Information leaflets could increase the information available to patients, with minimal impact on health care professionals' time. Leaflets are available, free of charge, from the National Health Service Blood and Transplant website. These have been introduced at each bedside, in pre-op packs and in outpatient clinics, with re-assessment planned in 6 months.
Objective-To investigate factors influencing a general practitioner's decision to do a rectal examination in patients with anorectal or urinary symptoms.
INTRODUCTION Knowledge and understanding of disease can influence time to presentation and potentially, therefore, cancer survival rates. The media is one of the most important sources of public health information and it influences the awareness and perception of cancer. It is not known if the reportage of cancer by the media is representative to the true incidence of disease. MATERIALS AND METHODS The top 10 UK daily newspapers were assessed over a 1-year period for the 10 most common UK cancers via their on-line search facilities. RESULTS Of the 5832 articles identified, there was marked over-representation of breast, kidney and stomach cancer with ratios of prevalence to reporting of 1.4, 1.9 and 3.2 to 1, respectively. Colorectal, non-Hodgkin lymphoma, bladder and oesophageal cancers are all markedly under-represented with ratios of 0.4, 0.2, 0.6 and 0.4 to 1, respectively. CONCLUSIONS A policy of media advocacy by health professionals could enhance the information provided by the media and thus reflect the true extent of disease. A partnership between health professionals and journalists could result in articles that are relevant to the population, informative and in a style and format that is easily comprehendible. Targeted public health information could highlight the 'red-flag' symptoms and break down any stigma associated with cancer. This enhanced awareness could improve the health-seeking behaviour of the general population and reduce the delay from symptoms to diagnosis.
The confidence of general practitioners in their ability to diagnose a condition based on rectal examination and a belief that they have been thoroughly taught rectal examination at medical school appreciably influence general practitioners' frequency of rectal examination. ' We investigated medical students' experience of rectal examination during training and assessed whether teaching at medical school influences attitudes to rectal examination. Subjects, methods, and resultsWe sent a questionnaire to 119 final year medical students in one medical school. General surgical subspecialty interest (breast, gastrointestinal, vascular, urological, or general) of the four firms that each student had been attached to and whether attachments were in teaching or non-teaching hospitals were recorded. Students were asked about the number of rectal examinations they had performed for specific anorectal conditions and in total; formal teaching of rectal examination, seniority of teacher, when they were taught, and whether they were taught on anaesthetised patients; reasons for omitting routine rectal examination; and confidence in their diagnosis of specific anorectal conditions based on rectal examination. The end points were categorised and analysed using Kendall's T C test.2 Overall score for confidence in diagnosis was determined by summing the values (yes=1, no= 0) for the five conditions (range 0 to 5). Confidence score was dichotomised around the median (Oto3,4to5).We received replies from 114 medical students (96% response rate). The median category for total number of rectal examinations performed was 11 to 30; 23 fistula (T C=0 143, p=0-031) among students who had done more than two non-teaching hospital attachments than it was among those who had done fewer. CommentFormal teaching (especially by a consultant) encouraged the view among medical and nursing staff that students are expected to do rectal examinations. Only 33 students had been formally taught rectal examination by a consultant. More confident students did more rectal examinations. Easily deterred students would become more confident if clinicians encouraged rectal examination. The outpatient clinic is ideal for one to one teaching and minimises patient and student embarrassment. Attachment to a firm with a subspecialty interest that regularly used rectal examination in diagnosis and treatment increased confidence.Possible reasons for attachment to a non-teaching hospital increasing confidence include the presence of fewer students and the heavier general surgical emergency workload, which provides a greater variety of anorectal conditions. Students in non-teaching hospitals did not receive more formal tuition than those in teaching hospitals.Though the factors affecting confidence identified might seem obvious, there is scope for improvement. A fifth of students had done fewer than 10 rectal examinations and 54% had been deterred from routine rectal examination. Frequency of rectal examination after graduation is influenced by attitudes acquired ...
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