2nd physical not the same as the first

Last week i had my second annual physical exam with a female doctor who performed a very thorough physical exam the first time (ie, DRE and hernia check). she spent no more than 5 minutes with me on the second exam and only asked some questions and listened to my heart. the same thing happened to me with my prior female doctor. is ordering blood work and doing next to no actual examining the standard protocol for physicals after the first one?

Welcome to the Era of managed care.

I would say it's time to shop for a new doctor again. Or you might want to try a nurse practitioner the next time. In my experience they consistently seem to spend more time with you and do a fairly thorough job. Your mileage may vary, of course.

So much these days depends on the insurance company. Doctors or NPs only do what they get paid for. If getting a genital exam is limited by the insurance company to some pre-set criteria, it's not going to happen otherwise. Often, this is limited to the initial visit, limited by age or by complaint or pre-existing conditions. Before you fire your doctor, ask.

So much these days depends on the insurance company. Doctors or NPs only do what they get paid for. If getting a genital exam is limited by the insurance company to some pre-set criteria, it's not going to happen otherwise. Often, this is limited to the initial visit, limited by age or by complaint or pre-existing conditions. Before you fire your doctor, ask.

This is very true. My NP said she would like to do a DRE but unless I had blood relative that had prostate cancer that insurance would not pay for it since I was under 50.

This is very true. My NP said she would like to do a DRE but unless I had blood relative that had prostate cancer that insurance would not pay for it since I was under 50.

It probably took longer to give the explanation than to do the exam.

This is very true. My NP said she would like to do a DRE but unless I had blood relative that had prostate cancer that insurance would not pay for it since I was under 50.

Isn't that sort of like saying that they're not going to listen to your heart or lungs unless you have some family history of heart or lung disease? I really doubt that DRE is a separate, billable line-item that is sent to the insurance company for payment, although I certainly may be wrong. I would think that it's just part of a normal examination (based on age of course), just like any other part of the hands-on exam by your physician. Or at least it should be. Granted, it does take a small amount of extra time, and that is something that the office does bill the insurance company for.

Generally speaking, a full physical takes a while. There's no way that a physician is going to have time to do everything to you. As a medical student, I've been taught that you should also do a heart and lung exam NO MATTER WHAT. After that, the exam completely depends on what the patient says. If the patient does complain of abdominal issues, I'm not going to do an abdominal exam. If the patient doesn't complain of genital issues, I'm not going to take a look at his penis.

Prostate cancer is not really a big deal, so the threat of it isn't going to be enough for people to do a DRE. If you came in and said that every once in a while, your stool looks black and tarry, EVERYONE would do a DRE on you. Or even if you said you had a family history of colon cancer, and were past 40, I might do a DRE. Or saying you have difficulty beginning to urinate sometimes. Otherwise, gotta use the time more effectively.

Isn't that sort of like saying that they're not going to listen to your heart or lungs unless you have some family history of heart or lung disease? I really doubt that DRE is a separate, billable line-item that is sent to the insurance company for payment, although I certainly may be wrong. I would think that it's just part of a normal examination (based on age of course), just like any other part of the hands-on exam by your physician. Or at least it should be. Granted, it does take a small amount of extra time, and that is something that the office does bill the insurance company for.

It's not a line item, it's a level of service that needs certain justification because it costs more.

OK, here's my two cents:

When you go to a Care Provider for the first time, it is not unusual to have a head to toe, soup to nuts (no pun intended) exam. This is so the MD/PA/NP has a baseline to compare future exams. After that, age can be a factor in how often you need to have an exam and how thorough it is. Recent studies have come out saying that in younger patients (under 50) without any history of medical issues, an annual exam is not needed. (They say every 3-5 years is good)

Now, I have blood pressure meds and other health issues, so I would always shlep on into Boston every 6 months to a year. Once I hit 50, however, the routine changed. The first time I saw my current NP, I had a full physical. Six months later, I saw her, she checked my meds, my vitals, HEENT, heart, lungs, abdomen, than stopped at the belt line. Both times I left for a slew of lab tests afterwards. The 3rd time (six months later) again she did a complete exam. She explained to me that this would be the routine. Since my last exam was "the Full Monty," next time I see her will be a checkup.

She also mentioned that I will be due for a colonoscopy in 2016.