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The History and Physical Examination

Strategies Specific to Men

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Vol. 18 • Issue 3 • Page 18

For all patients, a comprehensive health history and assessment are necessary to distinguish normal from abnormal findings as a means to differentially diagnose acute and chronic health alterations. The physical examination helps confirm the suspected differential diagnosis based on presenting signs and symptoms, past and current medical history, risk factors and epidemiologic considerations.

When the patient is a man, the health assessment interview presents unique cultural and gender-based challenges.

Professional Demeanor

Each patient encounter should begin with introductions. Provide your name, title and an explanation of your role, as necessary. Use the patient's legal name to confirm his identity, but ask him his preferred name, and then use it throughout the visit.

Conduct the interview in a nonthreatening and nonjudgmental manner. This requires phrasing questions in an open-ended or closed-ended manner that does not interject bias or judgment about lifestyle choices or preferences. If bias creeps through, the patient is more likely to provide a socially desirable answer rather than an accurate one.

Physical Environment

Men are sensitive and perceptive to the physical environment within the healthcare setting. Provide educational brochures that reflect men's concerns, magazines of interest to men, and educational models of male anatomy.

Ensure ample confidential space to conduct the interview. Provide every patient with the opportunity to wear a gown during the physical examination, and offer draping for added privacy. At no time should the patient be completely disrobed without appropriate privacy precautions. Before having a patient disrobe, solicit information about his level of comfort. Ensure that room lighting, temperature and privacy levels are appropriate. Secure permission for the presence of another person during the examination, if that situation presents itself.

Questionnaire and History

Some patients are more comfortable answering direct questions about sensitive topics when they are on a written questionnaire. Review the patient's responses to the questionnaire; the answers guide the focus of the interview.

As the patient becomes more comfortable, broach sensitive topics such as areas of concern about relationships, sexuality and genital health. The interview questions should begin with general topics and progress to more direct, focused and clear questions that ask about specific behaviors. Conduct the interview using culturally appropriate language. Active listening should be accompanied by culturally appropriate touch and eye contact.

Chaperones

Every patient should be offered an opportunity to have another person present in the room during the interview and physical examination. However, it may be appropriate to ask the companion to leave the exam room for a minute while you discern whether the patient wants that person in the room. The presence of another person in the exam room may produce a socially desired response and influence the veracity of information elicited during the interview. This is especially true in adolescent boys.

Physical Examination

The physical examination should initially focus on areas of the body away from the genitals. Most men like to be engaged during the physical examination, because it makes them feel like an active participant. Seize opportunities for teachable moments during the physical examination.

Engaging the patient during the genital portion of the exam includes having him hold and move his penis and assisting with testicular examination while you explain the exam and what findings are normal and abnormal. The patient can then use this information during his own self-examinations.

Discuss the real potential for an erection to occur, and provide the patient with an opportunity to stop the examination at any time.

Resources

Ceo P. Assessment of the male reproductive system. Urol Nurs. 2006;26(4):290-296.

Marcel A, Bell D. Making the most of the adolescent male health visit: part 1. History and anticipatory guidance. Contemp Peds. 2006;23(5):50-61.

Peate I. Examining adult male genitalia: providing a guide for the nurse. Br J Nurs. 2005;14(1):36-40.

Demetrius Porche is a family nurse practitioner who is dean and professor in the School of Nursing at Louisiana State University (LSU) Health Sciences Center in New Orleans. He has two doctoral degrees and has a special interest in men's health. Scharalda Jeanfreau is a family nurse practitioner who is an assistant professor at LSU.

History and Exam Strategies for Men

Create an atmosphere that is inviting to men.

Provide a written questionnaire, to be followed by verbal questioning.

Use culturally appropriate language and touch.




     

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