Doctors age vs. completeness of physical

Have you noticed a difference in the completeness of your physical exam depending on the age of the doctor? I had a physical by an older doctor who did hernia check and rectal exam. The following year my doctor was young and didn't even ask me to lower my pant during the physical.

In the past I felt that this was the case, that younger doctors didn't do as thorough an exam. But over the years, I think I've changed my mind. Now I think it just has more to do with the individual doctor than their age. Some young doctors seem to be very thorough and some older doctors seem to be rushed and can't seem to be bothered to do a good exam. The schools where they were trained and the policies of their current practice probably have more impact than their age.

I would concur. I have been examined by doctors of various ages. I think it boils down the individual doctor. Many years ago I was required to take a physical for trade school. Because I was uninsured at the time I went to a place called "Kickback Plaza". A Local strip mall which housed a personal injury lawyer, a walk in clinic and "Shakes The Dentist". The walk in clinic was sparsely furnished and unprofessional looking to say the least. The exam requirements were run of the mill and the attending doctor just checked my vitals, heart and lungs then signed off and sent me on my way with 50 dollars less in my wallet. You get what you pay for.

I wonder if we are a bit obsessed with "completeness" of physicals, without having a standard definition of completeness. Medical history and available information play intoa doctor's choices of what to do and not do during an exam.

If you have seen the same doctor for a number of years, your chart will have a lot of useful information. Even if it is a different doctor at the same facility, you medical history will tell a lot before the doctor ever lays eyes on you. To act like you just arrived from Mars and there is no available information would be a major waste of the doctor's time and yours. Not to mention the added cost, time is money. With today's electronic medical records, even a doctor that you've never seen before at a different facility can get your history records in a matter of minutes.

So if my doctor listens to my lungs over my shirt, no big deal. I have no history of lung issues, and if he were to hear something out of the ordinary, I have no doubt he would listen again under my shirt.

At last year's physical, my doctor did not do a DRE. He knew I was having a colonoscopy the following month, and the gastroenterologist would get a much better view at that time.

I'm approaching 63, and I have never felt that I got an incomplete physical. But doctor visits are rather matter of fact for me. They aren't the high point of my week.

Quincy you've said it all. I was going to comment on this but now I don't need to. Thanks. Also as always the question remains. Do you want to be taken care of and have a proper diagnosis made or do you want a long perhaps unnecessary exam for other reasons?

I wonder if we are a bit obsessed with "completeness" of physicals

Yes, I admit it, I am obsessed with what I'd call thoroughness. When I see a new doctor (primary care) for the very first time, I schedule a full physical exam. I use that to gauge how thorough the doctor is likely to be in future exams or when diagnosing an illness. Maybe that's not the best way to internally rate a doctor, but it's one of the benchmarks that I use when determining whether or not I'll ever go back to this doctor for a 2nd visit.

What is thoroughness or completeness? For me, it just means did the doctor (again, this is supposed to be a full physical exam on a brand new patient) cover the major parts of my body? Basics like HEENT, heart and lungs should be included (in my opinion). A quick thyroid check, basic neurological and reflex exam, abdominal exam, genital and hernia exam, and a prostate exam (I'm way over 50) -- all of that, in my opinion, should be included. But I've had doctors that will skip virtually most of that. Should I return to a doctor that doesn't even attempt to do an abdominal exam? What about a basic neurological exam -- shouldn't they do some very basic parts of that? I think so. If they don't it's doubtful I'll be seeing them again.

As long as I still have the freedom to choose my own doctor (it's doubtful that I will forever the way things are going), I'll use thoroughness as a determining factor.

Everyone has their own opinion of what constitutes completeness and thoroughness for any exam with any medical provider during a scheduled appointment, urgent appointment, emergency visit and referred consultation etc. What I feel is most important is that what needs to be taken care of in the appointment is properly taken care of, questions, concerns, issues addressed and nobody has their time wasted or taken advantage of on purpose. This includes the patient and all medical staff.

I haven't experienced a difference. I think growing up, the doctor always seemed older and worried what would happen. Now, I am often closer to the examiner's age so it doesn't seem as intimidating. If I am there for a physical, I have an expectation that it will be complete and include talking as well as an exam of my most intimate parts!

