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During our early years of medical school, my classmates and I were given a course in physical diagnosis. Usually, we practiced on one another. Each of us would percuss a classmate’s chest or listen to his heart with a stethoscope. But some procedures were considered too personal to practice on a classmate. For some of these, we were assigned a “model patient”—someone from the community who was “compensated” in exchange for undergoing an examination. This was how I performed my first rectal exam. A large group of us were led into a room where our model patient was bent over an examining table with his pants around his ankles. One by one, we approached him nervously from behind, inserted a gloved, lubricated finger into his rectum, and felt around for the prostate. “Thank you,” we all said politely to the model patient as we removed our index fingers from his anus. The model patient stared straight ahead, saying nothing. What made the experience oddly disturbing was not just the forced, pseudo normality of the instruction or the fact that the exam could have been done more privately, but the instrumentality of the encounter: a pretend patient bending over naked for anonymous strangers in exchange for money. The fact that the model patient had been paid did not make his work seem any less degrading. (Tipping him would have made it even worse.)
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