Annual physical is a thing of the past- PROOF

Just received this message from my (former) doctors practice:

"Please review the below information to clarify the billing policy.

Medical services and charges have changed over the last few years. What was formerly called an "Annual Physical" exam is now called an "Annual Preventive Service". This service only includes screening for any new conditions, along with guidance on how to stay healthy. This service does not include a physical exam (Medicare Patients), medication management or any other significant problem-oriented treatment.

If you have chronic, acute , or pre-existing conditions, a separate problem-oriented service will be billed if those conditions are also addressed during your visit. An annual preventive service does not require a copay, deductible or co-insurance. A problem-oriented treatment service does require a copay, deductible or co-insurance. There are signs posted in the waiting and exam areas regarding this policy."

Wow. there are just too many people and not enough doctors. My wife's annuals do not include a clinical breast exam or any type of pelvic exam at all. unless there is some indication to do one.

Years ago a thorough annual might have taken over an hour.

It's amazing that it is not a priority anymore. When I was a kid in the 1970s and even more so as a teenager in the 1980s, once you accounted for the physicals my parents took me to, and then mandatory physicals for school sports, summer sports like baseball, scouts, camp, and work permits, there was almost never a year when I had fewer than 3 physical exams. Now, people don't go that often in a decade.

This has been kind of the case with my current provider for years

Medicare calls it a wellness exam, and states it is not a physical.

I will be having one done tomorrow morning, and will detail my experience tomorrow evening.

Sorry for the delay in this post.

I had my first Medicare wellness exam this morning.

I received check in documents via email 1 week prior. This requested the same information they usually require before each physical, but with a twist: there were now lots of questions asked on behalf of Medicare. These included: am I depressed, have I fallen, do I need help with basic tasks like bathing and dressing, can I handle my own money. I filled them out, but with some trepidation.

When I checked in at my pcp, the receptionist handed me a piece of paper with a circle on it and told me to draw the face of a clock, with the time being 8:20, even though it was actually 8:45. I did, and was called back to the exam room.

The nurse told me she was going to give me 3 challenge words that I needed to remember. She then took height, weight, vitals, and meds; then asked if I remembered the words. I did. I asked what happens if I had not? She stated that was a good question as she didn't know.

This is the point where I am usually asked to strip to my underwear while given a paper drape. This didn't happen...she just said: The doctor will be in soon". I must say I missed hearing this pretty young woman instruct me to remove my clothes as she did every year prior.

The doctor came in and went over my bloodwork, which was all very good. She asked if I wanted to get the pneumonia vaccine, which I declined but told her I would research it, and possibly get it next visit.

There was no genital or rectal exam, although I have never had either of these performed by this particular female doctor during regular physicals. She told me since I visit my urologist annually, she would let him do the honors!

She looked in my ears and mouth. Next was a brief stethoscope of heart and lungs, and a palpation of the abdomen, all done through my shirt, even though I was wearing a button down with the top buttons open.

That was it. Come back again next year. No more being examined in my underwear, just because I am over 65!

@Russianbare sounds like you had a shortened version of the MMSE test, a test done to assess level of dementia ( if a full test is done, this is done under strict instruction with some tasks being timed)

The answer to not remembering the three words, in order would just be a deduction in points.

Clock face is either 8.20 or 10.10 as they are deemed the two most complicated to draw ( not sure how they figure that though)

Another part might also be having to copy, 2 interlocked pentagons.

As well as some other questions to determine understanding of time and space.

Thanks for that @Secret-sub !

Anything to get more money.

Its definitely a thing of the past for most doctors. I found a old fashioned internist and still get a full physical.

I still get full physicals from mine including genitalia and hernia exams

It might depend on the doctor, and where they practice. In the United States it seems that blood work is being used to identify illnesses, unlike the past. Medical care is all about making money, and time spent with patients equals less money.

