Current State of Physical Exams

@ls12 write back with details after Thursday. I’m sure a lot of us would appreciate it.

I will do that. I'm half tempted to ask for a head to toe exam if he doesn't do one. I have blood work/weight and height checked multiple times a year for medication reasons, etc and to show up at an annual physical exam just to do a rinse and repeat is a waste of my time.

A lot of providers in my area do a very limited hands on exam. They instead ask questions and order labs.

@ls12 write back with details after Thursday. I’m sure a lot of us would appreciate it.

My “exam” on Thursday went just as I expected it to go. It was like the other exams with the female MD and this time it was a male PA but it really wasn't much different. He did ask me to take my shirt and tee shirt off which she did not do. A LOT of questions which took 10 minutes or so, otherwise, heart, lungs, checked underneath my armpits for lumps, had me lie back so he could press on my stomach. He did ask about prostate but because I'm already seeing a urologist for that he didn't do any kind of genital or rectal exam. I already had the blood work/labs done previously. I am fully convinced that the head to toe examination done while undressed is a thing of the past. The closest I come to that is when I see my dermatologist in the fall for my annual skin exam when I am undressed to my underwear and a gown for that.

There is debate as to how useful a “complete” physical exam early is for a seemingly healthy person - or whether you really need an annual physical or not. I'm sure you could find articles that disagree - there are arguments on both sides:

https://time.com/5095920/annual-physical-exam/

My Son is a cardiologist and I asked him the value of getting periodic EKG's (since my provider no longer offers them unless you specifically ask for one). He stated you could have a 95% blockage and a normal EKG; unless you have some other underlying complaint, they really don't tell you much. This isn't medical advice to anyone - if you feel you need it to settle you anxiety, by all means ask for it. A lot of this is driven by cost - and that may alienate a lot of folks - but we are all paying for it and we are all paying for a lot of expensive and questionable diagnostic evaluations. Part of the reason medical costs are going through the roof.

... A LOT of questions which took 10 minutes or so, otherwise, heart, lungs, checked underneath my armpits for lumps, had me lie back so he could press on my stomach. He did ask about prostate …

I'm not trying to start an argument or heated debate, but what more do you expect? You've stated that you see a urologist twice a year and a dermatologist once a year, so I'm assuming that your PCP knows that going into your annual exam. It sounds to me that they are examining the main potential problem areas that aren't already being checked out by another specialist.

The only time i have a good examination is when im called for a diabetic check up and the doctor does a sensitivity test on my feet and checks my stomach each side as that is where i inject myself each day. other than that im usually called in for the results of my blood test for my sugar level

I have recently had issues where the physician needs to check things like abdomen and genitals. I think you should be able to ask for these exams no matter what to make sure everything is good, if you don't care then just don't ask for it. Even if I don't have any issues during a physical I ask for the exams anyways.

Of course just speak up if you think something is wrong, but in the case that your doctor knows you see other specialists they're not gonna worry. Just ask for the exam anyways and say you don't wanna wait until the next appointment with whatever specialist to ask a question or have a more urgent concern. But if you are only seeing them then I believe they should be part of a regular physical.

I have not had to undress at all during my last several wellness exams. I am 71 years old and have a cardiologist and urologist. I don't have a dermatologist. My question is how many skin cancers are missed. How many signs of abuse are missed, bruising, etc. What about lymph node checks. My wife discovered skin cancers on her nose and forehead even though she has her regular physical exams. They want to check her shoulder but that will take another separate appointment. Completely stupid.

It just seems to me - from my personal experiences - that many primary care providers are quick to write up a variety of referrals and loathe to actually make a diagnosis. Don't know if it's driven by insurance issues, time constraints, or a lack of competence or confidence… but it is reality.

It just seems to me - from my personal experiences - that many primary care providers are quick to write up a variety of referrals and loathe to actually make a diagnosis. Don't know if it's driven by insurance issues, time constraints, or a lack of competence or confidence… but it is reality.

I'm thinking a lot of it is malpractice issues.

