]

I think I'd get shot if I did a rectal on an infant, or 5 year old for that matter. Highly, highly contraindicated. Probably lose my license or something. Same thing for pelvic exams (Obviously.)

Pediatricians often take care of individuals up through age 20. It's less frequent, but not unheard of, for teens to have GI bleeds, ulcers, hemoroids, rectal STDs. And certainly not unheard of for females of this age group or younger to have gyn issues and not be plugged in with a gynecologist yet. So I kind of doubt you can plan to be a pediatrician and never do either, unless you specialize on neonates. Lots of late teens get a full physical from their pediatrician before they ship off to college, and a full physical is supposed to include these things. You don't really get to be a physician and say "I'll only examine everything above the belt".

 

[SocialistMD]

So I kind of doubt you can plan to be a pediatrician and never do either, unless you specialize on neonates.

Even still. If you have a newborn with Hirschsprung's, they usually get a finger in there around the same time the tube is placed.

 

[praying4MD]

Pediatricians often take care of individuals up through age 20. It's less frequent, but not unheard of, for teens to have GI bleeds, ulcers, hemoroids, rectal STDs. And certainly not unheard of for females of this age group or younger to have gyn issues and not be plugged in with a gynecologist yet. So I kind of doubt you can plan to be a pediatrician and never do either, unless you specialize on neonates. Lots of late teens get a full physical from their pediatrician before they ship off to college, and a full physical is supposed to include these things. You don't really get to be a physician and say "I'll only examine everything above the belt".

First off, I'm a PGY-1. Second of all, I never said, "I *never* perform rectals." I have re-stated the same thing three times on this thread. Jeez. I just said that we do it LESS frequently than Medicine or Surgery does. I have done my fair share of pelvics, believe me. That essentially what Adolescent Medicine is.

I NEVER NEVER said, OR implied that I would be a physician "above the belt." In fact, I have a great contempt for physicians like that.

I pride myself on being a better doctor than that. Yes, despite the screen name, I am already a physician. People who knew my history (I am an older member of SDN) would understand where my comment is coming from -- I originally matched to General Surgery and switched to Pedatrics later -- so that is my frame of reference for comparison -- pretty darn good if you ask me.

I still stand by my original statement: Rectal exams and Pelvics are LESS common in Pediatrics. And when we do them, they are *generally* less painful, less malodorous. For me, at least.

That is all I ever said or implied -- this immediate jumping on me and questioning my professionalism or work ethic is rather hilarious, and offensive (If I actually cared what random internet people thought of me.) Suffice it to say, I am blessed to train in one of the largest and busiest and prestigious Pediatrics Programs in the country -- trust me, my training is adequate and I'll do just fine as a Pediatrician and be well-versed in the nuances of pelvics and rectals.

Wow -- if I have to defend my performance of rectals of pelvics again....

 

[praying4MD]

Pediatricians often take care of individuals up through age 20. It's less frequent, but not unheard of, for teens to have GI bleeds, ulcers, hemoroids, rectal STDs. And certainly not unheard of for females of this age group or younger to have gyn issues and not be plugged in with a gynecologist yet. So I kind of doubt you can plan to be a pediatrician and never do either, unless you specialize on neonates. Lots of late teens get a full physical from their pediatrician before they ship off to college, and a full physical is supposed to include these things. You don't really get to be a physician and say "I'll only examine everything above the belt".

Second of all - please read the rest of my posts where I already addressed the fact that I am already a physician and already defended and addressed the various points you mentioned, including a huge learning experience I had on call regarding this very subject.