Drs Steidle and Lostchuck are correct in surmising that there is a reluctance on the part of doctors to perform pelvic examinations [BCMJ 2023;65:329-330]. My experience suggests it is nothing new.
While practising family medicine in the North of BC in the late 1960s and early 1970s, I was asked to explain why my practice profile registered three standard deviations above “normal” for pelvic exam billings. Investigating the matter, it was found that our nurse instituted a call-in system for Pap smears at the recommended interval for the time. The conclusion to be drawn is that “normal” meant that the need for Pap smears (and thus pelvic exams) was being neglected, perhaps reflecting such reluctance.
The authors also noted a reluctance of supervisors during their medical students’ training to permit them to perform pelvic exams. My medical school gynecological training featured an introduction to the pelvic exam. Four volunteers, suitably screened, permitted us trainees to perform pelvic examinations on them to become familiar with pelvic anatomy. It seems this helpful practice has been discontinued.
I suspect the reluctance toward pelvic exams extends to rectal exams. My student training included a pathology department presentation of the medical case of an obscure anemia, the patient having succumbed to this disease. The morgue pathologist was able to demonstrate that a large rectal carcinoma was the cause of the anemia. None of the many examining physicians had performed a rectal exam.
—Anthony Walter, MD
This letter was submitted in response to “How can we improve competence in conducting pelvic exams?”
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