Rectal examinations in elderly subjects: attitudes of patients and doctors

Objective: to determine the attitudes of older patients and hospital doctors to rectal examinations. Design: a structured interview and audit of case notes. Setting: departments of medicine for the elderly in two NHS hospitals. Subjects: 178 mentally alert patients and 76 hospital doctors in general and geriatric medicine. Results: some patients would feel embarrassed (13%), offended (2%), reluctant (11%) or neutral (73%) if asked to undergo a rectal examination (PR). Most (76%) thought a PR examination was important and 92% would give permission if a doctor asked. Of 200 case notes audited, only 38 patients had a PR documented.Of the hospital doctors interviewed 3 said they would routinely do a PR examination. Some doctors lacked confidence in detecting a rectal mass (33%) or abnormal prostate (41%). Thirty (39%) of doctors thought elderly patients were offended by PR examinations and 65% that there was not sufficient training in this procedure. Conclusion: most older patients do not find PR examinations disagreeable and regard it as an important examination. Despite this, few doctors routinely perform this procedure and some feel unable to detect abnormalities. The importance of PR examinations and adequate training needs to be addressed.