NP STUDENT STORY - SECOND MALE EXAM

While in the family practice office I had the opportunity to perform a complete physical examination on a 32-year-old man. I was glad he agreed to let the “nurse practitioner student” perform his physical examination. Not everybody is enthusiastic on having a student see them much less touch them. But it was another skill I would soon be exposed to as well as having it checked off on my skills check list. I had performed a male exam on a volunteer while in my physical assessment class. He was getting paid a set amount of money per exam. Needless to say the male volunteers did not want more than two or three exams before calling it quits. The opportunity to earn extra money somehow became less important as new nurse practitioner students started probing various orifices and squeezing personal body parts.

I began my physical assessment in an orderly fashion going from head to toe. I developed a system that seemed to work well for me. Once my examination was complete I was ready to do the male exam portion. For this I needed my preceptor so she could observe my technique. My patient did not seem to mind and was still willing to allow me to perform the male portion of the exam. This was my second time of doing such an exam.

My patient was asked to remove his underwear while I held up a paper drape to lessen embarrassment and apprehension about the exam. At this point he was standing in front of me while I was sitting on the roller chair. He held the paper drape in his hands as I began the exam. I did the exam (in gloved hands) in a systematic manner like I was taught while in physical assessment. Everything was going very well and the patient seemed relaxed having my preceptor and myself in the room. The exam to this point was normal. So far so good.

Then it was time to palpate the scrotum. I palpated the left spermatic cord between my thumb and forefinger. As I was doing this my preceptor asked me if I was feeling the spermatic cord. I palpated the right side. I then said to my preceptor, “The left one is smaller than the right one.” I sat there for a second. I thought to myself, “What the hell did I just say? I have this poor man’s testicles in my hand and tell my preceptor he has a small left ball!” I quickly looked up and told the patient, “But this is normal. Everything is fine.” He did not say anything. I wanted to crawl in a hole. How embarrassing for me (and him) and I was not the one in the room with no pants on. I quickly checked for hernias by palpating the inguinal canals. I then told the patient I would talk with him after he dresses, smiled, and my preceptor and I exited the room.

Well that was my second male examination. I could honestly tell you it could have gone better, but then overall it went well. The patient seemed okay when he left the office. I hoped I did not give him a complex and he did not go home and stand in front of his full length mirror to see what I called “a small left one.”

So I chalked this up to another experience and put more mental notes in my brain of things I would not do or say again while doing an exam. Right now I can only think that God needs to help my next male patient who says yes for me to perform his complete physical exam. He may have to leave the office with a prescription of Wellbutrin.