Much less thorough physicals

Interesting thread. Yes I've noticed that what's involved in a regular physical exam is quite different than it was 20 years ago. Why? Because they don't need to do most of what they used to anymore. Bloodwork identifies the vast majority of normal issues as does an EKG (I get one yearly from my PCP). If I have a specific complaint, I get a referral to a specialist and I'm fine with that. I've got a Gyn who handles well woman. I've got a dermatologist who handles skin checks. I've been to a gastroenterologist when I was having issues there. As diagnostic machinery continues to evolve as we move into the future, I suspect we're not going to even see much at all in the way of a traditional examination at all. They're not less thorough, they're just more accurate with the newer tools.

I think there has been a general medical trend towards relying more on wide ranging blood tests as being less time consuming on doctors. A nurse takes the blood, a distant Lab screens the samples. In many cases, though not all, this may detect more than a conventional physical might.

But those unhappy with their ever briefer annual medicals should spare a thought for those of us whose 'free at point of use' healthcare systems now deliver no form of preventative screening at all, except for cervical & breast checks for women. As this recent article details, hundreds of thousands of cancer patients in the UK are now being forced to pay for their treatments, such are the record waiting times:

https://www.theguardian.com/society/2024/feb/07/hundreds-of-thousands-of-uk-cancer-patients-forced-to-pay-for-private-treatment

If I have a specific complaint, I get a referral to a specialist and I'm fine with that.

My sub has a different reaction @Nurse_Phillips . Mostly because a specialist visit is just under an hour, one way, to attend. He hates the extra running. Because it usually takes longer to get to the appointment than the time involved in the actual appointment. Then we have the drive back home.

@MissStress I can certainly see that, yes I’d be annoyed too.

Fortunately, my DO still provides a more traditional ... old styled ... physical exam. Perhaps age may play into this ... I am 64 and he is 56 years old. Additionally, his practice is small which may lean towards a more thorough physical exam.

There never seems to be any time restraints. As a matter of fact, I have never been in the waiting room with more than two other patients. In addition to the doctor, there are only two other employees ... his receptionist and one nurse. Several years ago, I overheard the receptionist speaking to someone over the phone stating that "he blocks his physical exams for one hour."

In the past 7 years, I have witnessed quite a turnover in his nursing staff. Although, for my past two physical exams, he has maintained a younger ... looks to be around 30 ... male nurse.

The physical has been the same the last two years. The nurse takes me to one of only two exam rooms. He then instructs me to strip from the waist up and to remove my socks and shoes. He leaves me alone to undress. About three minutes later, he returns to the exam room with a portable EKG machine. As I sit on the exam table, he asks some basic questions regarding any changes in my health from the past year. Then, he takes my temperature, checks my blood pressure, and records an electrocardiogram.

I remain flat on my back ... electrodes still attached ... as he exits in order to show the doctor the EKG results. Upon reentering, he begins to remove the electrodes from my legs, arms, and chest. He then pulls out an exam gown and instructs me to "remove my pants and underwear and place the gown on with the opening in the back." I stand, strip completely down, then don the exam gown.

I sure hope this routine does not take a nose dive down! 😉

My latest Dr falls into the clothes on category. Fortunately I also see a uro once a year so I get a rectal and genital exam from him. I also get a colonoscopy from another Dr every 2 yr. So e b everything is covered but I now have to go to 3 different Dr's.

Back in the early 80s, i had one Dr who did it all fully naked. The rectal check was done by rigid sigmoidoscopy.

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

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

@Jd98765 I have Direct Primary Care, I keep my clothes on. They do it in the name of modesty and dignity.

@XR171 Does your doctor give you a genital and/ or rectal exam? Personally, I don't really care how they have me dressed or undressed for the exam, I just prefer they check everything that needs to be checked while I'm there. I have no problem remaining fully clothed and then lifting my shirt or dropping my pants as needed.

I had a direct PCP for awhile and that's how he performed my exams. He was always very thorough. Since leaving him, I haven't actually been examined during any of my annual physicals. The assistant takes my weight and BP, then the doctor or NP comes in and we talk for about 10 minutes.

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

Had to look up Direct Primary Care docs. Other than billing and paying a subscription fee for their service, I don’t see much difference from a regular doc, maybe I’m missing something. Sounds somewhat similar to concierage docs. Do you still have to carry insurance for medical tests/imaging? Anybody have any experience with DPCs - pros/cons.

@BenDover nope, closest was an abdominal exam over my shirt.

@Rigel for me I have much more access to my PCP. If I have a question I can just text her even send her a picture of its relevant. My membership covers all in office and virtual visits, annual physical, and labs. They even have cash discounts with other providers and specialists that's cheaper than my insurance.

