Much less thorough physicals

I’m sure we’ve all noticed over the last decade or so that more and more doctors are changing their yearly physical guidelines and procedures to be “more modest and less invasive”. Couple this with the growing popularity of Virtual Medicine and I fear that by 2030, I’ll have to schedule a specialist appointment with a urologist just to have an actual genital and prostate exam.

If I go to a doctor for a physical, I expect to be told to strip to my underwear and put on a gown. I know of several local primary care practices under 3 separate health systems who do not even require you to take off a shirt or belt for the so called “exam”. Yet they still bill your insurance over $350 for the visit.

Thoughts?

Every employment physical that I have had involved having to strip for it. That being said, I have had one physical, when I had to strip down, at my GP's office several years ago. Currently I'm 52 years old, have been diagnosed with enlarged prostate, and been dealing with urologists for over 2 years. I have even had a prostatic urethral lift done to try to alleviate urinary problems. So far, I have yet to experience the prostate exam (digital rectal exam).

I see two different doctors once a year one for my annual physical. This doctor is a little older individual. He provides a very thorough hands on physical exam. He requires a lot of lab work and tests. He still believes you need to come in and be seen in person at least once a year.

The second doctor does my DOT physicals a little younger individual. He provides a very good physical but not so much hands on. We talk a little after I'm done. He was asking about my blood pressure? I was showing him my history, I monitor it on my phone. He then started telling me how he had been at a electronics store and was looking at the home health monitoring and diagnostics devices on the market now. He then went on saying how he thinks in the future you won't need to come into the clinic that for the most part they will be able to take care of you from your home. Time will tell as the older doctors retire and the newer generation of doctors take over, things are going to change.

I myself like being seen in person. I really don't want to trust my health to a computer not completely.

I see my primary yearly for the annual Health check they call it now. Last time didn't even take off the light coat I was wearing.

I see a urologist because I was referred there when I asked about a small lump I thought I felt on a testicle. Turned out it was nothing. Even that is just lower your pants. Pcp wasn't even interested in looking she just referred. Now see the urologist yearly for exam and DRE since I know I won't get that from the PCP.

Have tried 3 PCPs now all with the same experience.

Oh US Healthcare is a joke. These doctors don't have the time to do anything but address a concern (only the one you scheduled for too).

We had to find a new doctor 10 years ago when our doctor retired. I let my wife do the choosing and she picked the most beautiful female doctor in the new consortium. Her physical was a month before mine and she mentioned that I was concerned about not having the places I can't see, checked. The doctor looked me up on her computer and said she had me scheduled for a nude physical. My turn, and she kept her word, her assistant handed me a gown saying take everything off and put it on with the opening in the back. The doctor came in and began the exam allowing the gown to fall off so I was really naked while she did a very thorough checkup. Then because I was already lying on the table she had me roll to my side for the DRE. She had me stand up facing her and she felt my testicles then did the cough test. I felt she did a great exam and she seemed comfortable with me being naked which changed my opinion of her drastically. When I first started going to her I felt she was uncomfortable looking at those places our parents tell us are our "privates". I now feel very comfortable with her and confident in her assessments. BTW she didn't have anyone in to chaperone it was just me and her. I took that as a testament to her confidence in what she does. For a physical I expect to be naked with my doctor so she has ample time to see anything that may need attention. I'm not shy at all and I want her to look me over thoroughly. This was such an improvement over previous exams by her but she didn't retract my foreskin to look under there. I do NOT want to have to see a urologist to get that checked and I will tell her that the next time. She's my doctor and I want HER to know me completely not someone else for a small part of me.

He then went on saying how he thinks in the future you won't need to come into the clinic that for the most part they will be able to take care of you from your home.

Yet I'm sure that he will still expect to bill you (us) at an exhorbative rate, as if he was still actually doing his job.

Unfortunately, I have to agree. I had my annual physical just last week with a new doctor but same thing, he did not even ask me to remove my shirt. It took maybe 5 min for the whole thing after I was left waiting for at least 20 min. I do not think it is worth it anymore (they bill full price, scheduling is a pain in the ass, that is if you are lucky to get an appointment within the next 3 months). Like somebody else mentioned, I am thinking just seeing the specialists will work (for me, a urologist and an ophthalmologist are enough)

Unfortunately, I have to agree. I had my annual physical just last week with a new doctor but same thing, he did not even ask me to remove my shirt. It took maybe 5 min for the whole thing after I was left waiting for at least 20 min. I do not think it is worth it anymore (they bill full price, scheduling is a pain in the ass, that is if you are lucky to get an appointment within the next 3 months). Like somebody else mentioned, I am thinking just seeing the specialists will work (for me, a urologist and an ophthalmologist are enough)

Yes, my sub calls that "Hurry up and wait.". He hates that.

