Nancy Hotte's letter1 concerning a new method for prostate examination confirms that the conventional digital rectal examination with the patient in the left lateral position involves an awkward contortion of arm and hand for right-handed physicians. A left-handed doctor probably has no difficulty with this position.
For several years I have been using a method in which the examiner remains seated and the patient stands, assuming the "moon" position. The patient faces away from the examiner and bends over to 90°, with his hands on a chair. Alternatively, the patient may stand flexed to 90°, with his chest on the examining couch. In this position both right- and left-handed physicians have ease of access to the prostate gland. I find that I can palpate further up the prostate when I examine in this manner. The posterior rectal wall is examined by changing the hand from the prone to the supine position. The examiner may wish to stand at this point.
Appendix 1
Submitting letters
Letters may be submitted by mail, courier, email or fax. They must be signed by all authors and limited to 300 words in length. Letters that refer to articles must be received within 2 months of the publication of the article. CMAJ corresponds only with the authors of accepted letters. Letters are subject to editing and abridgement.
Note to email users
Email should be addressed to pubs{at}cma.ca and should indicate "Letter to the editor of CMAJ" in the subject line. A signed copy must be sent subsequently to CMAJ by fax or regular mail. Accepted letters sent by email appear in the Readers' Forum of CMA Online (www.cma.ca) promptly, as well as being published in a subsequent issue of the journal.
Acknowledgments
The demands of the medical profession often leave little time for story-telling, reflection and comic relief. In this year's Holiday Review we are aiming for an eclectic mix of articles dealing with the soul of medicine.
In addition to cheeky treatments of serious subjects, erudite exegeses of kooky concepts, and other humorous pieces reminiscent of last year's efforts, for example the critique of Homer Simpson's medical care (click on Back Issues at www.cma.ca/cmaj), we are looking for reflective essays, "tales from the front" and descriptions of medical events that are uniquely Canadian.
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What is the hardest decision you've faced as a physician?
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The most exciting adventure?
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The most important learning experience?
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How have values in the medical profession changed?
We encourage you to submit reflective essays on these and other topics, personal accounts of unusual, thrilling or moving moments in your professional life, and stories - from the recent and more distant past - that elucidate the realities of medical practice in the Canadian context.
We also hope to include photographs and artwork contributed by readers that capture something of the meaning of medical practice in Canada and beyond.
To discuss an idea for the Holiday Review issue, contact Editor-in-Chief Dr. John Hoey, tel 800 663-7336 x2118; hoeyj{at}cma.ca. Articles should be no more than 1200 words, preferably accompanied by illustrations. Entries received by Oct. 1, 1999, are more likely to be published.
Send submissions to: Dr. John Hoey; CMAJ; 1867 Alta Vista Dr.; Ottawa ON K1G 3Y6
References
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