Prostate Exams: The Secret to Life, Medical School, and Everything.

Posted by Ben Frederick M.D. on May 2, 2014

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Audio Transcript Up to this point you’ve probably spent your entire academic career surrounded by textbooks or slouched in a creaky lecture hall desk. It’s boring, but at least it’s comfortable? You say you’re premed? Well I’ve got news for you pal… It’s a little secret and I’m going to share it with you right now, so listen closely. If you’re going to be a doctor, eventually you’re going to have to start sticking things up people’s butts. And it’s going to start with your finger. OH the horror! Your sullied finger is forever unclean! Picking your nose will never be the same again. But! (no pun intended) if you can learn the secret of rectal exams before you get to medical school. Awkward situations won’t seem that bad anymore. Read on in the blog post below.

Don’t Panic.

Whether you’re a doctor, a lawyer, or a business executive, you will never become great by being comfortable. So why does everyone avoid things that make them uncomfortable? Of course you already know the answer. It’s fear. Fear of the unknown. Fear of doing something wrong. Fear of looking like an idiot!

The “Uncomfort” Zone.

Stepping out of your comfort zone can be a scary thing. When I was premed at Mizzou, comfort was part of what turned me into an average applicant. I spent too much time IN my comfort zone. Luckily I stumbled my way into medical school and eventually wound up with a couple extra letters at the end of my name. But something happened along the way. I had a paradigm shift that made medical school (and life) so much easier.

You’ll be feeling fear and anxiety a lot for the first couple years of medical school. Your nose will be happily buried in your Netter’s Anatomy book, much in the same way you spent the last 4 years of your college life. But eventually you’re going to be thrown in a room with a patient and told to “play doctor.” It’s time to practice your physical exam. Let’s start with the heart and lungs.

“I’m not ready!” You’ll say. “Let me just read about it one more time!”

There was always a lot of fear and anxiety surrounding these practice physical sessions at my medical school. It was easier for some and harder for others, but if you were lucky you’d come to realize that none of it is that bad. For me, that epiphany happened after the practice prostate exam.

The Dreaded Male Genitalia and Rectal Exam.

The male genitalia and rectal exam (paired with the pelvic and breast exam the following week) was one of the most dreaded practice physicals in my 2nd year of medical school at Saint Louis University. Not just for me, but for everyone. It seems silly now having dreaded it so much, but at the time I was still basically a college kid that hadn’t done much but fill in scantrons and shadow a few doctors.

So there we were, the ten of us in short white coats sitting in the hallway outside of the practical exam rooms watching the “Intro to the Male Genitalia and Rectal Exam.” I don’t remember if this is accurate, but whenever I think of this experience there’s always 70s porn music playing in my head. If you started the youtube clip when I told you to, you should be getting to the really funky part just about now.

The Really Funky Part.

After we had been thoroughly “refreshed” on the intricacies of male genitalia, we paired up and made our way into the harshly lit 10’x10’ physical exam rooms that had suddenly begun to take the form of a jail cell. There we met our volunteer patient for the afternoon. Of course I’m not going to give out real names, but I’ll call him Richard Butkus in order to demonstrate a circumstance in which it’s best to greet your patient formally rather than attempting to be friendly by using nicknames.

Richard was a middle to late-middle-aged gentlemen. A prime candidate for prostate cancer. We said our hellos and he did his best to set me and my equally unnerved colleague at ease. I did some quick math… 175 medical students divided by 6 volunteers. That’s nearly 30 various sized, eager fingers over the next three days. He seemed oddly cheerful about his current situation. Maybe he just liked the idea of being trigintuply checked for prostate nodules. All joking aside, it was nice of these volunteers to subject themselves to this discomfort in the interest of our education.

I did some quick math… That’s nearly 30 various sized, eager fingers over the next three days. He seemed oddly cheerful about his current situation. Maybe he just liked the idea of being trigintuply checked for prostate nodules. Share on Twitter

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I’ll fast forward through the first part of the exam.

Lift Inspect Push to the right Push to the left “Turn your head and cough”

On a little side note, the only reason to ask the patient to turn their head to the side before coughing is to keep the him from coughing right on you. There is no magical relationship between the rotation of your neck and your groin.

So now we grab the KY jelly sitting on the side table next to the bed. It’s time for the main event. Richard bends over the bed and gives us the green light.

I say to Richard, “Alright, you’re going to feel my touch” and I do the patented one-hand-cheek-spread. As my lubed up finger moves closer to its target I remind Richard to, “bare down like you’re going to have a bowel movement.” I don’t think it was really necessary to remind him. He’s the expert here.

I’m in!

Twist right Twist left Press down Feel, feel, feel

Picking my nose is never going to be the same…

So what does it feel like to be on the giving end of a prostate exam? They say that the prostate is the size and texture of a spongy walnut. If that’s true, then combining that mental image with sticking your finger through a couple warm Gummy Life Savers should do the trick.

The Epiphany.

As it turned out, the prostate exam, the thing that I had been dreading more than any exam so far in medical school was not that bad. I didn’t know what I was doing and I’m sure I did something wrong. I did feel like an idiot through most of the process. But you know what, I wasn’t the one with the finger up my butt.

This was a turning point for me in medical school. I had successfully climbed to the top of Prostate Mountain and everything was downhill from there. Suddenly all the mildly distressing things were easy and the other “dreadful things” didn’t seem that bad.

Oh you want me to redress that infected wound? No problem! At least I don’t have a finger up my butt…

You want me to change that patient’s urinary catheter? You betcha! At least I don’t have a finger up my butt…

So What Does this Mean to You as a Premed?

You won’t have to perform a prostate exam for at least another couple of years. You’re certainly not going to go around offering free rectal exams (I hope…), but that doesn’t mean that you can’t benefit from my personal prostate epiphany. Next time you have to do something you dread, say to yourself, “At least I don’t have a finger up my butt.” Maybe this will help you realize that it’s not going to be that bad. Just do it!

Are you afraid of asking your professor for a letter of recommendation? It’s not going to be that bad. Just do it!

Are you scared to call places and ask for volunteer opportunities? It’s not going to be that bad. Just do it!

Are you afraid to ask you lab partner out on a date? It’s not going to be that bad. Well, actually that could be bad. Wait until your last lab then… It’s not going to be that bad. Just do it!

You need to get comfortable with being uncomfortable. The more you step outside your comfort zone, the more good things will happen for you. You’ll suddenly find it easy to find volunteer experiences. Your personal statement will write itself. People will be asking you how they can help you get into medical school. You will find the love of your life and live happily ever after!

Take the First Step Now!

I like to end my blog posts and podcasts with actionable advice that you can use TODAY. So today you are going to take your first step toward living life outside your comfort zone. Pick your favorite social network and announce the following:

“I’m going to be a doctor. I’m gonna stick my finger up people’s butts and I’m ok with that!”

Tweet, Pin, or Post right now and put your friend’s responses in the comments.