What do Victoria family physicians think about housecalls?

OBJECTIVE: To determine the proportion of family physicians doing housecalls, the types of patients they think are appropriate to visit at home, whether physicians are satisfied with the number of housecalls they make, reasons family physicians list for not doing housecalls, and what they consider acceptable remuneration and travel time for housecalls. DESIGN: A 12-question paper survey was formulated specifically for this study and piloted by 6 family physicians in British Columbia. It was then mailed with a cover letter to 250 physicians' offices and faxed back anonymously. SETTING: Family physicians' private offices in Victoria, BC, between December 1 and 19, 2010. PARTICIPANTS: A total of 250 randomly selected family physicians from a list of 552 physicians practising in Victoria on the College of Physicians and Surgeons of British Columbia website. MAIN OUTCOME MEASURES: Proportion of physicians doing housecalls, reasons stated for not doing housecalls, and mean acceptable remuneration and travel time for a housecall. RESULTS: A total of 73 surveys (29.2%) were returned, 5 of which were not fully completed but were included for the questions that were answered. Sixty-four physicians (87.7%) did at least 1 housecall in the past year, 23 (31.5%) did housecalls at least once a month, and 12 (16.4%) did them at least once a week. Of 71 respondents, 64 physicians (90.1%) listed lack of time as a barrier to performing housecalls, 37 (52.1%) listed unsatisfactory remuneration, and 35 (49.3%) listed lengthy travel times. Most physicians indicated that appropriate remuneration for a housecall was either $142.21 (n = 30, 42.9%) or $108.41 (n = 26, 37.1%). Thirty-seven physicians (52.9%) noted that 20 minutes was an acceptable maximum 1-way travel time for a housecall, while 29 (41.4%) listed 10 minutes. CONCLUSION: Several systemic factors, including lack of time, unsatisfactory remuneration, and large geographic catchment areas, make it difficult for urban family physicians to do housecalls.

Do patients undergo prostate examination while having a colonoscopy?

OBJECTIVES: To determine the rate at which physicians report performing a digital rectal examination and comment on the prostate gland before performing colonoscopy in men 50 to 70 years of age. METHODS: A retrospective chart review of all men 50 to 70 years of age who had a colonoscopy in Kingston, Ontario, in 2005 was completed. It was noted whether each physician described performing a digital rectal examination before the colonoscopy, and if so, whether he or she commented on the prostate. RESULTS: In 2005, 846 eligible colonoscopies were performed by 17 physicians in Kingston, Ontario. In 29.2% of cases, the physician made no comment about having performed a digital rectal examination; in 55.8% of cases, the physician commented on having completed a digital rectal examination but said nothing about the prostate; and in 15.0% of cases, the physician made a comment regarding the prostate. No physician consistently commented on the prostate for all patients, and in no circumstances was direct referral to another physician or follow-up suggested. DISCUSSION: A colonoscopy presents an ideal opportunity for physicians to use a digital rectal examination to assess for prostate cancer. Physicians performing colonoscopies in men 50 to 70 years of age should pay special attention to the prostate while performing a digital rectal examination before colonoscopy. This novel concept may help maximize resources for cancer screening and could potentially increase the detection rate of clinically palpable prostate cancer.