After saying I wouldn't get into this again , I feel compelled to. The physical exam is driven by a problem seeking history. Yes unexpected things are found by an exhausting physical exam but rarely. Findings are usually hinted at by symptoms and signs elucidated by a good history. For instance should a patient complain of new onset weakness a examination of the conjunctiva will show paleness and the rectal exam may show occult blood in the stool. The answer could also be found in the indices of the red cells in the CBC. It's just naive to think that these findings are in a vacuum. It's a web of history, findings and lab tests which give the diagnosis. It's rarely the case where an exhaustive physical somehow turns up a finding which is not suggested by the history. It's factoring all this together which reveals the ultimate diagnosis and thus treatment. Therein lies the skill of the practicianer. That's also why it's important to establish a rapport with one or a few docs. That is how you receive good care. Not by changing physicians at the drop of the hat. That said, as an ER physician I often have to streamline my H and P. Then is when the old chart must be reviewed with care. Casting the net wide enough to get meaningful data while doing it in a reasonable time is a bit of a balancing act. Yes I have missed things but believe me if the exam fails to reveal the diagnosis then I always reassess. If someone thinks I failed by not testing cremasteric reflexes when it's not indicated, well tough titty. It's taken me a number of years to arrive at my level of expertise, but damn I'm good.

Liquidsky, you're right! Damn you ARE good!

Thanks Jimmy. I don't want to dislocate my shoulder patting myself on the back though.

I believe that two of the most important (but often overlooked) skills for a physician are to be a good listener and a good questioner. May people understate their symptoms on a written history, with forms being so prevalent now, or even when speaking with their doctor. If a good exam is predicated, in part, on the history, then the history is only as good as the physicians communication skills allows it to be.

I have never been examined by a doctor younger than late 40s. Every exam is what I would describe as thorough. They generally only take ten to fifteen minutes but I am not complaining of any ailments. The doctors have all covered the major body areas and were not overly concerned with my modesty.

I believe that two of the most important (but often overlooked) skills for a physician are to be a good listener and a good questioner.

One of the best clinical professors I had in medical school would drum into us that it's all in the history. Get a good history! The patent will tell you what's wrong if you ask the right questions and listen.

Unfortunately, people equate thoroughness with "doing doctor stuff". Rarely does that "doctor stuff" give me the key to what's going on with the patient. They don't equate knowing what to ask, and integrating the patient's answers and adding the next appropriate question to finally reach a diagnosis as being thorough.

Doc

I would guess that my doctor was about 30 when I started to see him when I was a kid, and I've been going to him for about 15 years. He's always been thorough and never really seemed rushed.

I had so many exams during my life time, beginning from my school and teenaged time, that i can remember. I was examined by younger and elder doctors as well, but I cannot say that there was a real difference in the thoroughness of an exam. Most of the exams were completely from head to feet and very thoroughly, but that depends not onthe age but mainly on my long history of problems and illness. I also remember some exams by some old doctors (by the paediatrician, public health offoce and in the Childrens Clinic), and they were always very long and thorough at all. Maybe, older doctors would have taken some more time earlier?!

Another very interesting thread in my opinion about a doctor's age versus the completeness of their physical exam. I feel that I need to clarify what a physical exam is . A physical examination is the process of evaluating objective anatomic findings through the use of observation, palpation, percussion, and auscultation. The information obtained must be thoughtfully integrated with the patient's history and pathophysiology.

I think what Jay11ish refereed to in this thread is a periodic health examination. How often this is done depends on the patient's age, sex, and risk factors for disease. It provides an opportunity for the healthcare professional to obtain baseline information about the patient for future use, and to establish a relationship before problems happen. It provides an opportunity to answer questions and teach good health practices. Detecting a problem in its early stages can have good long-term results.

A complete physical examination usually starts at the head and proceeds all the way to the toes and should takes about 30 minutes. First, the examiner will observe the patient's appearance, general health, and behavior, along with measuring height and weight. The vital signs—including pulse, breathing rate, body temperature, and blood pressure—are recorded.

With the patient sitting up, the following systems are reviewed:

-- Skin: The exposed areas of the skin are observed; the size and shape of any lesions are noted.

-- Head: The hair, scalp, skull, and face are examined.

-- Eyes: The external structures are observed. The internal structures can be observed using an ophthalmoscope (a lighted instrument) in a darkened room.

-- Ears: The external structures are inspected. A lighted instrument called an otoscope may be used to inspect internal structures.

