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Errr, genitalia exam...


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So...After discussing what I did on my exam before admitting a guy from the ER, my attending told me that I should be doing a complete physical exam and not problem focused. He mentioned genitalia and rectal, breast, etc. That kind of threw me off, so I said to him "I am not sure if I will get away with a breast or genitalia exam when someone is coming in for a URI or a headache"...He responds basically saying I need to do everything as a student.

 

How on earth???

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I would say, that as a student, you should be doing more thorough of an exam (probably more that you will do once you are out of school) for a number of reasons. First, you need to get exposure to the multitude of normals to learn to recognize the abnormals. Also, you may be surprised at how many people come in complaining of a sore throat, and may have something much more complicated going on. And, until you get exposure to this, you may jump right to the most likely explanation. Now, as far as doing a breast, rectal, pelvic exam on every patient, that may be pushing it!

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When I was a student the only time I was allowed to do a breast, rectal, pelvic exam was when there was a reason for it. My rotation in women's health gave me that experience for the female exams. I did breast/rectal/genitalia exams in my ER rotation only if it was indicated for the presenting condition....such as vaginal bleeding, scrotal pain or injury, hernia, foreign body removal (i.e. retained tampons), painful breasts such as mastitis, etc. In family practice rotation if I did a complete history and physical then the whole exam was done, with my preceptor present.

 

Your preceptor is off. Is your preceptor an MD/DO/PA/NP? Be wise so you do not get accused of sexual inappropriateness, which could be a risk if you did a rectal exam for an URI, for example.

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Glad you didn't do it. I agree with many of the other comments. I'm currently in my ER rotation and my preceptors all tell me to only do the exams that are absolutely necessary given the CC. I would try talking to him to see if he really was serious or not and ask him for why he said what he said. If it was a joke, then you're okay; if it wasn't then that would certainly be awkward...

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  • 2 months later...

If it is a teaching institution (med school affiliation) AND the individual is being admitted from the ED to the floor with the initial exam being performed by a student and to be later signed off on by faculty staff, I could see this being requested. I seem to recall a similar policy many years ago when on IM and I was asked to do the floor H&P. Our hospital admits would have a student note, resident H&P, and on occasion an attending H&P. Was this an ED note or the actual admission H&P?

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If it is a teaching institution (med school affiliation) AND the individual is being admitted from the ED to the floor with the initial exam being performed by a student and to be later signed off on by faculty staff, I could see this being requested. I seem to recall a similar policy many years ago when on IM and I was asked to do the floor H&P. Our hospital admits would have a student note, resident H&P, and on occasion an attending H&P. Was this an ED note or the actual admission H&P?

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