I had always looked at the "Housecall Annual Health Assessment" offered by many Medicare Advantage insurances as intereference with my Doctor-Patient relationships. With the current state of Physical exams we're discussing in this thread, I finally aquiesced (plus they'll pay me $15 for doing it) and had them come to my home. When the NP got there, I told her that I was more interested in getting a good physical than answering all the Medicare questions about depression, self-care, fall-risk, etc. She spent a good hour with me (as opposed to the 10-15 minutes you can get at the doctors office) and spent more than half of that on physical assessment. I did have to request the Digital Rectal Exam (I don't trust the false-positive rates of the PSA) and she actually had the ability to do an FIBT test on my stool for blood to screen for Colon cancer (my PCP inexplicably doesn't even stock the tests in the office anymore. I had the results of extensive labwork from a recent hospitalization, but she was able to do an A1C to screen for diabetes as well. Overall, I was quite happy with the assessment and my ability to direct what I felt was needed. She may have been more willing to do that as she knew I was a retired Physician.

The questions asked and the brevity of exams is what I get as a veteran at the VA hospital when I go.

Thing is, I worked at that very facility for over 20 years. Because of my job I required a yearly physical w/ treadmill and pulmonary testing. They were fairly thorough and shots to If needed.

I had one; has to be a good 25 years ago. The nurse I saw before the doctor ( a female student doctor and a regular MD) first told me if I didn’t mind , that when she did my vitals she asked if she could take my temperature ( glass mercury thermometer) rectally because she needed to give me a DRE. I got both. The DRE was because of my age at the time. So she killed two birds with one stone.

I only remember one after that as a veteran where I got a DRE. Haven’t had any since. But I have a new PCP I haven’t met yet so when I do I might relate my “exam” here.

Unfortunately it looks that way. I'm lucky I'm still a student and still get a yearly sports physical for my college athletics, but I definitely see the trend shifting towards an over reliance on blood work and making even more money. It's a big business and doctors aren't giving patients suitable time other than for a quick in and out visit. Most general health practices are just glorified urgent care clinics now. I could write an essay on this topic which maybe I will publish here at some point. Hoping to find an acceptably thorough doctor to get acquainted with once I've graduated.

@Clarkeston - You're assigning blame in the wrong place, in my opinion. The changes we're seeing here are driven by the Government and Insurance industries need for data and documentation, and their poor compensation for the "Art" portions of Medicine. Doctors now need to see 4-6 patients an hour (10-15 minutes per patient) to make ends meet and take some money home at the end of the day. Included in that time is time spent with the patient in history and physical, time spent in documentation, time spent planning which testing is needed, time spent on the phone explaining to some high-school graduate Insuance employee why the patient needs this test instead of that one, time spent in review and interpretation of the tests ordered, time spent discussing the case with a referring specialist, etc. Don't forget it would be nice to fit a cup of coffee and a bathroom break in there too.

Recently had my annual physical. I arrive at the clinic a little in advance, check-in and take a seat waiting to be called in. After a short wait, a medical assistant brings me to the exam room and takes basic info. She confirms that I’ll be getting an annual physical, hands me a gown and tells me to get undressed. I ask what needs to be taken off and she responds: “Please remove all your clothes, including underwear. If you’d like to keep them on for now that’s fine but they’ll likely come off later during the exam.”

The MA leaves the room, and I get fully undressed, waiting for the PA to enter. A few minutes later, she enters the room wearing black scrubs and her white coat. She goes over some basic health info and asks if there are any concerns. “Well, sound great, let’s get started with the exam”

She starts with feeling my head and looking at my hair and scalp. She looks in my eyes, nose, ears, and then in my mouth. Lymph nodes in the neck are palpated and then she lowers the gown to look at the skin on my chest and back. She listens to my lungs, and heart and tells me that everything is fine with that. “I’ll just have you lay on your back, going to examine your abdomen.”