-- Nose and sinuses: The external nose is examined. The nasal mucosa and internal structures can be observed with the use of a penlight and a nasal speculum.

-- Mouth and pharynx: The lips, gums, teeth, roof of the mouth, tongue, and pharynx are inspected.

-- Neck: The lymph nodes on both sides of the neck and the thyroid gland are palpated (examined by feeling with the fingers).

-- Back: The spine and muscles of the back are palpated and checked for tenderness. The upper back, where the lungs are located, is palpated on the right and left sides and a stethoscope is used to listen for breath sounds.

-- Breasts and armpits: A woman's breasts are inspected with the arms relaxed and then raised. In both men and women, the lymph nodes in the armpits are felt with the examiner's hands. While the patient is still sitting, movement of the joints in the hands, arms, shoulders, neck, and jaw can be checked.

Then while the patient is lying down on the examining table, the examination includes:

-- Breast: The breasts are palpated and inspected for lumps.

-- Front of chest and lungs: The area is inspected with the fingers, using palpation and percussion. A stethoscope is used to listen to the internal breath sounds.

The head should be slightly raised for:

-- Heart: A stethoscope is used to listen to the heart's rate and rhythm. The blood vessels in the neck are observed and palpated.

The patient should lie flat for:

-- Abdomen: Light and deep palpation is used on the abdomen to feel the outlines of internal organs including the liver, spleen, kidneys, and aorta, a large blood vessel.

-- Rectum and anus: With the patient lying on the left side, the outside areas are observed. An internal digital examination (using a finger), is usually done if the patient is over 40 years old. In men, the prostate gland is also palpated.

-- Reproductive organs: The external sex organs are inspected and the area is examined for hernias. In men, the scrotum is palpated. In women, a pelvic examination is done using a speculum and a Papamnicolaou test (Pap test) may be taken.

-- Legs: With the patient lying flat, the legs are inspected for swelling, and pulses in the knee, thigh, and foot area are found. The groin area is palpated for the presence of lymph nodes. The joints and muscles are observed.

-- Musculoskeletel system: With the patient standing, the straightness of the spine and the alignment of the legs and feet is noted.

-- Blood vessels: The presence of any abnormally enlarged veins (varicose), usually in the legs, is noted.

In addition to evaluating the patient's alertness and mental ability during the initial conversation, additional inspection of the nervous system may be indicated:

-- Neurologic screen: The patient's ability to take a few steps, hop, and do deep knee bends is observed. The strength of the hand grip is felt. With the patient sitting down, the reflexes in the knees and feet can be tested with a small hammer. The sense of touch in the hands and feet can be evaluated by testing reaction to pain and vibration.

-- Sometimes additional time is spent examining the 12 nerves in the head (cranial) that are connected directly to the brain. They control the sense of smell, strength of muscles in the head, reflexes in the eye, facial movements, gag reflex, and muscles in the jaw. General muscle tone and coordination, and the reaction of the abdominal area to stimulants like pain, temperature, and touch would also be evaluated.

It should be noted that with certain aspects like the Reproductive exams your GP or Family doctor may forgo in favour of a gynecologist or urologist.

I personally think that there are a number of factors that influences how thorough or complete an exam you receive. Age I feel is one such relevant factor as being competent occurs from practice which you gain from experience which takes time. As you gain experience over time you become an Expert which implies extraordinary proficiency and often connotes knowledge as well as technical skill, all of which aids how thorough a physical you get.

Another factor that needs consideration is the Doctors own level of dedication when comes to actually performing the exam, as with all professions some are more dedicated than others .

JimmyJohnson makes a couple of excellent points:

The schools where they were trained and the policies of their current practice probably have more impact than their age.

Having worked with doctors from all over the world I can attest to their various levels of thoroughness which performing a physical exam. This to a large extent depends on their training in medical school and their post qualification training .

This may be more of an issue in the US than the UK where the cost of the examination will depend on the charge for the professional's time and any tests that are done coupled with the individuals health insurance and what they allow.

Both Andie and Docinny45 provides another factor:

Everyone has their own opinion of what constitutes completeness and thoroughness for any exam with any medical provider during a scheduled appointment, urgent appointment, emergency visit and referred consultation etc. What I feel is most important is that what needs to be taken care of in the appointment is properly taken care of, questions, concerns, issues addressed and nobody has their time wasted or taken advantage of on purpose. This includes the patient and all medical staff.

