I Have to Put My Finger Where?

In medicine, everything’s about the clinical skills. Taking a history, explaining results, performing an abdominal exam, performing a rectal exam, auscultating the heart…


Performing a rectal exam??!!!!

The “Rectal” Finger

Yeap, that’s part of the clinical skills of medicine too. For any normal person, the idea of putting your index finger up someone’s anus is not a very pleasant idea. It’s something that no one likes to do, but it’s something that must be done. The doctor doesn’t like doing it, and the patient doesn’t like someone’s finger up their back passage either.

For me, the very first one I did was in a coaching tutorial. There were actors who got paid to have medical students perform rectal exams on them. I applaud those actors for being “live” practice models. Medical students really don’t know what they’re doing, and I’d certainly give those actors a bravery award.

Anyway, I remember the sheer awkwardness in having the actor tell me where to put my hands, and how far and how deep to go in. After placing my finger as deep in as it could go, I was instructed to do a 360 degree swivel of my wrist, feeling the prostate with my index finger. Knees bending, and body swiveling too, I somehow managed a 360 degree turn, and shortly after withdrew my finger with great relief.

Fast forward to this year, and I had to face doing a rectal examination on a patient. In the time from my first rectal on an actor to a real patient, about 2 years had elapsed. I’ve seen other doctors do it, and I felt sorry for them doing it. But now I had to do it. So, I asked one of the other doctors if they could supervise me doing it. The doctor looked at me weirdly and laughed it off “I never got any supervision when I did my first one”.

Yikes! So, next best thing was to ask a nurse to “assist” me. She helped to get the patient ready and in position. All I had to do, was put on some gloves, some lube, and put on a brave front as I anticipated my finger will be in someone shortly. Suffice to say, the procedure went smoothly, and I couldn’t feel any abnormalities of the prostate.

At least now that I’ve done it, I can perform many more with more confidence ><