Rectal Exams In PM&R?

[Llenroc]

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I'm a currently doing Emergency Medicine. I really hate the frequent rectal exams, even though I try to avoid "abdominal pain" cases. They even made me do it on a guy with uncomplicated lower back pain yesterday.

Last year I did three rotations in PM&R. I don't recall any rectal exams happening, but then again I never did SCI or a whole lot of consults.

How frequently do you have to do rectal exams as a resident? How about as an attending?

Now I'm scared.

 

[MSKalltheway]

You'll have to do them on SCI when doing an ASIA exam. I did a couple myself during the RIC externship.

To be honest, those were relatively mild compared to my experience with rectal exams on VA General Surgery, after that I'm pretty immune

 

[topwise]

I'm a currently doing Emergency Medicine. I really hate the frequent rectal exams,

Really?? Cuz I absolutely LOVE them. 😛

Any inpatient ward will require at least occasional rectal exams. The ASIA exam requires it and a lot of other patient complaints may require it. I probably did a lot more as a medicine prelim than as a rehab resident, mostly due to sheer volume of patients. On outpt rotations, esp stuff like Sports, you never have to do it.

But if you really don't want to ever do rectal exams, you should become an ophthalmologist. I'm fairly sure those guys do minimal rectal exams. (correct me if I'm wrong)

 

[SCIronMike]

Just about every spinal cord patient on the unit gets a rectal exam on the admission ASIA exam. A few BC reflexes too in the outpatient clinic for the low back pain patients.

 

[AviatorDoc]

Rectal exams are not the most disgusting thing in medicine, by far. If you don't like doing rectals, you won't like the first few years of PM&R residency.

 

[lobelsteve]

Plenty of rectal exams for the ASIA exam in acute SCI and chronic follow-up (at the VAMC). The acute exams provided useful info as far as tone. The chronic may provide useful info as they are done yearly on a large number of veterans with chronic SCI and there will be a very large data base of ASIA EXAM info.

Bulbocavernosus exam: not me. I do not think it has any utility. But if you like squeezing some dudes wanker- you can use it as an excuse.

 

[Llenroc]

Do you guys ever have to do pelvic exams? Because they made me do one of those yesterday, and I really hated it. One of the nurses yesterday was insisting that we do one on a pt. who was being treated for hyperglycemia, because she had mumbled something about a yeast infection. The attending said it was up to me, and I said that it wasn't indicated. Then the nurse told us that she had already set the pt. up for it without anyone's permission, so the attending made me do it.

Of course it changed nothing. I really hate Emergency Medicine. It's kind of like John Edward's theory of two Americas. One America is a long depressing cycle of Percocet, which revolves around the ED, and ends with a Percocet overdose in the ED parking lot. I've never seen the ED doctors refuse anyone narcotics. The other America is a depressing series of incidental crotch and/or rectal exams. 🙁

 

[olafa]

Do you guys ever have to do pelvic exams?

NO thanks, I'd pass on that.😱
But as the others said, with SCI its definately part of the exam. It's quick and not too terrible. Not doing it would be like doing a neuro exam without testing the cranial nerves.

 

[Llenroc]

Do you guys ever have to do pelvic exams?

NO thanks, I'd pass on that.😱
But as the others said, with SCI its definately part of the exam. It's quick and not too terrible. Not doing it would be like doing a neuro exam without testing the cranial nerves.

Noted. That I can live with. 👍

 

[dc2md]

Do you guys ever have to do pelvic exams?

NO thanks, I'd pass on that.😱
But as the others said, with SCI its definately part of the exam. It's quick and not too terrible. Not doing it would be like doing a neuro exam without testing the cranial nerves.

i must be hearing you wrong. you're saying pelvic exams are part of a SCI exam? not an ASIA requirement that for sure. maybe you're considering a clitoris pinch to check for spinal shock part of the exam. i'll pass on that though. 😀

 

[Fro]

Do you guys ever have to do pelvic exams? Because they made me do one of those yesterday, and I really hated it. One of the nurses yesterday was insisting that we do one on a pt. who was being treated for hyperglycemia, because she had mumbled something about a yeast infection. The attending said it was up to me, and I said that it wasn't indicated. Then the nurse told us that she had already set the pt. up for it without anyone's permission, so the attending made me do it. 🙁

Are you seriously a med student? How could you not know these procedures were coming? Suck it up you pansy, this is part of the training process. Wait till OB/gyn when you gotta check effacement & dilation, prep, catch, episiotomy, etc.

 

[Llenroc]

I'm no student. I get paid money for doing this.

As for the pelvic exam, no I was not suggesting that it's part of an SCI evaluation. LOL.

No my main concern was like these ED suckers who pull out (or at least are supposed to pull out) the speculum whenever the inner city female population complains of something not being right with their vagina (which is 110% of the time) as an incidental finding on the review of systems, whether inpatient physiatrists get stuck doing the same thing.

 

[PMR 4 MSK]

I'm no student. I get paid money for doing this.

As for the pelvic exam, no I was not suggesting that it's part of an SCI evaluation. LOL.

No my main concern was like these ED suckers who pull out (or at least are supposed to pull out) the speculum whenever the inner city female population complains of something not being right with their vagina (which is 110% of the time) as an incidental finding on the review of systems, whether inpatient physiatrists get stuck doing the same thing.

Rare, very rare.

 

[SSdoc33]

i must be hearing you wrong. you're saying pelvic exams are part of a SCI exam? not an ASIA requirement that for sure. maybe you're considering a clitoris pinch to check for spinal shock part of the exam. i'll pass on that though. 😀

pelvic exams are not part of ASIA, but you do gotta yank on the pubes for the BC reflex. yummy.....

 

[SSdoc33]

Do you guys ever have to do pelvic exams? Because they made me do one of those yesterday, and I really hated it. One of the nurses yesterday was insisting that we do one on a pt. who was being treated for hyperglycemia, because she had mumbled something about a yeast infection. The attending said it was up to me, and I said that it wasn't indicated. Then the nurse told us that she had already set the pt. up for it without anyone's permission, so the attending made me do it.

yeah. you should do a pelvic on that patient. or at least look at her vah j-j, i dont know about a whole speculum exam. sucks being a doctor, and getting paid to use your mind. tragic......

thats a pretty rare situation, as is the need for a rectal in LBP patients IMHO...