‘Could you push for me please?’ and other awkward moments of physical examination.

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(This article is a translation. Find the original piece on the website or in the PanEssay paper)


‘Would you drop your pants please.’ One of the few moments at which this statement isn’t inappropriate and/or uncomfortable, is prior to physical examination. Or no, scratch that - even in a medical setting it can still feel quite strange to ask complete strangers to undress. And to think at that point the actual touching, tapping and moving about hasn’t even started…

I’ve written before about the constant insecurity that comes with the transition from medical student to doctor. It is never more apparent as during the physical examination; radiating professionality and confidence is much harder when you’re standing there shaking with sweaty palms, palpating someone's stomach..

The whole thing starts with hand hygiene (if you haven’t already forgot about it): washing with soap or disinfecting with alcohol? Washing takes longer but can help to warm up your cold hands a little. Disinfecting alcohol is correct by protocol, but, however, not an optimal combination with the above mentioned sweaty hands. Whichever way you solve this, do it as the patient is undressing - how much time that takes is often unpredictable. One patient needs half an hour to take off their shoes, another might need only seconds to appear stark naked from behind the curtain while you thought you still had time to quickly pick something from your teeth.

And after that the real scary part arrives: sweaty feet, strange belly buttons, unexpected piercings. When my last patient opened her mouth and I thought WHAT IS THAT, I only managed to interrupt my DD when I realised I was looking at a tongue piercing.  

Seriously nasty stuff we luckily only rarely encounter, although I heard some pretty gnarly stories as a result of writing this cocolumn. ‘A friend of mine did a rectal exam, and when she spread the patients cheeks, poop fell onto the exam table.’ The rectal/vaginal exam is of course by itself already a cause of discomfort. ‘You’ll feel my finger now, can you push please?’ it’s still difficult for me to say these things.

And how do you deal with the fact that physical examination sometimes can hurt the patient? I’m slowly getting the idea that doctors learn with the years to ignore squeals and grimaces. ‘So this is where it hurts?’ the rheumatologist cheerfully asks while she palpates a terribly infected joint affected by arthritis. Starters like me have the opposite inclination, which is to stop the examination at the first little sound from the patient: ‘Well alright, I’ve seen enough!’ This can also be the result of a patient feeling more comfortable to complain of our actions than those of the all knowing specialist. 


The last dilemma: do you let the patient fully dress themselves before you call in your supervisor? Sometimes things can take longer than expected, and to leave someone laying naked on the table for twenty minutes isn’t really ideal. But on the other hand, I do sometimes see the annoyance in a patient when the specialist asks them to undress a second time - and yes, the socks too, Sir. Some specialists don’t have the patience for this themselves either: watching as an eighty year old arthritic patient fumbles with buttons is more than the average orthopedist can handle

Yes, we all surely deserve compassion, having to go through all this. Until the day arrives that you have to be on the table yourself for a smear test, skin biopsy or throat swab - then you’ll see who really deserves compassion.