Current State of Physical Exams

@tabitha32 Did you have your appointment? How did it go?

It is definitely the trend now to do bare bones minimum physical exams. The main thing is bloodwork and vitals, checking abdomen and lymph nodes. It’s ridiculous. I would prefer a completely nude physical with everything checked including my genitals and prostate.

My np does a very basic exam. Although she did have me lay down on the table to check my abdomen. No genital exam or rectal though. That's what my urologist is for. I figure I'm 45 so it's important to me to get a urological exam

My academic internist always does a very thorough complete physical exam. It always includes a thorough genital exam as well. Academic physicians are more likely to do a very thorough physical exam because they are more interested in the science of keeping their patients healthy than they are at just making money and trying to see as many patients per day as they can (non academic physicians).

In the UK you will need to have a private health assessment cost around £600 by eg BUPA or Nuffield to get a full physical. You get up to an hour with an assistant who does an ECG, takes blood samples, requests a urine sample together with other tests. You then get up to an hour with the doctor who does a complete head to toe examination including a testicular exam. ( in my experience they do not touch or examine the penis). There is then an opportunity to discuss the findings with the doctor including the results of all the tests. (The organisation has a laboratory on site).

I've posted on this elsewhere but will add my 2 cents here as well. I graduated from medical school in the dark ages of the early 70s. Most of the advanced imaging technology such as ultrasound, CT and MRIs hadn't been invented. In med school we had a year long course on physical examination and practiced it on patients for 2 more years. It was darn near all we had so a patient in for an annual exam got the works. Nowadays it's clearly different but it is scientifically based. Truth is, if you walk into the exam room and don't complain about an organ system, there's probably no point in examining it. We had a neurosurgeon tell us basically that: if the patient walks in, sits down and tells you a coherent story without neurological symptoms, there's no reason to do a neuro exam. Now if you complain about testicular pain, you're gonna get a genital exam. Otherwise it's not worthwhile. A few basics like blood pressure, routine lab work and in my view palpating the thyroid are all you need. Colonoscopy periodically takes care of gastrointestinal issues. That's the long and short of it. Now if course play exams are totally different. But a contemporary clinician isn't going to perform all the exam components that we did 30 years ago... there's no longer a material reason.

Physical exam? What's that? She listens to my back and chest, dazit.

Previous to 10 years ago for 30 years I stripped upon entering the room and he told me to sit on the table. He slid his stool over in front of me and we talked for about 5 minutes. Then he listened to my heart and lungs then I laid back while he tapped my abdomen. Then on my side for the DRE and back to sitting while he bonked my knees and ankles then tickled my feet and toes. Then we sat there talking for another 10 to 15 minutes until he had me get dressed and it was all over.

I left feeling I had had a physical and that he had had time to look over my whole body so if there WAS anything questionable he would have found/seen it and told me to see a specialist if necessary. Then his receptionist would call to get me an appointment with one.

Today I feel like I go there just to get her to renew my prescriptions. It is up to me to decide to see a dermatologist and urologist and I haven't figured out who else I should see yet. I seem to be in charge of my own prescriptions but she has the license to write them. I have had to tell her if they're too strong or not strong enough.

I forgot, he DID do a testicle check. I don't think he trusted me to do a good enough job or perhaps recognize something wrong since I'm NOT a professional.

It's now 3 years later, and I can say the exams seem so much more modest in nature. I agree, they tend to check the bare minimum and are also concerned with the patients privacy above all. They instead rely on their initial vital check and the patient's family history.

I'll never forget my well woman exam with my pcp. Her nursing assistant would not let my husband go back with me! I was very upset about it, to the point that I physically couldn't let her stick the speculum in my vagina because I was so on edge. They finally allowed him back there with me, which is my right; come to find out, they figured I wouldn't want him back there because "most of her female patients don't feel comfortable having their husbands go back with them." I was the first that did apparently haha and then she proceeded with the exam.

