Scans making examination redundant

Very disappointed that GP no longer ever examine us. Straight to VUS 🤬

I think you might need to explain this further. When you say “VUS”, what do you mean? Transvaginal ultrasound? And if so, what were the circumstances?

I went to my GP with post menopausal spotting and pain. He said ‘I don’t need to examine you as the ultrasound tells us everything’

Reminds me of the diagnosis of appendicitis. In the old days it was confirmed by digital rectal exam and pressing on the appendix area from the rectum. Now it’s done by ultrasound

They seem to get everything they want to know from blood tests and the scan. I just developed an umbilical hernia. They already knew about it from the top to bottom CT scan they did a few months ago. They didn't mention it at the time, apparently they were waiting for me to notice it.

Very disappointed that GP no longer ever examine us. Straight to VUS 🤬

@Daisymay You tell us about a particular case.

Indeed, if you have pain and bleeding after menopause, what interests your gynecologist is to know the state of the lining inside your uterus.

For that, actually carrying out an ultrasound is the best means of diagnosis.

Otherwise, and possibly in addition, a hysteroscopy should be performed by entering an optical fiber through natural channels.

On the other hand, we should not generalize, for an annual follow-up, we will continue to ask a speculum, to look at the state of the tissues of your vagina and your cervix.

A vaginal and rectovaginal examination to assess your ovaries as well as a careful palpation of your chest remain part of the usual gestures.

A good gynecologist must first know how to handle his basic instruments: his fingers and his eyes!

Reminds me of the diagnosis of appendicitis. In the old days it was confirmed by digital rectal exam and pressing on the appendix area from the rectum. Now it’s done by ultrasound

That is progress, the number of open or laprascopic appendectomy performed on a heathly appendix reduces as a result.

Generally its clinically pretty apparant without DRE if raised inflammatory markers and typical presentation you can be fairly confident of making diagnosis.

Scans for gyne issues have their place and will detect endometrial pathology better than a clinical exam but its not instead off. Doesnt come close to clinical exam to assess pelvic mobility, cervical excitation etc.

Update:

I had the trans vaginal scan which was extremely painful both at the time but also after. Simple paracetamol wasn’t touching it. The scan was fine so I phoned my GP who recommended I attend the surgery later. I was booked for a half hour appointment with a locum male GP. I explained all my symptoms and he thoroughly examined my tummy. He said I was wrong , he said it wasn’t a pelvic infection and said it was my bowels. I said I disagreed and wanted a proper examination this time including swabs. He said‘I don’t do intimate examinations on females’. I laughed and said ‘you’re a doctor, of course you do’. He said ‘it’s my personal choice, I don’t do them’. As I was feeling so much worse than the previous week i stood my ground and said ‘I’m not leaving until I’ve been properly examined and swabs taken’. He went and found a female GP who took the swabs and then instructed him how to do a bi-manual. All he did was feel my uterus for lumps.

the diagnosis is a severe Candida infection which is in my gut and reproductive system.

I much preferred the days when doctors pretended nothing phased them. It was a terrible experience

@Pecan_nutjob appendicitis is generally diagnosed by CT these days. Ultrasound returns with too many “not viaualized” as even the slightly overweight hide the appendix behind the abdominal fat.

A good radiologist with a good scan can see the inflammatory changes without oral contrast, just IV contrast. Some especially talented ones can pick it off a plain CT.

He said‘I don’t do intimate examinations on females’. I laughed and said ‘you’re a doctor, of course you do’. He said ‘it’s my personal choice, I don’t do them’.

What a bizarre “doctor”…… no words for it, except how can it be this man is a doctor…. In my view he shouldn't be…

Several times I have expressed my pains, symptoms and/or conditions to only have them say, 'go get it scanned'. No exam.

I thought they had to examine before they could order scans? Seems like a waste of time to send for a scan, then head back to the doctor to go over the results?

