Lengthy post for those who like detail... here's an account of my physical exam with a new doctor yesterday.
I had a physical examination this week - my first proper physical in about 6 years. I get annual wellness checks through work, but realize that I should have more regular exams and also need a new local primary care physician since we moved back to the midwest a few years ago.
Anyway, I found a doctor affiliated with a major local university medical school. She has strong academic credentials and patient ratings, and was accepting new patients (though it took a while to get an appointment).
I arrived on time to check-in. My appointment was at 10.30. I fasted in case they were going to do a lipid panel, and also guzzled a bunch of water beforehand in anticipation of a urine sample.
Matt, an EMT I’m guessing in his late 20s, came into the waiting room and called me back. I was happy to be greeted by a pretty cheerful professional, and wondered if he’d be in the room during my exam. We stopped in an area just inside the corridor of exam rooms to get height and weight measurements, and then went back to the assigned exam room.
He had me take my sweater off for easier access for blood pressure, which he measured along with pulse and oxygen levels. Then a quick oral temp. My BP was a little high, so he re-checked it a few minutes later, and it had normalized.
Matt reviewed my medication usage and a few medical history questions to complete what I had already submitted online. I gave him my immunization records from my prior doctor and my company (which handled travel immunizations). He actually found that I had a more recent Tetanus booster than I remembered from a trip to the ER about 18 months ago. We covered that I still needed a flu shot this season, which I had hoped could be taken care of while i was there.
Matt let me know his work was done and went to get the doctor. Unfortunately my water intake finally caught up with me, so I went down the hall to use the bathroom before the doctor would arrive.
I got back to the exam room and waited a few minutes, looking around the exam room as I love to do. There was the usual array of different sized gloves on the wall, as well as a wall-mounted otoscope. The BP cuff, oxygen monitor (fingertip thingy), and thermometer were mounted on a rolling cart. I was sitting in one of two chairs next to a desk with a computer, and of course the exam table was in the corner. There was a rolling supply cart next to the exam table. I thought maybe supplies for my exam might be on it, but there was a reflex hammer and a disposable vaginal speculum, and a swab and container to capture a swab for lab analysis. While the reflex hammer might be used on me, I was pretty sure the other items would not be! I was surprised that I didn’t see tubes or packets of lube out. They’ve been a fixture at other doctors’ offices, even though they haven’t been used on me.
The doctor came in after a couple of minutes and introduced herself. She’s late 30s and had a very pleasant and disarming style. She also introduced a medical scribe, a younger woman with a laptop cart. She indicated that the scribe would be catching notes on medical history. I was between the scribe and the doctor, and since I was talking with the doctor didn’t really pay attention to the scribe being there. We covered the usual medical history topics, surgical history, and lifestyle habits. I had brought in my labs from my last employer wellness testing, which we reviewed.
I also mentioned that I had been feeling a little heaviness or pressure in my perianal area. It was minor, but still had me a little concerned enough to bring it up, even if it’s not comfortable talking about stuff like that with a stranger, doctor or not. She indicated a few courses of action - getting a urine sample to make sure there’s not an infection (she sweetly acknowledged that i had just peed, so that may be tough to provide), and suggested ibuprofen and possibly a course of antibiotics. She also mentioned that she could do a prostate exam and get a PSA test done. I agreed to having both done. She was pretty active in seeking my permission to do a prostate exam. I told her I was frankly expecting it at this point, so not to worry. That told me that had I not mentioned the issue I would not have had anything checked “below the belt” otherwise.
She then got out a gown and asked me to change into it, taking everything off underneath. She left the room, and the medical scribe went out with her, laptop cart in tow. I wondered if the scribe would be coming back in, or if Matt might be rejoining to assist or chaperone. I got undressed and quickly changed into the gown.
The doctor came back in solo, after knocking to make sure I was ready. She offered me a sheet to hold over my lap while she did the other usual checks - listening with stethoscope; checking eyes, ears, nose, and throat; possibly checking reflexes (I don’t remember); and doing a quick abdominal check.
Next she had me stand up in front of her. She put on a pair of gloves and quickly checked my penis, and then felt my testicles and perianal area. She had me show her where I was feeling some pressure.
She removed her gloves and opened the cart and took out a pad and a rather large packet of lubricant. She spread the pad out on a tray and then opened the lube packet and squeezed some onto the pad. She put on a new pair of gloves and then got me into position for what was next. She asked if I had a prostate exam before. I told her I hadn’t, but knew the drill (she didn’t need to know that I’ve had a number of them from play doctors, right?). She had me lean over the exam table. She let me know it would feel a little cold at first, and then opened my gown and spread my cheeks a little and pushed a lubed finger inside, saying “OK, I’m putting my finger inside your rectum now”, or something like that. She was very gentle and felt around a little. She put a little pressure on my prostate and asked if it was similar to the feeling I had experienced. I told her it was similar, but not quite the same. She removed her finger and let me know everything felt fine, and then offered me some tissues to clean up. Overall it was pretty quick, and very gentle.
I had always expected doctors to be pretty matter of fact about including and performing that exam, so I was surprised that she made it seem somewhat optional, and if it was ok to do it.
(I should mention that, no, I didn’t get any particular joy out of the examinations. It was quick and clinical, and I’m very conscious about not mixing my medical fetish interests with someone’s professional responsibilities.)
She let me know that I could go to the lab for a urinalysis and PSA test, and that if it continued to be an issue for me, or if something came back in the labs, she’d refer me to a urologist. She told me this as I wiped the lube away (she used a lot of lube…I’m assuming her usual patients are less experienced and open-minded about having a finger put up there….). WE wrapped up and she left to let me get dressed.
Once I was re-dressed, Matt came back in to give me my flu shot. I wanted to make a joke about what had just been done to me, but I figured he’s heard and seen it all. I asked him where I could put my gown, and he just had me put it on the exam table, saying “I’ll take care of it… you can’t do all my work for me.” Next thing I was seated again, pulling the sleeve of my t-shirt down so Matt could give me the flu shot. That was it, and then I went back to the lobby.
The scheduler made sure the lab got instructions, and then helped me make an appointment with a dermatologist for a routine check-up.
I went downstairs to the lab and was seen pretty quickly. I had chugged some more water, so I was ready for the urine sample. I peed in a cup and put it in the little two-sided cabinet in the bathroom. Then I had a quick blood draw for the PSA test.
That was it, and then back to work!
Later in the evening I got an alert from MyChart app letting me know I had lab results. My doctor sent the lab results and let me know that the urinalysis was clean, and that PSA was normal. So, she said to try ibuprofen if I continues to feel any pressure, and to let her know if it persists to she can get me into a urologist. She also suggested laying off cycling for a while (I haven’t been cycling much since it’s winter, so not a big deal) and to avoid sitting as much as I usually do at work.
Overall it was a really positive experience - I was impressed with the care the doctor took in covering medical history and the actual physical exam, which was pretty quick. I was also impressed with the fact that i was getting a message from her late on a Friday night with lab results from tests done just hours before. I know medical professionals have a tough job - demanding case loads, insurance coverage challenges, and more - so I don’t take it for granted that she was generous with her time and focus, gentle, and approachable on delicate topics.