Physician performance and patient perceptions during the rectal examination

Objective:To describe internal medicine residents' training and performance as well as patients' attitudes and knowledge regarding the rectal examination. Design:Descriptive survey of university-trained internal medicine residents and general medicine clinic patients. Setting:General internal medicine residents' longitudinal clinic at a university-affiliated Veterans Affairs Medical Center. Patients/participants:Ambulatory male veterans attending their general internal medicine clinic, all of whom were over the age of 40 years and had previously had a rectal examination (n=100), as well as all second- and third-year University of Minnesota internal medicine residents (n=78) were surveyed using a self-administered questionnaire. Measurements and main results:Residents differed in their training in, practice of, and understanding of indications for the rectal examination. Little formal instruction regarding patient comfort had been provided to residents, and many residents had never received supervised instruction in the rectal examination. Patients frequently were uncertain about why the examination had been performed, lacked understanding of the results of the examination, and often had preferences for examination comfort measures that differed from those utilized by their physicians. Conclusions:Increased supervised instruction in the rectal examination in medical training programs is recommended. This should emphasize not only appropriate indications for this procedure but also attention to patient communication and comfort.