The patient should be positioned for comfort, ., in Sims position (lying on the left side with knees and hips comfortably flexed). A chaperone and/or a drape should be provided for patient safety, comfort, and dignity. After an explanation of the procedure to the patient, several mL of surgical lubricant are placed on the examiner's glove, usually on the index finger. The examiner visually inspects the anus and perineum, then places the gloved finger on the anal opening while asking the patient to bear down gently. After the finger enters the anus, it is used to sweep circumferentially around the interior of the distal intestine. It is then directed anteriorly (when examining a male patient) to evaluate the consistency, size, and nodularity of the prostate gland. Samples of stool obtained during the exam may be sent to the lab to test them for the presence of occult blood.
For all its flaws and the awful “ doctors are killing lots of patients ” reporting that it provoked, reporting that frustrated many of the investigators who carried out the IOM study because it distracted from the true message of the report, which was to encourage further investigation and a “culture of safety” in hospitals to improve the safety of patient care, the IOM report does deserve a lot of the credit for sparking the movement to improve quality and decrease medical errors over the last 17 years. At the time, I tended to agree with IOM panel member Lucian Leape, MD, who pointed out that, even if the IOM report did greatly overestimate the number of deaths due to medical errors, “Is it somehow better if the number is only 20,000 deaths? No, that’s still horrible, and we need to fix it.” Exactly.
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