No Surprises

"No Surprises." That was the lesson of today's lesson.

Last week was the female pelvic exam and today was the male pelvic exam. Our educator, reminded us that the the pelvic exam is not as simple as asking someone to "stick out their tongue." Like the female pelvic exam, there are many parts to the exam that take us to an entirely new physical exam territory.

Our educator emphasized the importance of remaining "nonjudgmental," when we start dealing with real patients from the real world, including real human sexual behaviors that may not seem normal to us. We gain to learn from our patients and in doing so, we must pay attention to our facial expressions, verbal and body language.

There were three main parts to the exam: the breast exam, pelvic exam and rectal exam.

Although breast cancer is most common in women, men can develop breast cancer. For this reason, it is important to perform the breast exam and teach patients to perform self-exams. The cases of breast cancer in males generally is more severe, because cancer often goes undetected.

The pelvic exam was not nearly as complicated as the female pelvic exam (there was no metal instruments). Most of the exam was external, involving visual inspection and palpation, with the exception of the classic hernia exam (turn your head and cough test). As our educator walked us through the motions, he explained how to be sensitive to our patients, including the golden rule of "no surprises," to stress the importance of open communication and clear explanations.

The last part of the exam is the dreaded rectal exam (uncomfortable for the patient and the examiner). Our educators had some great tips to help patients relax (because no one really relaxes if you tell them to "relax.") Lubrication and deep breathing exercises combined with Kegels may do the trick to help patients relax (or to help the examiner relax, at least).

As I mentally prepared myself for the rectal exam (specifically thinking about where my finger was to go), I realized how we have learned to palpate and navigate every corner of the body, including orifices, such as the anus. Using a wind-shield motion, I could feel the surface of the prostate gland and with a 360 degree rotation, I could feel the rectal wall (the anatomy can only be appreciated your finger has made it's way far enough up, in case your are interested in knowing).

The last exam will be the breast exam. After that, I will have learned the full head-to-toe physical.

We come a long way. It will be interesting when we start performing full physical exams on our patients. Hopefully, we'll remember the lessons our educators have taught us and have too many surprises.