Unfortunately, people equate thoroughness with "doing doctor stuff". Rarely does that "doctor stuff" give me the key to what's going on with the patient. They don't equate knowing what to ask, and integrating the patient's answers and adding the next appropriate question to finally reach a diagnosis as being thorough.

Individuals will have their own opinion about what constitutes a complete and thorough physical, so this is very subjective and open to a wide variation in its interpretation. So what is perceived by someone may not be for others .

Finally Srg Rik makes an excellent point:

I believe that two of the most important (but often overlooked) skills for a physician are to be a good listener and a good questioner. May people understate their symptoms on a written history, with forms being so prevalent now, or even when speaking with their doctor. If a good exam is predicated, in part, on the history, then the history is only as good as the physicians communication skills allows it to be.

We can all relate that some doctors do have a well developed sense of the "god complex" which can often exclude effective interpersonal and communication skills. That unshakable belief characterized by consistently inflated feelings of personal ability, privilege, or infallibility so it would not come as a surprised if they are not as thorough as they should be.

Most of my mandatory physical exams were performed by experienced practitioners and required examination of the genitals. Prior to entering clinicals in college I was required to have a physical exam. I didn't have a family doctor so I went to the county health department. They looked at the form and said they could call it a "sports physical" for 10 dollars. I was seen by a young NP. I did not have to remove any clothing, not even roll up my sleeve for a BP check. Hernia - ???? I certainly felt short changed. How do you establish a baseline with that kind of exam?

10 dollars? You get what you pay for.

For ten dollars they just might be able to figure out if you were alive or not.

Good question! As I have stated, our family doctor is very thorough, not only with me, but my wife and sons as well - we are all naked at various points in her exams. She is 57 years old.

The only comparison I have is our dermatologist who is only in her early 30s. I saw the dermatologist only once to have a skin exam done when our family doctor spotted a suspicious mole on my leg. I was in undershorts and a gown as the dermatologist did her exam, moving the gown as needed during the exam. She then asked me first if I wanted my groin and buttocks examined as well, to which I replied yes and she asked me to remove my shorts and gown at that point. Knowing there are risks of melanoma that are hard to find, such as near the anus, I was surprised that she made that part of the exam optional. But, once she did do the exam, she was thorough, including spreading of the buttocks.

Interesting question. Never thought about it from this angle. However, my personal experience/sample size is too small... I have noticed more differences between practices than between doctors.

@rn1933 has provided the criteria for a complete physical exam eleven years ago which might be of interest, or importance to someone who missed it because they were not accessing Zity then.

Having reviewed and reflected on my 30 plus years working in the medical field as a RN and previous reply on this thread, I can say that older doctors tend to perform a more thorough and complete physical exam. I have notice there is much more reliance on the use of technology than physical exam. There seems to be a proliferation of the use of scans (CT and MRI), X-rays, ultrasounds ( abdominal, vaginal etc).

One example for instance; having worked in ITU (UK equivalent of ICU) for over 20 plus years. Junior doctors rely more on using a portable ultrasound scanner to determine the position of Internal jugular vein or Subclavian vein for the placement of a central catheter. Speaking to a few of the junior doctors there is greater reliance on the use of technology during their medical schooling.

I can totally understand as imaging can produce more detailed information than a physical exam can....leading to earlier definitive diagnosis and intervention especially in time sensitive medical interventions.

I had the same doctor from about 1992 to 2024 or so. He was maybe late 30s when I started with him. He was very thorough in the 90s, but since the 2010s not so. The appointments his last 5 years were too short to get any type of thorough exam.

I was a concierge medical practice member for a year, having given up on the 15 minute appointments @mas1978 noted above. The corporate entity set 2 hours for a physical exam. The first hour was spent with a (nurse? np? technician?) who measured blood pressure, pulse on both arms, and ankles, BMI, EKG, vision. The results were handed over to the doctor, in his 40's, who spent most of the second hour going over them, adding lab work results, and other data that I had supplied him with. The actual physical exam was 5 minutes. Heart, lungs over clothing. Jeans, underwear dropped for a hernia check because the urologist, at the prostate clinic, had decided that one side was hard. He said that both were normal. I chose him, over an hour away, connected to hospitals that I wasn't, because his profile indicated that he swam, so should be used to men dressed in swimsuits, think underwear.