Well now.
What I find interesting is, as you say, there are structured exams and there are the more "interactive" exams, which I prefer.
I think it comes down to whether you are into this for control or for pleasure, and whether you are thinking about a two-sided game or more one-sided.
As you say with the structured situation, there is clearly a situation in which the Doc gets what he or she wants, but whether that actually addresses the needs and desires of the patient is a crapshoot, because of one simple fact:
Without communication (and to go back to the term "interactive" for a second), there can be no understanding of the MUTUAL goals for a given session.
It may very well be that you and I don't understand the dom/sub aspects of this play, but I suppose that is just one more thing that makes horse races - differences of opinion.
I find that most trouble comes from a lack of communication. In the event that you talk through things on various levels (for instance I use normal typing for online conversation within a play scene, for description of the scene, and (...) for questions of my patient "outside" the scene - (are you there?) (good so far?) (Wow this is hot) as opposed to ...you get the idea. I don't know whether this kind of thing is standard, but it seems to work as an agreed-upon framework for the exams.
Again, some things in place which allow the process to go forward in a way where both parties get something, and come (!) 😁 away satisfied.
Your point about the "safety" issues is very well taken - it is so strange to me that people (apparently) get into situations where they are surprised by anything that happens. Jeeeez, I usually ask whether the term vulva, pussy or cunt is preferred, and let's face it, that will speak volumes, yes? Sort of a progression of softer to harder, if you will, and then as the doc I can see how to tailor the exam to the patient's needs.
I haven't figured out how or whether to cross the water of actual f2f exams - I am married and am still working through how much of this to share with my wife. It seems clear to me that she would have to be OK with it, and I wouldn't want to have any lack of communication there (duh...).
You sound as if you have done many f2f exams and perhaps we could talk about that via YIM or other less public venue.
I like the idea that you talk about what I would call "developing a practice" - repeat visits and so forth. I have three on-line patients currently and there have been many "visits", so I am relatively certain I am doing something right.
Thanks for your response - it's always good to meet a fellow traveler.