Back to the question...physicals are not what they used to be. No eye check or ear check (looking at at least) is done any more. It is check your blood pressure, heart rate, temperature, and asking if there is a possible issue or problem.

If there is an issue you get shipped out to a specialist where you have to wait for an appointment. Even if it is a big concern...wait to get more info and a possible answer.

Truthfully I get more time and attention from the NP and schedule to see her now. Just go for routine stuff like med refills. Being on a PPO I just seek out a specialist if I have a concern. Waste too much time to see a PCP and then even more time waiting for the specialist anyway after a referral. Plus many times the referral Dr may not have the best reputation.

I was a child in the '70s and a teenager in the '80s and I have said many times on here that my physicals growing up and in my teens were MUCH more thorough than any that I have had as an adult. Both the doctors that my parents took me to and the physicals my school did were more detailed, comprehensive - and invasive - than any I have had since.

@JakeNewYork fully agree. Grew up same time period. Diffence is when we grew up Dr's were not tied to conglomerate Healthcare money machines and ran their own private practice. Now that is rare to find.

My ortho that just did my bicep tendon tear surgery is a rarity, private and no hospital ties, does 95% of surgery in a private surgery center. Awesome Dr, takes lots of time with you, doesn't schedule 15 min appointments, doesn't over book, and complains about our Healthcare systems as much as me. Wish I could find a PCP like him.

This is a very common topic on Zity and I understand, having experienced it from both sides over the past several decades. I suspect it's driven too, in no small degree, by conflating what a doctor bills with what he/she DOES rather than what he/she KNOWS. It's really the practitioners knowledge you're paying for rather than their just putting their hands on you. Just having someone put their hands on you without knowing what they're feeling or hearing is called a play exam. When I started practice in the 70s, the physical exam was about all we had to check things out. What we've learned is that if a patient can walk into the office and tell a coherent story and has no physical complaints, there's not much an exam is going to reveal. So one checks blood pressure, lab including glucose and lipids, a couple other things like thyroid gland and that's it. If a patient has a complaint that's a different story. Then you examine that system. Medicine just looks at the physical exam differently than it used to but I reject the notion that has anything to do with billing.

I have to concur with many of the postings here that physicals have changed over the years and they are less thorough. I had a PCP that I had been seeing for about 20 years. I always had an annual exam with her by having to take my clothes off except for my underwear and put on a gown. She would give me a full exam by looking at and palpating my entire body that ended with getting a rectal exam. About 2 years ago I moved to a new area of the state and obviously had to find new doctors. When I went to one PCP for my first annual physical with her, she went over my lab results and then listened to my heart and lungs with my shirt on. That was pretty much my annual physical with her. I was bewildered and felt her exam was less than thorough. I switched to another PCP, and when I went to him for my first annual exam with him, it was pretty much the same thing…go over lab results and then he listened to my heart and lungs through my shirt. I just don’t feel that I get a comprehensive annual exam anymore and times have changed to save doctors time and it’s about saving them money.

I don’t usually wear underwear on a daily basis, but I would wear underwear to a doctor’s appointment in case I was told to get undressed down to my underwear and put on a gown. The only good thing is that now since doctors don’t have me put on a gown, I don’t have to bother anymore with wearing uncomfortable underwear to a doctor’s appointment. 😊

Mine are still thorough. Gown and underwear. Underwear removed for the genitalia/hernia exam. He spends about 15 minutes on the history & 15 minutes on the exam. So I spend about 40 minutes in the gown including waiting for him. I feel that’s good these days.

