How many of you have had a recent occupational health physical exam? I'm asking because I had an accidental exam a few days ago...
I currently work in healthcare administration and am familiar with occupational health examinations. Over the last few years, our organization has undergone several changes and the occupational health department has changed dramatically since I began 8+ years ago. Most recently, we brought in a new mid-level provider and she has completely turned our pre-employment examinations into what a "true" occ health exam might consist of. By that I mean it now includes the job candidate having to lifting a set of predetermined weights, demonstrating their ability to push, pull, and lift objects, etc. However, we continue to "send out" our pre-employment drug screens to an outside laboratory. Essentially, the candidates visit any of the lab locations in town with a Chain of Custody form and the specimen is collected (unobserved). The lab has their own Medical Review Officer to determine whether or not the non-negative (that's what they call suspected positive results) are actually negative or positive upon review of the donor's (job candidate's) prescription records.
Up to until this past month, our organization has not conducted random urine drug screens (UDS). However, after a substantial change in the C-Suite, we have recently implemented this. Today was the day that I, the person in charge of facilitating the random UDS, had to pull the first list of randomly selected employees. Low and behold, I was selected in the randomizer as one of the several employees. Since this is new to the organization, we're taking a soft initial approach, so it was a smaller group of selectees than what will be the normal. Upon learning that I was on the report, I notified my manager that I would need to either report to the off-site lab or notify them to come here. After discussion and knowing that several of the other employees were off-site, we decided that I would drive to the off-site clinic to provide my specimen. I should preface this by saying that the clinic is a well-known national chain and has facilities all throughout town here and in many southeastern states. Therefore, imagine that I was testing out the process. I knew that my results would be negative, but we wanted to make sure that the employees at the clinic, or at least the closest one were friendly, didn’t make our staff feel like criminals, etc. Now this is where it got interesting...
When I arrived at the lab, I of course read the COVID-19 warnings on the door and wore my mask into the building. After standing inside of makeshift cubicle made from plexiglass, I answered my COVID-19 screening questions, had my temperature taken and checked in. I presented the paperwork to the receptionist and was told to "wait in the socially distant chairs, do not visit the restroom or leave the building." The receptionist took my ID and told me that I'd get it back from the medical assistant after I completed my initial paperwork online via the link that they were texting me. I went and took my seat and filled out the paperwork electronically.
After waiting about 10 minutes, a young medical assistant came to the front door and called my name. She handed me my ID and said I could return it to my wallet. Then, we proceeded to a curtained off area near a restroom. The woman was very pleasant and kind. She instructed me to empty my pockets and place everything into the lock box. Then, I was told to wash my hands and randomly select the collection cup. She cheerfully showed me that the container was empty, and she placed a mark on the cup indicating the 45mL of urine that was required. I disappeared into the restroom where the toilet water was stained blue and after trying my hardest, I finally was able to produce the specimen. Trust me—it took me forever! I have never had a problem peeing for a pre-employment drug screen because I usually go loaded…. But peeing randomly on demand with little notice always causes me problems!
After that, the woman told me that my organization also indicated electronically that a physical exam was also ordered. Being the person that set up the account and the protocols, I began to tell her that this was incorrect. She insisted that it was on the electronic documents and even showed me. Trust me, this wasn’t planned on my part! That was not what the paperwork that I had with me in my file in the car said! After speaking with her practice manager, I was told that if I didn’t submit to the ordered tests and exams, they would have to deem it a complete refusal and it would be reported back to my employer as such. After thinking about things and being incredibly nervous, I followed to the MA back down the hallway and figured that I would see what was going to occur…
Once we reached the end of the hallway, she took my height and weight on an electronic scale. After that, we proceeded around the corner where I was instructed to cover one eye and read the eye chart. After that, we repeated the same process with other eye. Once complete, she stated, follow me, we’ll put you in Exam Room 4. I couldn’t believe that somehow the organization we contracted with messed this up. I was relieved to see walking down the hallway that what appeared to be the provider, was a male. This was somewhat reassuring as I prefer not to have a female doctor examine me while naked…and I knew that an occupational health exam typically included a hernia check.