Although I will likely never be a real doctor a t my current age of 33, it is quite likely that I would literally be the very last doctor who performs physicals with patients in a gown or less 20 or 30 years from now if I was a doctor. Nowadays there are already doctors well into their 50s and even 60s who are cutting back on the thoroughness of physical exams.

I'm not trying to start an argument or heated debate, but what more do you expect? You've stated that you see a urologist twice a year and a dermatologist once a year, so I'm assuming that your PCP knows that going into your annual exam. It sounds to me that they are examining the main potential problem areas that aren't already being checked out by another specialist.

I didn't “expect” anything other than what I got which was the same procedure that was used the past several years. I was merely explaining what happened and the similarity to most examination procedures today.

@ls12 I am fully convinced that the head to toe examination done while undressed is a thing of the past.

I agree. My previous doc was old school. During my annual physical, he would ask me detailed questions about the state of my health and follow up on any issues for which I paid him a visit from during the past year. Once the question session was complete, he would tell me to strip down to my underwear, hand me a paper sheet and then he would leave the room to give me some privacy. He would then re-enter the room, and conduct the ‘hands on’ portion of the exam.

My new doc didn't even bother to do a ‘hands on’ exam. The nurse/tech took my vitals, recorded them and drew blood for testing. She stepped out of the room, the doc came in and asked questions about specific issues. He checked my eyes and ears and used a steth to check my lungs. At no time did he ask me to get on the exam table or take any clothing off. He told me to take ibuprofen for the tendonitis in my knees and that was it. He asked that I schedule a follow up appointment in six months (which is now in four months) and sent me on my way.

I do not know why he wants to see me in the near future (I know, I should have asked), but I can only assume he wants to give me another assessment and hopefully he'll conduct a ‘hands on’ physical. I was really disappointed in the way the he conducted the exam. I feel he really didn't delve into the status of my health to detect any potential issues.

If he doesn't do a ‘hands on’ exam during the next visit, I will definitely ask him why he isn't doing so. I feel this is vital for a proper exam to identify any issues which may not become evident from blood tests. I really miss my old doc because of this.

If he doesn't do a ‘hands on’ exam during the next visit, I will definitely ask him why he isn't doing so. I feel this is vital for a proper exam to identify any issues which may not become evident from blood tests. I really miss my old doc because of this.

If he doesn't do a thorough exam the next time, I probably wouldn't give him another chance. At that point I would be likely to go find another doctor. But that's just me.

There's not been much happening at my physicals the past few years. Gathering history, following up on past concerns, some auscultation and palpation with me in gown + underpants, and that's about it.

I didn't go to the doctor at all last year trying to avoid medical offices for fear of COVID (plus I've been feeling fine), but it's about time to get checked up. I'll have a report on how my exam goes in a week or so.

I do not know why he wants to see me in the near future (I know, I should have asked)…

Well, he gets to bill your insurance company again.

I'm not trying to start an argument or heated debate, but what more do you expect? You've stated that you see a urologist twice a year and a dermatologist once a year, so I'm assuming that your PCP knows that going into your annual exam. It sounds to me that they are examining the main potential problem areas that aren't already being checked out by another specialist.

While this wasn't specifically directed at me or my comments, I wanted to add my two cents…

What do I expect? I expect my primary care provider to do their job and not count on a specialist to pick up the slack.

If the care provider is focused only on one thing, assuming that other providers are being more thorough, that is a recipe for poor care. Let's expand the scenario:

Your primary care provider know that you are seeing a urologist, so they don't check your prostate, genitals, or for a hernia figuring the urologist will.

You're seeing a urologist for kidney stones. They figure “this patient has a primary care provider and came to me for kidney stones, so I don't need to check for testicular lumps or hernia or do a prostate exam because the primary care doc is checking those things.”

Likewise, the dermatologist is looking for skin cancers but notices edema in the lower extremities, but figures that the primary care doc has taken note and is referring the patient appropriately.

No, medicine shouldn't cut corners and assume that someone else will notice.

So, what do I expect? I expect the provider to do their job - their bills certainly seem to assume that they are.

I agree, Fred. I also see all of the specialists but when I leave for my PC exam in about 30 minutes I expect more than a “Can you hear me, Can you see me and Cough”.