I have had Docs tell me that my PSA results are within limits and no DRE is needed. Even after I have informed them of constipation and bowel emptying issues. I also have heard the PSA tests are not to be trusted without a proper DRE performed as well. I have recently been told my groin pain requires an ultrasound and no exam would be done, before or after the US scan. Seems like being a PCP has turned into being a robot ordering scans and other tests so they don't have to work as hard. Insurance companies should demand better care for their clients.

Early this year they did a full body CT scan on me. For every complaint I have had since they seem to look at that scan to decide what is wrong or thankfully not wrong with me. My liver was in question so they sent me to the liver doctor. She looked at that scan and told me there was nothing wrong with my liver. Possible gall bladder problem, off to see the surgeon for that. He looked at that scan and said no problem there. Developed a hernia recently, off to see the surgeon for that. He looked at that scan and told me they saw it coming on that scan (they just didn't bother to tell me) and it wasn't ready to be fixed just yet.

I hope they saw my balls and prostate on that scan because no one has checked those for nine years now.

I never knew that I was prone to cysts until I had two transvaginal ultrasounds. I've never been told I had a cyst during my annual pelvic exams.

I assume that was what caused my previous abdominal pain and nausea when they ruptured. It happened quite a few times but I never went to the emergency room. The first time I thought it was my appendix. Then it was over and done. I still have my ovaries but it's been over a decade since I've experienced that.

Your Doctor should have examined you..

We are using Ultrasound more in clinic and also in hospital… It is used as adjunct to physical exam.. It will never be able to replace full physical examination.

I never knew that I was prone to cysts until I had two transvaginal ultrasounds. I've never been told I had a cyst during my annual pelvic exams.

They can't detect cysts without an ultrasound, of course they wouldn't tell you during your pelvic exams, because they couldn't have known.

I have heart issues, and the only non-ultrasound exam I could possibly have is my doctor listening to my heart and hearing the irregular beat. Obviously my normal doc does that at every appointment still, but there's nothing further to be gained in regards to that issue. So every few years I get an ultrasound where they basically physically look at the condition of the valves.

Personally I'd love to have just one full CT scan that they'd then look at when I complained of ongoing issues instead of going to my primary care doc, her being unable to do anything and referring me to a specialist or telling me it probably is nothing, and continuing to jump through hoops. But even just being sent straight for an x-ray or other scan saves so much time, like when my appendix tried to kill me as a small child. They might have pressed on my stomach? But there certainly wasn't anything going into my butt, there was just a CAT scan, they put me under, cut it out, and sent me home in the morning (because it had been in the middle of the night).

But all of this is just me being thankful for modern technology and wanting results fast (and also when I had a scan of my knee once they gave me a CD that let me view the 3D image and that was cool, but I don't even have a CD drive plugged into my computer right now).

My wife consulted the GP for vaginal bleeding and this appointment was by phone. she was refered for a pelvic ultrasound. The GP did not examine her.

Technology is taking over the world.. including the medical profession. Makes things easier for the doctors.. and certainly more accurate of a diagnosis in most situations.

Yes, it is all about scans and lab work. I don’t think these new doctors have to assessment skills of the older doctors. These doctors rarely touch you. When they want to check on my rectal tumor is a MRI or PET scan. Why not stick a finger in my butt to feel how it is doing. My husband says it feels very hard.

Unless the doctor runs their own stand-alone practice, most doctors are expected, by their health care system, to use referrals to specialists or for additional testing as often as feasible for several reasons:

This is not a defense for poor medical care. If you, as a patient, think a finger wave would be appropriate for your care, by all means speak up and request it. If the doctor refuses, find a new doctor pronto.

I would think that a thorough physician would want to do a full physical exam, including a pelvic exam, in addition to an ultrasound or any other testing. It would be interesting if you got a second opinion to see what happens. My guess is that every doctor's standards are somewhat different.

It surprises me to learn that not every pelvic exam includes all the standard parts, visual, speculum, bimanual and after a given age (35?) a rectovaginal exam. Have ultrasounds really negated the need for some of these old-school procedures?