Perform digital rectal exams (DREs) on obese individuals can be a challenge. Excess fat around the gluteal region may make it extremely difficult to adequately perform this exam with the client simply bending over.

One way to overcome this challenge is to have the patient lie on the exam table in the supine position. Have him move his buttocks to the edge of the exam table with his feet placed in the footrest usually reserved for female gynecologic exams. The practitioner can perform the DRE with the index finger turned upward (i.e., toward the umbilicus). The posterior surface of the patient’s prostate should be palpable from this position. — Omar Abdul-Malik, DHEd, MPAS, PA, Washington, D.C. (167-5)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it, here.