So, I had my physical exam yesterday.

I enter and the physician's assistant takes vitals and asks what I'm here for. She tells me to undress and put on the exam gown. I ask if she means to take everything off - she answered in the affirmative. That was unusual … my doctor typically did exams with the patient in underwear. After some amount of waiting, the doctor comes in and does a cursory exam, basically. Checks eyes, ears, and mouth, used the stethoscope to listen to my heart and lungs. Palpation of the stomach. I had some issues with dermatitis lately, so she looked at that.

The only reason for her to examine my genitals was to keep following up on a skin condition there, too. However, there was no full genital exam, and the doctor took great pains to keep my modesty preserved. So, pretty much what I expected, overall.

Besides blood pressure and vitals, nothing much goes on

I agree with most here that the exams are definitely getting less “hands on” and it’s disappointing. I have had a few doctors that are better than others who examine you more, definitely prefer them.

I understand and agree that more efficiency is important, and to that end I'm fine with the increased use of RNs instead of MDs for simple things, but I think the big expenses and inefficiencies that plague the medical industry are to be found, shall we say, further up the chain. What's more, I believe in preventative medicine and focusing on the root of the problem rather than symptoms. So I think it should remain, as it has been in so many places for so long, common sense to disrobe completely and get at least a quick run-over with eyes and hands every single time. You never know when you might have a new suspicious mole that you can't see yourself, and since people are increasingly isolated (and family no longer regularly sees you nude), there would be no other way for you to find out about a skin problem on your back.

And while my preferences (particularly that, to save even more time, full disrobing ought to be done out in the hallway during weighing) aren't realistic in this current day, I do find it frustrating that there are so many things (medical and otherwise) that people are forced into going with that are much more bothersome and offensive than any nudity could ever be, even to the most prudish person. And why the long wait times? That doesn't save anyone any money. Well that's going off on a tangent now.. honestly I'm just sick of the 'Verification is required for all users with less than 4 posts" so I'm finally posting. (that should be 'fewer' than 4 posts!)

I got an exam recently and I was not even asked to undress. They used to ask me to undress and put on a hospital gown but they stopped that years ago.

I got asked a lot of questions, which is good because history helps. But it does seem that it used to be more physical years ago.

He checked my heart and lungs with the stethoscope. Checked my adamen by pressing on it. Checked my lyph nodes but only in the face. Checked my eyes. Strangth test which I don't usually get. Didn't check ears. Didn't check throat. Didn't check for hernias (so no turn your head and cough). Didn't check reflexes.

Yeah they are a lot less with the physical part now. It's very disappointing. But I think he was pretty thorough when counting the questions.

I did also get vitals by the nurse ahead of time: bp, pulse, oxygen level, temp.

Think they should check for inner groan hernia, because I think that is important. They used to years ago every physical, but now they NEVER do. Guess they don't want to make the patient feel uncomfortable.

BTW I got undressed anyway while I was wating for the doctor. They used to have me get undressed and change into a hospital gown for EVERY physical. Now they generally don't.

I had a physical today for the first time in five years. I was not asked to undress, but to be fair its been a long time anyway since I was asked to undress for a physical, not just during the pandemic.

I actually ended up being examined by two doctors! I’m going to a doctor’s office with a residency program, so my new doctor is a resident. My doctor was running behind schedule, so one of the other residents came in to take all of my history and she conducted a full physical. Eyes, ears, mouth, listened to my heart, lungs and tummy, palpated my abdomen, tested reflexes, checked cranial nerves, etc etc. She then left to go catch up with my actual doctor l, and when she returned with him he performed the same physical exam himself, with her present! I was pleasantly surprised to get two physicals for the price of one today, haha.