Upon entering the exam room, I saw an electronic machine on wheels was in the exam room ready to take my vital signs, etc. She instructed me to sit on the table. Very matter of factly, she stood in front of me and stated that she would begin the exam and one of the physicians would be in shortly. She stood behind me and whispered two words and had me repeat them, “Yellow ducking.” That was the hearing exam… Then, she returned in front of the machine and placed the BP cuff on my right arm and the pulse ox on my left index finger. The machine clearly was noticing that I was nervous because it inflated and deflated several times--I was absolutely shocked at the high BP reading on the screen. The medical assistant replied, “Oh my, this thing has been messing up all day…hopefully the doctor doesn’t burst in here and see this!...” Without further ado, I heard a slight, one-time knock on the door. In walked the doctor, in a mask and disposable gown. I had to turn around to see him because the exam table was arranged so that I was facing the TV (on mute) on the wall and the sink in the corner of the room. He walked in quickly and said, “hey kiddo, where’s your new job…Oh wait, is that blood pressure real?!” After hearing those words, I didn’t know what to think. He stated, “oh, we’ll take it again at the end. Maybe you’re just nervous.” The next few minutes consisted of one of the fastest exams that I’ve ever had…. He immediately, without introducing himself to me, took off his stethoscope and told me to take several deep breaths while placing the stethoscope on my back. Right before he began, I heard a few quiet beeps. I later saw that he had a digital/ electronic stethoscope which must have explained the beeping. As he came around to the front of me, the MA stepped out of the room and said that she would return later. He continued by listening to my heart sounds from the front. He then asked me if I had any heart disease, trouble breathing, or any other medical problems. After saying, “no…” he quickly retrieved the otoscope from the wall and looked in both of my ears. After that, he reached up and lowered my mask beneath my jaw and instructed me to say, “ahhh!” As he returned the otoscope to the wall, I heard a pat on the table behind me. I glanced over my shoulder and he said, remove your shirt, toss it in that chair and lay back. Before I could even fully remove my shirt, he was extending the leg extension of the exam table.
Once I laid back, he immediately placed his hand with the palm facing down and pressed deeply over my belly button and said, “scrunch up your stomach as if you’re doing a stomach crunch in gym class… Okay, now relax, raise your head up like you’re starting a sit up. Good…now relax all the way. He then began to tap all around my abdomen on both sides and pressed and pushed. Then, he quickly placed his fingers on the outside of my shorts near my right inguinal region. He said, “any problems with hernias down here?” I responded initially with, “no…” but that without thinking I, truthfully said, “well, lately I’ve been wondering if I do have something on my right side. I sometime feel something or a dull...” before I could finish, he said, “well, we better take a look. Stand up.” As he quickly pushed the leg extension of the table in, he then turned around and began putting on his purple nitrile gloves from the size L holder on the wall. He was already sitting on the exam stool and finishing up putting on his gloves when I was then standing in front of him. It all happened so fast—from when he walked in the room until the end…
After I undid my belt and only partially unzipped my fly, he then reached over and lifted my t-shirt slightly above my belly button. I began to slightly lower my boxer-briefs and shorts but only had slightly exposed my penis and not even my entire scrotum when he completely caught me off guard and used his right hand to tug my underwear down while his left hand was still holding up my shirt. It was forceful and quick. My navy shorts completely dropped to the floor with my phone and keys making a “thud” when they hit the floor. I then grabbed ahold of my t-shirt and he then placed one hand on my left hip and said, “hang on here…” I’ve had several hernia exams in my life…but never one as deep at this! I was almost in shock as he definitely was working to insert his finger as far into my inguinal canal as he could. I’ll admit though that I was slightly relieved to finally see if this was in fact a hernia. He inserted and removed his finger into my inguinal canal probably 3-4 times before looking up at me and saying, “turn your held all the way to the left and cough…again….another cough….really deep and hard this time….. Nah, it’s still inside the ring…” He then palpated my inguinal lymph nodes for a few seconds and began doing the exact same thing on the other side. “Hold on….cough…cough….really hard….last time….one more….okay relax…” After that, he took ahold of my testicles, first on my left and palpated it between his thumb and index finger. He definitely had a firm grasp as he felt the entire testicle and then felt the spermatic cords all the way to the top. He then said, “one more cough…again…” And repeated the process on the other side. After that, he stood up, removed his gloves, and said, “all looks good. I’ll go sign the paperwork in the computer and it’ll be sent to your employer. Wait here for her to be back. Good luck to you.”
I’m not kidding when I say that this was the most thorough scrotal and hernia exam I’ve ever had. Not to mention, the fastest exam ever. He didn’t check my reflexes, he didn’t ask me to follow his finger, he didn’t really take a history or anything. It was odd but when I left the office because I continued to feel the pressure of his finger inserted so far into my inguinal canal for the entire day. I won’t say that I minded that though. It was somewhat nice to find out if he thought that I had an actual hernia. However, it was concerning that they had the paperwork all messed up. Needless to say, I have some work to do on Monday with the company. Regardless, the exam experience was interesting.