Map of life expectancy at birth from Global Education Project.

Friday, June 03, 2011

And we might have fewer no-shows

British GP Des Spence, writing in the new BMJ (off limits to commoners, alas), suggests that doctors can stop doing the dread Digital Rectal Examination (DRE).

"Logically it has two purposes: to detect rectal tumors and palpate the prostate. It has no obvious logical diagnostic value in appendicitis or acute abdominal pain, which were once traditional indications."

Tell me about it. As I have revealed here previously, I was admitted to the hospital many years ago with acute abdominal pain. Doctors in training lined up to stick their fingers up my ass. None could elicit any pain, but they all decided I had acute appendicitis anyway, which I didn't. (I had a solitary cecal diverticulum.) So what was the point?

As for detecting rectal tumors, as a screening test the DRE is too nonspecific to have any value. In older people with symptoms suggesting a tumor, either endoscopy is indicated or it isn't. The DRE isn't going to change that opinion either way. Ditto with prostate cancer -- annual DREs don't reduce mortality but do result in overdiagnosis and associated harm.

Spence says, "Rectal examination is unpleasant, invasive, and as an investigation has unknown sensitivity and specificity. In a young patient [DRE] has almost no value, and in older patients may have very occasional and limited indication."

So just don't do it, okay?


roger said...

okay by me.

kathy a. said...

not quite on topic, but JAMA reports that annual screening for ovarian cancer is not effective, and leads to false positives, unnecessary surgery, and a higher death rate than the control group.

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