Volume 13 | No. 1 | Jan / Feb 2025 query_builder 1 minute

The importance of sensitive examinations

Practice standard

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Since the pandemic, virtual care has become a standard part of medical practice, improving access to care across the province. While it offers many benefits, important nuances can often be overlooked.

As highlighted in earlier College Connector articles and other CPSBC communications, registrants must integrate virtual care with comprehensive, ongoing primary care. Additionally, in-person care must remain available for all patients when needed.

One challenge that has emerged in virtual care is the reduction of certain sensitive physical examinations, such as pelvic exams and digital rectal exams. Although patients may hesitate to undergo these exams, omitting them can lead to misdiagnosis and potentially harmful outcomes.

In one example, a family physician referred an 80-year-old patient experiencing urinary obstruction symptoms and abnormal kidney function to a urologist based on his clinical picture. However, the family physician did not perform a digital rectal exam before the referral, and the specialist later discovered an enlarged prostate, suggesting malignancy and urinary tract obstruction. 

Similarly, a 90-year-old patient complaining of abnormal stools and a hemorrhoid for two years was referred to a specialist. The specialist performed a rectal exam and found that the hemorrhoid was a tumor, which had previously gone undetected.

Whether such omissions are the result of a virtual care encounter or from time constraints in a busy practice, full examinations are vital. Of course, registrants should only perform sensitive physical exams after discussing the rationale for the exam and its procedure with the patient. Patients have the right to refuse, but registrants must inform them of the risks involved in not proceeding. The Physical Examinations and Procedures practice standard outlines CPSBC’s expectations for conducting any type of physical exam or procedure.