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Finger up the bum - uncomfortable but comforting


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Jim Marshall (not a doctor) said ...

Research shows that people trust people who touch them.

Some waiters who depend on tips make use of this by brushing the arm of clients.

One reason for the appeal of alternative therapists may be the "high touch" they typically use.

Doctors are beginning to realise the symbolic importance of touch - from regularly doing a blood pressure, to regularly doing physical examinations of breasts after breast cancer surgery.


Now it has reached our world.


The study below confirms that, uncomfortable though it may be, having a physical examination is reassuring for advanced prostate cancer patients. 83% said it was highly positive.


... end Jim



Cancer. 2014 Jul 15;120(14):2215-21. doi: 10.1002/cncr.28680. Epub 2014 Jun 4.

Cancer patients' perceptions regarding the value of the physical examination: A survey study.

Kadakia KC1, Hui D, Chisholm GB, Frisbee-Hume SE, Williams JL, Bruera E.

Author information




Despite its clinical utility, progressive reliance on technology can lead to devaluing the physical examination in patients with advanced cancer. The primary objective of this study was to determine whether these patients have a positive or negative perception of the physical examination. A secondary objective was to determine whether these perceptions are related to interpersonal/relational values (symbolic) or diagnostic/objective values (pragmatic).


One hundred fifty patients with cancer who were receiving concurrent oncology and palliative care were administered a 26-item survey regarding their overall perception of the physical examination. The primary outcome-patient responses to "In the last 3 months, I believe my experience while being examined has been overall: very negative (a score of -5) to very positive (a score of +5),"-was analyzed using the Sign test. Other items were predefined as either symbolic or pragmatic statements, and patient responses from strongly disagree (a score of 1) to strongly agree (a score of 5) were further analyzed. Multivariable logistic regression was used to test for associations between baseline characteristics and the primary outcome.


Most patients (83%) indicated that the overall experience of being examined was highly positive (median score, 4; interquartile range [iQR], 2-5; P ≤ .0001). Patients valued both the pragmatic aspects (median score, 5; IQR, 4-5) and symbolic aspects (median score, 4; IQR, 4-5) of the physical examination. Increasing age was independently associated with a more positive perception of the physical examination (odds ratio, 1.07 per year; 95% confidence interval, 1.02-1.12 per year; P = .01).


Patients with advanced cancer indicate that the physical examination is a highly positive aspect of their care. These benefits are perceived as having both symbolic and pragmatic value. The physical examination should remain a cornerstone of clinical encounters. Cancer 2014;120:2215-2221. © 2014 American Cancer Society.

© 2014 American Cancer Society.


patient acceptance of health care; patient satisfaction; patient-centered care; physical examination; physician-patient communication

PMID: 24899511


This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free).


Any highlighting (except the title) is not by the author, but by Jim Marshall.

Jim is not a doctor.

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When the continence physiotherapist (female) was checking my pelvic floor muscles, comfort was not a description that came to mind.  I felt like a ventriloquist's dummy.

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