And speaking of my new doctor - he is an absolute delight. By far the best doctor I’ve ever seen. He listens to all of my concerns and takes me seriously. Very thorough, very friendly. I’m absolutely ecstatic. 🥰

My most recent physical exam was very mild. It started with being weighed in all my clothes. The I was taken to the x-ray room and given a chest x-ray with all my clothes on. She did check to see if I had any metal buttons or anything in my shirt pocket. She then took me to the exam room and had me lay down on the exam table. She told me to pull my shirt up and she hooked up the leads for an EKG. She put all the pads on and did the EKG. Then she took all the pads off and told me I could pull my shirt down. She also took blood pressure, pulse, and temperature. She ask me some questions about my health and gave me three words to remember for later on. She some history questions and then ask me to repeat the three words, which I did correctly. She then stood up and said the doctor will be in soon and left. So in a coupe of minutes the doctor came in and started looking in my ears, throat, eyes, feeling my glands. He then listened to my lungs and heart over my shirt. He also listened to my cartoid artory. He did not have me lay down and palpape my stomach to feel my liver, and other internal organs. He did not check me for a hernia. Eventhoght my PSA has been growing and it now at 6:0 he did not do a digital exam of my prostate.. I think this is only the second time in many ears that I have not had to take my pants down for a hernia check and prostate check. He then talked about my EDG, my being over a year past the date for a colonoscopy, and because my PsA had risen about a ½ a point, he wants me to go to a ulologist. So I left the office with an apppointment for a colonoscopy, with my heart doctor to examine the EKG as the doctor thought it was irregulor. He also sent meet to a dertmatologist for a full body skin examl. all t his occurred in two weeks and I had a previous dental appointment during this two week also. I have been to all of the but the gastrointekignets (sp). I do have to go back to the Urologogist for a special blood test, I believe it is called a 4K test. So this week I have the follow up blood test for my prostate and next week I have the full blown colonoscopy. Hopefulu, after the colonosdopy I will be through with this round of thest and can proceed with life for a while. The last two years the actual physical exam is getting smaller and quicker but the tests he sends me for are increasing. He also made an appointment with my heart doctor to check my EKG. So it seems that the current state of physicla exams expecially for older people is to refer patients to a whole realm of specialists for evaluation. I am hoping this current round is over next week and I can get back to normal. Time will tell. So they want to test me for skin cancer, prostate cancer, and colon cancer. In addition to that my primary doctor thinks something may be wrong with my heart and he wants the specialist to evaluate me. It seems like never ending string of tests. But I guess this is now new medicine works.

It seems like never ending string of tests. But I guess this is now new medicine works.

I might just be young but what's the alternative to testing? Treatment without knowing the cause of an issue?

I had a physical today for the first time in five years. I was not asked to undress, but to be fair its been a long time anyway since I was asked to undress for a physical, not just during the pandemic.

I actually ended up being examined by two doctors! I’m going to a doctor’s office with a residency program, so my new doctor is a resident. My doctor was running behind schedule, so one of the other residents came in to take all of my history and she conducted a full physical. Eyes, ears, mouth, listened to my heart, lungs and tummy, palpated my abdomen, tested reflexes, checked cranial nerves, etc etc. She then left to go catch up with my actual doctor l, and when she returned with him he performed the same physical exam himself, with her present! I was pleasantly surprised to get two physicals for the price of one today, haha.

And speaking of my new doctor - he is an absolute delight. By far the best doctor I’ve ever seen. He listens to all of my concerns and takes me seriously. Very thorough, very friendly. I’m absolutely ecstatic. 🥰

It sound very good. Can i only ask, were you barefoot and did they check your feet?

This might be a crazy thought, but what if doctor visits are less “physical” nowadays because doctors are learning about people like us and are afraid of going too far and making a professional exam become inappropriate?

My annual physical with my GP is almost a waste of time , my doctor i love her to death but now at 68 they are called wellness visits and are pretty much a waste of time , no gown , fully clothed , all they do is ask a few questions , check temp and BP and simple blood work and a cognitive test oh and a medicare requirement is they look at your feet and thats it , this years visit i canceled and am just doing the blood work and for all other health junk i see specialists , in fact my Primary Care Doctor , she has in 12 years never seen my pussy or my boobs

Until about two or three years ago, my primary would check for a hernia and prostate. He doesn't do either anymore. He did send me to a Urologist because of a high PSA and the Urologist checked my prostate. But actual physical exams seem to be on the way out.