I don’t know what everyone means by “less thorough” unless they are referring to being “less exposed”. As I’ve got older, I feel I’m being looked at more thoroughly for issues associated with age. I’d rather have a specialist check me for heart, urological, skin, liver or organ issues than a generalist not trained as well in those areas. Fortunately, I’m pretty healthy, but feel I'm scrutinized more thoroughly now than ever before. My docs years ago who did head to toe exams never found anything, until once I complained about lower back pain and difficulty urination. Nothing showed up in my blood or urine infection wise, so she sent me to a urologist. They did an IVP and put me on some meds, bruised kidney. . My PCP is my quarterback, directing me where I need to go based on my input or concerns or things she picks up on in our conversations. She coordinates with all the specialists and manages the big picture. It’s not because of billing. The insurance companies have created the expenses, not the docs so called “greed” and desire to bill or make quotas.

This was the first year that my physical was done in record time. Heart and lungs, eyes and ears, abdomen - done. No rectal or genital exam, unlike the past many years. On the other hand, the same PCP spent longer than usual on my wife’s breast exam as he thought he felt something. Usually the breast exam is really fast (unfortunately for me) but this year he used two hands at once and really examined them well. Mammogram showed no issues at all, which is great, especially for a woman in her 70’s.

Our doctor sees us once a year and she does a complete physical and gynecological workup. So she is still thorough.

@Rigel I agree. My PCP is great. If I complain about a particular area she refers me to a specialist. Honestly, too many PCP’s including internal medicine doctors missed so many things. When the company I worked for at the time gave all its employees PPO coverage I self referred and got a lot of things my PCP’s had missed for more than 40 years, fixed. Now I have a medicare advantage plan with a reputable non profit health system. Referrals are easy and seldom require authorization. Thorough friendly specialists and hospital personnel.

Had a physical examination the other day with a new doctor. Was pretty brief until I was laying on the table in briefs and he said I am going to reach in your underwear to check your testicles if everything seems normal only take a few seconds. He reached in felt a bit, felt a little more and said you better take off your underwear, I’m going to have to examine you further as I think theres issues

My internist is extremely thorough but is more of a old school doctor. I get examined head to toe and even though he doesn’t do paps he still gives me a woman exam up top and down below.

My new pcp does an ekg, med review, orders labs, asks if anything’s wrong, then refers me to a specialist for anything I ask about. Doesn’t actually “examine” anything.

I'm an actual doctor and the newer generation of physicians aren't just referral monkeys sending people to specialists. There's a middle generation of docs that decided everyone needs a specialist instead of learning how to do the work themselves. Certain exam pieces have fallen out of favor due to lack of evidence that they change outcomes, i.e. prostate exams for people without symptoms. My exam is very thorough, but thorough in ways that are evidence based and not just for the performance of doctoring, unless it's play.

Been in the military 20 years, and after MEPS I haven’t had to remove any clothing for my annual, just run through the checklist of labs/shots, questionnaire, eyes, weight, blood pressure. Seems like a joke but I get why, understaffed mostly. Like seriously, not a hand laid on me, no stethoscope to listen to heart or lungs, no auscultation, no reflexes, no turn your head and cough, Nothing! My most hated part is the audiogram though, I’ve been told I’m hitting the button too many times!

@trythatonforsize I'm a military doc and the PHA isn't really an annual. You still need to schedule that separately. PHA is primarily a survey to see if there are any recent changes that make you undeployable.

I also miss the good old thorough physical examinations that I remember from my younger days. I think it's been several years since I've been told to undress, let alone been actually touched by a PCP. While I can't stand the thought of tele-health appointments, maybe that's the best route for these new annual physicals?

My new pcp does an ekg, med review, orders labs, asks if anything’s wrong, then refers me to a specialist for anything I ask about. Doesn’t actually “examine” anything.

my pcp also listens to my heart and lungs. Otherwise my “exam” is just as you describe it.

I have had a similar experience with PCP in the past few years.

Has anyone had any experience with direct primary care doctors? I imagine they would be more thorough.

I recently changed primary care providers - had been seeing a PA at a large family medicine practice. I felt that her exams were, at best, just going through the motions with a quick referral to a specialist if there were symptoms of anything. My lady two appointments were less than 10 minutes with the provider.

I switched to an internal medicine primary care group, based upon the recommendation of a nurse I knew. I wanted an MD as my primary care doc this time, and the first available was a female MD in her 50s.

It was the most thorough exam I've had in at least 15 years.

Here's the big post about that appointment: https://en.zity.biz/index.php?mx=blog;ox=showpage;pg=7914

@FredD That story reminds me I should post one about my last physical too

Male physicals without removal of underwear or the crucial genitals part does not deserve to be called physicals at all.