Rectal Exams

From Trust Me, I'm a Doctor:

I've quit doing screening rectal exams. Unfortunately, it takes more time to tell the patient why we don't need to do it than just getting it over with.

He's right.  The PSA conversation takes 20 minutes, but just ordering it takes about 20 seconds.  No wonder so many physicians just to the rectal and the PSA and .. treat bronchitis with antibiotics. 

My nurse complained to my wife yesterday that I take too much time with my patients.  She's right that I do.  But shouldn't I explain things?  She asks "what in the world are you doing in there for so long?" 

I'm mostly listening – but sometimes I'm explaining.

We physicians do a rotten job in general to explain things to people.  we use this secret language to communicate with eath other.  We learned it in medical school, and some of us forgot how to actually speak English when we graduated.

"Mrs Jones, you have microcytic anemia and your ferretin is decreased.  YOu need to take the feso4 tid.  We'll check a CBC in a month."    No kidding .. I've seen it this bad.  

Of course in my "other job"  (of which I rarely speak here, it seems) I see this even worse.   I work with computers in a hospital.  It's a bit more complicated than that — but — you get the idea , right? 

Computer people are worse at the translation from their secret language than physicians.   Interacting with humans was never a required component of their education like it is in medical school (albeit a small component).  So it is rare to find someone in technology who communicates well with "the other side."  Today was no different – and I felt bad reminding them again how speak English instead of TecnoSpeak.   

When I teach medical students how to un-learn the DoctorSpeak – they are appreciative and – yes – a bit ashamed.  I don't mean to make them feel silly – but sometimes when we have a student in the office and we're in a room together with a patient and the student says "do you have any dysuria?" and  I say to the patient "did you understand that?" and the patient says "no" and I ask the student to try again and they say "does it hurt when you pee?"  And we all wonder why the "dysuria" question would EVER be asked.  But it is .. very often.

Maybe the poor student has just finished surgery where some jerk told them that it's important to "be precise with your language."  ugh.

6 thoughts on “Rectal Exams”

  1. I liked your comments about language. I’m curious what you do with computers at your hospital. Any chance of you writing some about it?

  2. You make a good point, that docs can ber perfectly medically precise and completely opaque at the same time.

    I have taken to asking patients, “and what did I just tell you?”, and they tell me what they heard. The majority of the time I got their problem and discharge info across correctly, but not always.

    Every specialty has its own vocabulary, and that’s as it should be, it makes for precision in communicating with others in their field. However, I have to remember to use two different vocabularies at work, one for the patients and one for the docs and nurses.

    And, I’m with Bill, what’s up with the computers?

  3. Great post – as you can see I have posted on your post. I try to teach these concepts on the VA medicine wards. In particular when we have a difficult conversation with a patient, I sit down and try to put the concept into clear English. We then spend time after the discussion dissecting the conversation including the words I used. Obviously you do the same thing in the outpatient setting. Kudos! We need more teachers like you. They just don’t teach some of the important stuff in the first 2 years of medical school.

  4. This is very true, and it is very easy to go into technobabble. Or even professional jargon babble.

    Its good to be reminded of the audience, before the glazed looks in the eyes appear.

  5. Thanks for this great post. It’s so important to keep stressing that we need to listen more, and that we need to lay low on the medical jargon. I also like that you pointed out that with your patients, “I’m mostly listening – but sometimes I’m explaining.” I heard recently that on average, docs listen to their patients for 17 seconds before interrupting with questions and answers (from a survey). Interesting.

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