Laura Forsyth

1901

CTA Reflective Essay

Doing: On the 2/8/2012 we were introduced to our male CTAs, which was the first of the CTA programs that I was involved in. We sat in the initial circle and introduced ourselves, and our purpose for being present. Resoundingly the men spoke of the need for better training and manner, as in their experience in the past doctors seem undertrained and unwilling to perform these sensitive examinations. One MCTA spoke of being passed from his usual GP to another local GP as his usual doctor just didnt do, sensitive examinations. His comment (and others) both surprised and shocked me- that I was aiming to become part of a profession where these services are under offered and underperformed somehow offended me. I wondered that night why doctors, both past and present, wouldnt be offering these checks to their patients, and resolved to learn as much as I could. Sadly this same conversation was virtually repeated verbatim in the womens CTA introductory circle. 2 of the 6 women specifically mentioned that they were passed off to another GP so as to have their Well Women Checks performed. Again, that these ladies were actively seeking preventative screening, only to face a barrier, offended my sense of the role of the doctor as a partner in healthcare and prevention, and made me feel on some level that I needed to apologise for this having happened. Reflecting: When looking at the graduate profile I read the line demonstrates a commitment to compassionate, professional and ethical behaviour. I have chosen to reflect on my situation with this line in mind, as it seems to best describe my emotions and reactions. When examining my own feelings about this situation I realised that initially I felt angry and frustrated that these people had faced a barrier put up by the GP when they were doing the right thing by getting checked. I then moved through feeling surprised, and even a little suspicious that these stories were true (surely the profession I am working towards wouldnt have let this happen?). Concurrently I felt the need to apologise to these patients for being let down by something that I am hoping to becoming a part of, the medical profession. That night I calmed down and then began to question why the doctor would have felt the need to pass these patients off. Was it simply time constraints? Or were they really feeling undertrained and underprepared? How had this happened? I realised that I was coming at the situation with my own beliefs of the medical system in mind, and that may help to explain my reaction. To me, medicine is a collaborative partnership between patient and doctor, with each bringing their own knowledge and skills. The patient agrees to be honest and compromising and the doctor agrees to be compassionate, professional and ethical. In the situation with the CTAs I realised that I felt like the doctor had let down their half of the bargainnamely by refusing or avoiding such examinations. I came to understand that this was a little unfair, and that I couldnt really judge until I knew why these doctors had moved these patients on. Perhaps they were acting judiciously by admitting their shortcomings, and were actually acting in the best interests of the patient? As the modern Hippocratic Oath dictates- I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. This may have been the case in these consults.

Laura Forsyth

1901

Connecting: My initial process of connecting was made through discussion with our various clinicians about their own feelings surrounding the intimate examinations and their own training process (or lack their of). Many of our teaching clinicians made mention of their limited training, stories of performing these examinations on anaesthetised men and women, and limited opportunities to practise were discussed. Two of the clinicians discussed that they did not once perform one of these examinations for the duration of their medical school guys. It was discussed that because of a lack of early training, graduating and practising doctors were not confident at these exams, and as a result often avoided them by referring to someone who was more practised. Wilt and Cutler (1991) explain that little formal instruction surrounding patient comfort, consent and proper explanation before and during the rectal examination was provided to residents.

My follow up research showed that the CTAs experiences were not uncommon. Turner and Brewster (2000) tell us that while symptoms from the anorectal and urogenital tract account for 510% of consultations in general practise, up to 2/3rds of the patients presenting will not undergo a digital rectal examination (DRE) before being referred on to someone else.

Deciding: While I cant say that I would have acted any differently if I was

Laura Forsyth

1901

Reference List: Turner, K., Brewster, S., 2000, Rectal Examination and Urethral Catherterisation by Medical Students and House Officers: Taught but not used, British Journal of Urology, Vol. 86, pp 422-426 http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410X.2000.00859.x/pdf Wilt,