I still have my insurance, for example my DPC doesn't provide a CPAP but they did refer me to a sleep specialist and my insurance covers the CPAP.

@Rigel for me I have much more access to my PCP. If I have a question I can just text her even send her a picture of its relevant. My membership covers all in office and virtual visits, annual physical, and labs. They even have cash discounts with other providers and specialists that's cheaper than my insurance.

I still have my insurance, for example my DPC doesn't provide a CPAP but they did refer me to a sleep specialist and my insurance covers the CPAP.

@XR171 Thanks for your response. I know one big complaint doctors have is the overhead with dealing and justifying their medical decisions with insurance companies, even if it’s Medicare. Doesn’t surprise me that alternative and innovative methods of supplying quality medical care are emerging to avoid a lot of the unnecessary beauracracy inherent with insurance. Next time I see my PCP I’ll ask her what her views are on this. Since I’m on Medicare now and have minimal to no out of pocket costs, this wouldn’t be an option for me, but it’s a novel and interest approach.

Sorry, I guess my previous doctor is not exactly a direct doctor. I believe he is more of a personal care or concierge doctor, I just assumed they all meant the same thing. With my previous doctor, I paid an annual fee and kept/ used my insurance. My annual physical was included in the fee. I called, texted, emailed the doctor's cell any time of day any questions or problems I had. Obviously, he preferred you not abuse that and use common sense. He limited his number of patients drastically compared to most PCP's. Most appointments were scheduled for 30 minutes, physicals were scheduled for 60 minutes. I never had to wait more than 2 days to get in to see him for any reason. If I was sick or it was urgent, never more than a few hours. He would do house calls and visited patients in the hospital everyday. He knew the history and background of all his patients by sight. Basically, he wanted to get back to the way his father practiced medicine many years ago in a small town. It was great for people with chronic conditions or many ailments. Probably a waste of money if you are healthy and never go to, or need, the doctor.

I think it depends on the age of the doctor, as others have alluded to. My GP is older, and I'm still asked to undress to my underwear. I receive a fairly standard physical exam that does include a genital exam: after the abdominal exam, I am asked to stand up and lower my underwear, at which point the doctor, with gloved hands, feels my scrotum and testicles. No exam of my penis or prostate though (not old enough for the latter).

Since I have been on medicare the annual exams are called "Wellness Exams". My doctor use to do a complete exam including hernia and prostate exam. No more. I don't take off any clothes and he listens to my heart and lungs over my shirt. Most of the time is his asking me questions and he always wants to know when my last colonoscopy and urologist visits were. About the only time I undress at all is if am sick and he prescribes an antibiotic shot. Then I have to lower my pants and boxer shorts for the shot.

I personally think that a physical exam can't be done properly unless the patient is undressed. For a doctor to perform an exam with the patient fully clothed and to call it a "full exam" is completely nuts. It's wrong for them to bill the government/insurance company for a physical exam when they don't actually conduct one, not to mention it's not fair to the patient because they aren't actually getting checked over completely.

Around 20 years ago, I switched doctors, and was pleasantly surprised that my new doctor didn’t do thorough physicals, or more often than once a year. The other part, was that I was no longer asked to strip off my clothes. Every doctor prior to that, had required me to strip down to my underwear, and then poked and prodded me, which I absolutely hated. According to my current doctor, all of the old school procedures are unnecessary, because of blood tests that can reveal most things. These days, the doctor asks a few questions, and the visit doesn’t always include bloodwork.

I personally think that a physical exam can't be done properly unless the patient is undressed. For a doctor to perform an exam with the patient fully clothed and to call it a "full exam" is completely nuts. It's wrong for them to bill the government/insurance company for a physical exam when they don't actually conduct one, not to mention it's not fair to the patient because they aren't actually getting checked over completely.

Exactly. When i came home tonight, I got a bill from my physician. After billing the insurance co. 200 bucks for a brief office visit that included next to nothing, the notice said I owed 36 bucks. And I thought about how I didn't remove any clothing after revealing a concern about having a possible UTI. If I got to expose myself in a jockstrap to her, it would have been worth my 36 bucks.

My GP has done “well exams” once a year because my old insurance allowed it and it didn’t cost me anything. Unfortunately it was a pretty worthless exam. I think I had to take my shoes and socks off.

New insurance this year so we’ll see what happens. Pretty sure I’ll be shopping around for a new GP.

Definitely get more complete exams with play doctors!