I do so and she palpates all over my abdomen and asks about any problems. She moves over to my legs and feet, feeling the pulses there.

She then turns to the box of gloves on the wall and grabs a pair of small blue gloves. She walks back over to me. “I’m going to examine your groin, is that ok?” I say that’s fine, and she slips on the gloves and raises the gown to uncover the area. She actually feels my armpits for lymph nodes first, then checks for lymph nodes and pulses in the groin. “Just going to do a testicular exam” She rolls each testicle gently and then examines my penis. “Everything feels healthy, can you just flip over quickly”. She looks and my backside and spreads my buttocks to look in between. “For the last part, I’ll have you stand in front of me, and I’ll check for a hernia.” I do so and she has me cough a couple times on each side check for that. She rolls away and removes her gloves. “Exam is done, you can sit back up.”

She goes over a couple of items before leaving and recommends seeing her a gain in a year’s time.

This is such a common observation/complaint on Zity and is 100% understandable. It's driven fundamentally by the current belief that everything should be standardized and evidence driven. To that end in 1984 the US Preventive Health Services Task Force Guidelines were developed. These are updated annually and are intended to use approaches coming from medical science studies to identify preventable disorders that kill a lot of people. So it's true that the days of the thorough physical exam that I was taught to perform in the 1970s is indeed dead. What is now the goal of the annual exam is to identify high blood pressure, diabetes, common and treatable cancers such as breast, cervical, prostate and colorectal. And these can all be checked for using lab and imaging testing! No more head to toe in person exam by the skilled clinician required. Sensible but sad for many of us and that definitely includes us denizens of Zity.

Growing up, physicals were very extensive. Every part of you was examined, to the point of nudity, and an embarrassing feeling. Fast forward to today, the exam consists solely on blood work and any questions you might have. The difference is insurance. Back in the day, exams were paid for by cash or check, no charge cards, no insurance. Doctors made a healthy living.

Today, because of insurance, nobody is paying anymore and the insurance company takes over. They pay doctors a small fraction of what they charge, and doctors don’t make anywhere near the money they did 40 and 50 years ago.

As many have said "Covid has changed everything in this world and it took about 2 1/2 years".

How long did it take to get where we were before Covid.

Just think of how we did many things before covid and now how they are done. Your routine of coffee and going to work. Dropping off kids at school.

Take out, drive thru, ordering online, grocery delivery and or pick up and so much more.

How we make appointments, phone?, online? or what? shopping online? Or in person?

We are all living in a different world. Do things differently. Our interaction with others is different.

Look what politics is doing to us. In the 2020 USA Presidential Elections democrats spent $3.1 trillion dollars. Try to comprehend that!!!!!!!

And Medicine that is a whole world by itself $$$$$$$$.

Stay healthy and smile!!!!!!!!!!!!!!!!!

That’s more about how they bill than anything else.

@MrABC - I think that all would’ve been enough to give me an erection. I don’t suppose you got erect?

I had a previous primary (older internal med doctor) who didn’t have me undress at all for my annual visit.

The physician assistant I established with as a new patient back in May did have me change into a gown and she performed a decently thorough physical exam.

Something like this I'd just say "Yeah...we can skip the in-person. I'll do the blood work, the rest can be a video call. The effort of getting in to the office just isn't there."

It was that way with my previous provider. I saw a young female PA for about 10 years and the only time I ever took of an article of clothing was to get an EKG.

About 2 years ago I changed practices because the billing department was just atrocious.

Anyway, at my new practice they do full physicals - after taking vitals, the nurse always says "please take everything off and put the gown on, opening in the front. You can leave your underwear on if you prefer, but they will come off eventually."

Maybe dated medical procedures are still done in some countries, but from my experience, most doctors in the United States, work on a tight schedule, and every minute spent with a patient, is money lost for them. Also, bloodwork is more advanced today, and has eliminated the need for earlier types of exams. The medical and pharmaceutical industry is all about making money.