Monday, December 10, 2012

Does your patient need a rectal exam?



25 comments:

  1. In med school I was assigned to do a rectal on a guy who hadn't bathed in weeks. Fortunately for me, when I went in the room to do it he was dead.

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  2. You forgot, "Is he/she hot?"

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  3. Dr. G - WRONG END!

    As a patient who had a prolapsed bowel as a child, the closest you are getting to me to do a rectal exam is 50 feet.

    If the MDs, students (baby docs) and other medical professionals care for me as a person, they won't even suggest it.

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    1. Are you suggesting that those of us who are trying to find your potential rectal cancer, evaluate it and decide on the proper type of surgery, don't care for you as a person?

      Wow. That takes being self-centered and buried in long-past trauma into a whole new level. All I can say is that I hope you don't stay 50 feet away from that MD long enough to have a cancer prolapse out of your bottom end.

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  4. Wow, Snarky Scalpel and Grumpy, MD, just made my day.
    Grumpy, it's always the awesome when your patient being dead is a good thing. I remember looking at the sick people in bed during residency and thinking "God, I wish I was sick, I want to lie in bed!"
    And Snarky Scalpel, that is right on the nose. Ms. Donna, if you don't want a rectal exam, don't get one, but please don't act like it's a good and respectful choice on the part of your doctor. It's not like we wake up in the morning looking to traumatize people and hoping to stick fingers in butts.

    Dr. Alice

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  5. This is offensive to morbidly obese people. So, you're okay with making fun of fat people as a doctor?

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    1. Everything is offensive to someone. Suck it up, you'll live.

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    2. This comment is offensive to doctors. Are you saying doctors aren't allowed to have a sense of humor?

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    3. Does a sense of humor always entail making fun of fat people?

      I'm pretty sure you can still have a sense of humor without resorting to making fun of fat people.

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    4. This post also makes fun of dermatologists, proctologists, physiatrists, GI docs, med students, residents, and just physician squeamishness in general, and any of those people could be rightfully offended. You chose to find it offensive from that particular viewpoint, for whatever reason. If the requirement for physicians is to avoid saying anything that could possibly be construed as offensive to anyone, then you are grossly limiting our freedom of speech and definitely our ability to find humor in our lives, which I think is a basic human right.

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    5. I just think doctors should be aware of making fun of fat people especially since obesity is the number one health risk and problem right now in the U.S.

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    6. So of all the thousands of different groups out there, somehow obesity alone is off limits to make fun of? Why can't other groups make similar arguments? "You can't make fun of med students because you train them. You can't make fun of elderly people because they are at risk for a lot of health problems." Any group can come up with an argument why they should be off limits. Doctors are human too and allowed to vent about their lives with humor just like everyone else, and shouldn't be restricted based on fairly arbitrary criteria.

      Of all the jokes that could be made about obesity, the one in this cartoon was pretty benign unless you're specifically looking for things to offend you. It's simply a fact that rectal exams on people who are morbidly obese are incredibly technically difficult. If anything, the joke was more about doctors who are reluctant to perform rectal exams for stupid reasons, but if you're prone to be offended about obesity, of course you'll see it that way.

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  6. "Why can't other groups make similar arguments?"

    Because, like I said, obesity is the number one health problem in the US right now. Smoking used to be it, obesity second, but now obesity is number one! That's why!

    I'm not offended, but I think that as a doctor, if you're poking fun at obesity for any reason whatsoever(ex. "rectal exams on people who are morbidly obese are incredibly technically difficult"), you're probably not helping obesity be taken seriously nor contributing to the decrease of this health problem.

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    1. So whatever the number one health problem is, that's off the table for making fun of? So if less people were obese, I could make fat jokes again and it would be okay? Come on!

      Rectal exams ARE incredibly technically difficult on morbidly obese people. That was a serious statement and absolutely not a joke at all. Most procedures are much more difficult on people with a very large body habitus. Therein lies the problem: I can't even make a serious statement about obesity without you getting offended (and obviously you are, otherwise why comment?). As someone commented above, everything is offensive to somebody, so there's usually no point in even trying.

      I always give the example of the SAHM who felt that a particular cartoon I drew was offensive to SAHMs when it really had pretty much nothing to do with SAHMs: http://www.kevinmd.com/blog/2010/05/cartoon-guide-nonclinical-jobs-doctors.html

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    2. I'm with you fizzy. Other anonymous' mamma just so fat, that when she jumps for joy, she gets stuck. Anonymous, that is offensive to fat people. And also a bad joke. The point being nothing is ever off limits. If its worth taking seriously, its worth taking the piss out of.

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    3. lol ok. That may be a true statement, but there's a double entendre in your chart, no? I mean, at least that's how I saw it.

      Again, I'm not the one offended here. If I was morbidly obese, maybe I would be. But after learning in med school that way too many doctors judge fat patients and don't treat them as well, I could see why. It's alarming because
      it's the number one national health problem. I'm just raising awareness. And, I think it would be appreciated to be a little more sensitive to obesity itself and treat it with more seriousness.

      @ Anon: I would disagree that nothing is ever off limits. Anybody can make yo mamma jokes, sure, but it's a little different if a doctor is promoting jokes about fat people. Again, I know this post doesn't represent the worst of the jokes out there, but I've already made my point.

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    4. So in summary, a post that you are not offended by is too offensive to post?

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    5. Yes, Fizzy. You are always right. God forbid that for once you open up your mind and realize that maybe you're a little wrong. It seems like you're the kind of person that always has to be right, so you have to always argue your point so that you always have the last word. It never crosses your mind that "mmm...maybe that person has a point, even a little one? Could I be wrong, maybe just a little bit?" Good for you. End of discussion.

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    6. "Why can't you open your mind enough to admit that you are wrong and I am right?"

      I love hypocrisy :)

      I disagree with you. I'm entitled to my opinion, aren't I? Or can't you even grant me that?

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    7. 1. It's her blog, so she does get to have the last word.
      2. Ask any person in medicine whether it's harder to deal with morbidly obese patients than it is to deal with patients of average weight. It's not a value judgement, it's the truth: harder anesthesia, harder to auscultate, and yes, harder to get into the rectum with a finger. That's one of the many reasons it is recommended that people not be morbidly obese: it's harder to deliver medical care.

      --Dr. Alice

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    8. I think Dr. Alice is totally, 100% right.

      See? I can admit other people are right.

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  7. This just made my week. Earlier today I had to cath a morbidly obese woman. It took THREE med students to lift the apron of fat high enough that I could even do it. The whole time I was thinking that at least it wasn't a rectal exam!

    You made me giggle, offended anon.

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  8. I agree with Fizzy and Dr Alice!
    1. For a fact it is a lot harder to deal with morbidly obese patients, whoever denies that ís either lying or has no physical contact with patients.
    2. Humor is a great way to deal and vent with everyday day issues and problems in hospitals. Just on a side note I live/work in Austria, where Smoking is still the number one health problem. So its perfectly ok to make fun of fat people here, according to anon.
    Dr Phil

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