Another time recently, I went to the ER due to sever abdominal pain. The ER doctor, who I think was a resident because he was awful young like 26, first asked me about my symptoms and what was happening. He then asked me if it'd be okay to check and palpate my abdomen. I lifted my shirt, and he palpated my abdomen which I didn't think was very thorough. He didn't bother to lower my pants even the slightest and I had to lift my boob just so he could more accurately examine me. I remember looking at his face while he was palpating and he seemed a bit nervous. Little did he know, if he would have asked for me to remove my clothing to further inspect, I would have gladly. Honestly, as much as I understand they don't want to get in trouble so they err on the side of modesty, I just don't see how that helps getting an accurate diagnosis.

I'm with @Pollux on this. The accuracy and effectiveness of diagnostic tools today is far superior to manual inspections. It's worth the effort and cost (at least to me) of using the technology that didn't exist 50-60 years ago to more accurately and objectively diagnosis problems versus less accurate and more subjective manual palpatations etc. If one has a specific issue, the doc will erither check it or order a test (or both)- they aren't going to ignore it. The cost of a mis-diagnosis from a subjective exam could result in much higher costs and health issues.

Here in the UK in my earlier years, physical exams almost always ended with me being naked.

These days it seems that Doctors place a lot of reliance on blood tests and scans.

No bad thing I suppose as I always wondered whether a physical exam would detect many problems.

It would be good to have an old fashioned physical exam by a Doctor who took his time.

I used to get physicals when I was younger. In my 40’s I came to the conclusion that they were a waste of time, money, and medical resources. They never detected my deviated septum, hernia, vision problems, asthma/allergies or psoriasis. If multiple doctors can miss the simple things they sure as heck are going to miss the big things.

It took an ENT doc all of 3 minutes to catch my deviated septum.

I have no problem with them getting better information from other tests but it WOULD be nice if they explained that to US, the patients. They don't need to be so secretive. It IS my body they're working on and there is something in my noggin despite what that nurse told me once when I went to the ER. They had done a scan of my head and was awaiting the results. She came in and said "Good news, there's nothing in your noggin". I liked her. A nurse with a sense of humor.😃

My wife has MS and gets full body MRI's every other year. The doc once commented that "Yes, you still have a brain!" She's very thorough about explaining and interpreting the radiologists reports and findings to us. I used to get a CD of the scan and could play it on my computer. All of our docs communicate with us very well.

I do a detailed exam during regular annual exams. Most of the regular annual exams are fast/within 10 mins. For women with pelvic exam, it takes bit longer. I have few female patients who get their pelvic/pap smears by GYN and i do the annual regular exam except (Pelvic). We are using ultrasound for evaluation both in hospital and in clinic.

With fetish exams when meeting outside, i like a good long detailed exam/play..

In the last five or six years the only times I've been physically touched by my GP was when he examined a painful cyst on my back and the one time he checked my prostate because I'd been on testosterone replacement therapy. Every thing else has been a blood test or a scan. Must be why I love a playdoc to take his time examining my cock and rectum.

Maybe a function of getting older or a sign of the times, seems like you end up getting sent to various specialty doctors by the PCP.

A whole team of doctors for a particular part your body.

I do a detailed exam during regular annual exams.

@RealDr4Play What does that involve for men?

Maybe a function of getting older or a sign of the times, seems like you end up getting sent to various specialty doctors by the PCP.

A whole team of doctors for a particular part your body.

I wish mine would send me to some or maybe I don't.

I do wish she would tell me which ones I should be seeing annually. I just began going to a dermatologist because friends at the coffee shop do it and were surprised when I told them I don't. They have nothing wrong but they go annually to be sure there isn't. My next goal is the urologist but I got that from the coffee crowd not from my PCP. I'm wondering who else I should be seeing annually. It would make me feel a lot better if my PCP was telling me that.

It seems that as soon as I became comfortable enough to fully enjoy my exam, exams became much more cursory in nature. I was always required to undress completely and have the doctor probe every inch of me growing up. Once I started going for exams as an adult, I barely removed a stitch of clothing. The doctor did more typing than touching. I am interested in experiencing a thorough and embarrassing exam as an adult, similar to the exams that I had growing up. I don't think that will ever happen with a real doctor. I can only hope for a play doctor who will provide a realistic experience.

@jblasphemy17

Annual physical exam is same time. Prostate testing/exam is if patient meets the criteria and is interested in getting the tests.

I meet only women for fetish play exam.

