Introduction

Reviews

The Warning Signs of a Less-Than-Adequate Physical Exam, Part 2

Timothy B. McCall, M.D.

Here are a few more warning signs of a less-than-adequate physical exam:

• The Doctor Doesn't Follow “Universal Precautions”

Because of the possibility of spreading infection—either from the doctor to the patient or vice versa—doctors should wear gloves during certain parts of the physical exam, for example, if they'll be putting their fingers inside your mouth, examining a skin infection or performing a genital exam. Don't feel insulted if a doctor or dentist wears gloves while examining you—it's for your protection and theirs. Be more concerned if they don't, because if they’re not wearing gloves with you, they may not be wearing them with other patients whose infections you could catch.

• Embarrassing Exams Are Skipped.

Doctors are most likely to “defer” rectal exams and gynecologic exams and other tests that they and their patients find embarrassing. Doctors who skip a needed test to save their patients from embarrassment are doing those patients no favor. At times, they may be doing a grave disservice.

I remember an elderly man with a drinking problem who complained for years of stomach pains. His doctor examined the man's belly on several occasions but never bothered to do a rectal exam, despite the man's ongoing symptoms. If the doctor had done the exam, a simple chemical test probably would have shown hidden blood in the man's stool, a warning sign for cancer. Instead, two years went by until the man turned up at a local hospital where stomach cancer was diagnosed. By that time, the cancer had spread extensively and was inoperable

Doctors are more likely to forgo embarrassing exams on members of the opposite sex. A recent study in the New England Journal of Medicine showed that female physicians were twice likely as males to obtain Pap smears on women patients. Young males doctors were found to be least likely to do the test. I have seen several cases where male doctors failed to perform a gynecologic exam on young women with unexplained abdominal pain, a necessity to rule out a pelvic infection or life-threatening tubal pregnancy.

• The Doctor Doesn't Respect Your Modesty

The flip side of a doctor's being complete and risking embarrassment is the importance of respecting your modesty. When in doubt, a doctor should take care to drape the areas of the body being examined with sheets and to expose only as much as is necessary at a time. Doctors examining you in a hospital bed or in an Emergency Room should close the curtain separating you from other patients and when possible, shut the door. A doctor who leaves the room while you change into a gown should knock before re-entering to avoid barging in before you're ready.

When a male physician performs a gynecologic exam, it's reasonable to request that a female nurse or other female employee be present, to act as a chaperone of sorts. Many clinics do this automatically. If you feel more comfortable, you may request that a nurse be present for the entire physical exam.

Remember though, if you don't wish to have a rectal exam or a PAP smear, it's your choice, although it can sometimes be a mistake to delay a needed exam. The doctor should only recommend which parts of the exam to perform. Doctors who think you're making a mistake by refusing an exam should explain why. If in spite of this information you refuse, they should respect your decision.

The doctor should respect your modesty to build trust and rapport, both of which can positively affect the outcome of medical care. Its beneficial effects on quality aside, respecting your modesty—as much as is possible while still being thorough—is common decency.

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