And then Ahmad wrote:
>Another is post-natal exams. There aren't really many occasions when
>you have to poke and prod. Problems are evidently clear from the
>history.
Sometimes problems are not that evident. A post-natal is quite acceptable
practice (we do it at six weeks).
Now for the shocking part: I take most PAP smears without chaperone. I do
most vaginal examinations without a chaperone. Same for prostate
examinations. On average I perform some of these procedures three times a
week. Nevertheless, some patients I would not *dream* to touch without a
chaperone. Call it a sixth sense, if you like. One must rely on common
sense, the degree of confidence between patient and doc. Never had problems
(so far...[knock, knock!!]).
I guess if you have known the patient for some time all this is quite
acceptable - specially if you let the patient share the decision-making
process. I never force any examination upon the patients - I suggest its
usefulness. If they don't want it performed by me I suggest a female
colleague (the most frequent second option); if they don't want it
performwed at all we live without the examination altogether.
Ahmad again:
>There is a whole host of other intimate examination that I would
>think un-necessary if they are not going to alter your management.
A hundred percent in agreement with this. The point is, the positive
predictive value of a correct history and physical examination is still
better than many tests, and most of the touchy gestures such as
rectal/vaginal examinations may often alter our management.
Armando
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Armando Brito de Sa'
Lisboa, Portugal
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