According to my current doctor, all of the old school procedures are unnecessary, because of blood tests that can reveal most things. These days, the doctor asks a few questions, and the visit doesn’t always include bloodwork.

Will bloodwork show a testicular lump that is headed toward cancer?

Will bloodwork show a hernia?

Will bloodwork show edema in the ankles or knees?

Will bloodwork show bruises from domestic abuse?

Will bloodwork show skin cancer?

If all patients need is bloodwork, then why don't we do labs before meeting with the doc? Why do we even see a doc? Why not just have an annual blood panel done and only see a doc if results are abnormal?

I wonder why?

$$$$$$$$$$$$$$$$$$$$$

My annual wellness check is coming up in a few weeks. There will be a fasting blood draw a 7:00 A.M. and I will see my doctor at 8:10 and review the results. The lab is that efficient. I will probably get a gown and leave underwear on. This is how it should flow IMHO.

@HeatherR I completely agree with your statement below.

I personally think that a physical exam can't be done properly unless the patient is undressed. For a doctor to perform an exam with the patient fully clothed and to call it a "full exam" is completely nuts. It's wrong for them to bill the government/insurance company for a physical exam when they don't actually conduct one, not to mention it's not fair to the patient because they aren't actually getting checked over completely.

It definitely depends on the doctor and practice because I know there are definitely still some out there who do still require undressing! I am lucky to have still been able to see a doctor whose stayed traditional. It also helps to look at reviews of different offices for keywords like 'thorough' 'excellent service' etc (because most people aren't going to outright say on a public google review that they had to strip lol) but it's really hard to know what kind of treatment you're getting unless you can build a relationship with that doctor. I think smaller practices are better as well.

But I also think it has to do with this weird paradigm shift in the West where nothing can be offensive or unapologetic anymore. Everything has to be comfortable and safe for the sake of our own sensitivities, which is okay for some things for sure, but shouldn't be in medicine where your health and life are concerned, there I think its more important to be thorough in treating every patient. In our busy lives and extreme reliance on technology, people look at a doctors visit as a financial and time inconvenience rather than an essential routine to maintaining a healthy life so I guess doctors get you in and out as fast as possible so they can send you on your way with a prescription for a magic pill, and get to their next waiting patient. It's definitely a sorry state from how it used to be when I was growing up and even up to a few years ago. It goes along with our current trend of "shrinkflation" where things are sold in smaller quantity but for the same price, you end up getting a medical bill for $300 that may not have included anything worthwhile.

Anyways, that's just my two cents! Even though the field of medicine is changing, it doesn't mean medical-play has to. We can keep the spirit of traditional physicals alive in play exams!

@Clarkeston: Well said! I agree with your statement 100%!

I've lived in the UK for over 25 years and only once did I have to undress for the doctor and that was for the urologist and just down to underpants. In my experience clothes stay on and for anything remotely involved you get sent to the hospital to a consultant after a few tests. I remember the day when you stipped down to underpants and they didn't stay on long. Growing up my family GP used to give me a thorough going over quite often. Even at university an appointment could last over 20 minutes, but these days it's in and out in about 5 to 10.

I had my annual physical last week that was pretty thorough...happy to chat about it if anyone wants to hear more

My adult physicals are quite different from the ones I and many others grew up with. Then, we were immediately in our underwear. The nurse came back to weigh and measure, do BP, and, of course, rectal temperature. Then you were told to remove your undershirt and wait for the doctor. Eventually your underpants would come off as well, and you would be fully naked in front of the doctor and a parent.

Today, it is much different. You either fast and do blood work in the office, or it could be done in advance at a lab. You speak to the doctor for x number of minutes, sometimes a half hour, and he is taking notes. The only exam you get is a minute with a stethoscope over your shirt.

I would say there are 2 reasons for this. One, everything is going less invasive. Many people are embarrassed to undress, and that has become a trend.

Secondly, there is the matter of insurance. The doctor can charge anything he wants, but the insurance company has set rates for everything and they only get a fraction of what they charge. In fact, while there is still extensive training for doctors, I.e. 4 years college, 4 years med school, internship, and residency, while the cost of these things have skyrocketed, the doctor’s earnings are but a pittance compared with 50 years ago.

So there is a time factor. They need the volume. They need to see as many people in a day as possible to defray some of the loss of earnings.

I just got done with my annual physical. And this year's was just as thorough as my past physicals maybe even a little more so. This year he had me back naked in a gown were the past two years he just left me clothed and would have me lift my shirt and drop my pants. This year he took the time to check me out completely and also did a skin check. He took the time to ask questions and then let me ask my own questions. I feel I was given a very complete and good physical.