The paper rustled and bunched up here, there, and everywhere as I rolled him from one end of the table to the other. Finally I said, "I need to do a rectal exam." He shot up straight, and yelped, "A what?"
"They learn that once they enter the court, they are in someone else's operating room." - Donald J. Ciaglia, on teaching legal procedures to medical students
My next patient that morning was a lawyer whom I have known for some time. A quiet man, nothing flashy. He sits on the board of a local charity that works with the homeless. A good fund raiser, I have made appropriate contributions (as all physicians should) yearly.
He advertises locally on the radio for malpractice cases.
Now, I have never taken malpractice personally. Like most of my colleagues, I have been sued. Three cases over the last 29 years (I am currently ahead, 2 - 1). The average physician get sued once every 7 years. I was overdue.
"Hi Doc, how've you been?" was his opener.
"Good, thanks. How are you? What brings you in?" I like to keep things simple when I deal with lawyers.
He loosened his silk tie. "My throat, for the last week, it just won't get better. It hurts, especially in the morning. By late afternoon, I get laryngitis." He went on to describe a few more points about his sinuses and ears, his lungs, and his tongue. My mind wandered. It was Friday. I was off for the weekend.
I asked, "Ever smoked?" He quit 15 years ago, and only smoked for 3.
"Well," I said. "We'll need to take a look." I pulled a paper sheet and paper Johnnie out from under the cotton ponchos I normally give my patients. "I'll step outside and let you change. Everything off, socks and underwear included. Put these on".
"But Doc, it's only a sore throat...." He didn't move to the examining table.
"Now, you know how it is," I said. "We don't want to overlook anything and make a mistake, do we?" (I've always wondered who the physician's "we" is, but right now, it felt good to have back up.)
With a sigh, he said, "OK, Doc." A few minutes later I returned to the examine room. He sat, surrounded by wrinkled paper, uncomfortable and awkward. I said, "Let's get started..."
Checking blood pressure, pulse, then his ear, nose and throat, I palpated all his lymph nodes. I listened to his lungs, his heart. I palpated his belly. I moved his joints, rolled his legs, checked for symmetric muscle tone. I did a skin survey. The paper rustled and bunched up here, there, and everywhere as I rolled him from one end of the table to the other. Finally I said, "I need to do a rectal exam."
He shot up straight, and yelped, "A what?"
I repeated, "A rectal exam."
He sputtered, "But, it was only a sore throat!"
"Now, you remember, I said we need to be thorough. No mistakes. We don't take anything for granted."
"But a RECTAL exam?"
"Roll over," I said. Gloved and lubricated, I started.
"Doc...easy does it, please," he said.
I continued, "Just relax".
Again, as time stood still, "Doc, please, you're really going deep here."
I continued, "Just relax."
"And Doc, he said, "you're fingers feel so cold..."
I said, "That's not my fingers. That's my wrist watch."
* * *
Just like a Tarantino Revenge Fantasy Film, when the lights come back on and the credits are rolling, I took a deep breath. "Well," I said. "We'll need to take a look."
After the brief exam, normal ears, throat, and lungs. No abnormal lymph nodes. I said, "I'll do a throat culture just to be sure it's nothing, but it all looks fine. Probably nothing more than a minor viral infection."
He straightened his tie, got up and was saying his Thanks, and Goodbyes, and was moving for the door.
As he was leaving I added, "Or, it could be cancer."
"I always have to laugh when the AMA claims that doctors have no special powers over people. How many people can tell you to take off your clothes and you'll do it?" - Robert S. Mendelson