I have a female pcp and she does a fairly thorough physical including full genital and rectal exams because they get extra bonus money if they don’t send you to specialists so I haven’t seen a urologist for a couple years and when I do need to be seen it’s by the urology PA that’s female and she prescribes my one medication since I have not had issues since the medication was started.

Does anyone get an actual rectal exam anymore? You know, where the doctor actually sweeps the top and sides of the rectum and feels for abnormalities? I haven't had one of those in years.

Most doctors now just go straight in to check the prostate for 2 seconds and then withdraw.

@KC_Patient recently, just prior to getting my colonoscopies. I was asleep both times (thankfully). I haven’t had or wanted one from my PCP. Last one from there was in 2002.

I just had my annual physical in February. I have been seeing this same doctor for nine years now. He has been and still is very thorough, and hands on literally. He has made sure all of my screenings and testings get done. Colonoscopys, PSA, and echocardiograms. This year as well as the years prior, I was given a complete physical, including a genital exam and prostate and rectal exam. He always asks if I'm seeing a Dentist and a Optometrist. I think that I have a good doctor? When I leave his office I feel like I'm healthy, or if something is not right? He will figure it out.

Does anyone get an actual rectal exam anymore? You know, where the doctor actually sweeps the top and sides of the rectum and feels for abnormalities?/quote]

@KC_Patient When I went in for my hemorrhoid consult and possible banding was the only time I have ever had a real rectal exam. Had it twice in a month period, have to go back next month. Both times it was incredibly arousing, I posted in one of the anoscope threads about it. Besides that my PCP seems scared to touch me below the waist (hell haven't even lifted my shirt for her) and my urologist is really quick.

@patient1985 an internist IS a PCP. PCP is a primary care provider. Internists, pediatricians and family practitioners are PCPs. My PCP is an internist and he does my yearly physical as well as any sick visits which I may have.

@patient1985 an internist IS a PCP. PCP is a primary care provider. Internists, pediatricians, and family practitioners are PCPs. My PCP is an internist and he does my yearly physical as well as any sick visits which I may have.

Internists can and do provide PCP services. My PCP is an internist that specializes in Nephrology. Not that I have any kidney issues, she's just a very good doc that I am comfortable with.

I'm a retired internist who did maybe 70% of my practice as a PCP, with the remainder in my subspecialty of endocrinology. I enjoyed the people and the variety of primary care medicine. Although I was trained, in the 70s, in rigorous physical diagnosis I have written often in these pages in recognition of, if not full support of, the modern trend away from the thorough physical exams of yesteryear. Using modern lab and imaging technology you catch nearly all disease states that you might with a thorough exam. But as I was musing about all of this and prompted by another current thread on Zity about thorough rectal exams, I was reminded of my first real rectal exam when I was a third year medical student. I was just starting my medicine rotation on the hospital wards and was told to take a thorough history and physical on a new admission. On my most detailed rectal exam I felt a rock hard mass just at about the limit of where my finger could reach. So on my first exam I found a rectal carcinoma. Without a real rectal exam that would have been missed. So sometimes a real exam brings real value.

I certainly have nothing against the newer methods, I just wish they would explain it to us. When they change the way they do things without telling us why I feel like I'm not getting a good exam any longer. It may have happened just as my 30 year doctor decided to retire so the lack of a thorough manual exam seems like I'm not getting something. Being run through those machines that go click-click-clunk surely must be showing them something they can't feel manually but it would be nice if they told me about it. At my part time retirement job as a crossing guard we joke about how they treat us like mushrooms. They keep us in the dark and feed us horseshit😁 When they put us in a new place they don't tell us anything, we're expected to figure out what we should do on our own. I saw my boss twice this year. Once in the checkout line at the supermarket and a couple weeks ago when she came by my corner to give me a hug and ask if I was coming back for next year.

That's about what my doctor does but without the hug. When I left the hospital after having cellulitis I did see two of her underlings. One told me the tests showed I am the same as I was when I came home from the CABGx6. That was 27 years ago so that was very good news, better than a hug which I didn't want HIM to do anyway. The surgeon who did the CABG just died this year. I went back to have him take the staples out of my arm 27 years ago and asked him what I could or could not do. His reply "As far as I'm concerned you're as good as new and you can do anything you want". So being as good now as I was then sounds pretty dam good to me.

My mother made it to 102. My goal is 120.