Doctor not thorough enough?

Hi, I'm a newbie to the site. I'm just wondering how, if there is a way without sounding weird, I could ask my doctor to be more thorough with his auscultation? I like him quite a lot, but his auscultation is somewhat lacking. The past few visits he's checked my heart in just one spot and lungs only in two. He also just listens over clothing. I realize these visits were for depression medication so it probably wasn't as necessary, but it's a bit disappointing. Honestly I don't think I've ever had the apex of my heart checked as an adult. Part of me worries there's something going undiagnosed!! Would it be super bizarre to say something? I also really don't want to try to find a new doctor as I do feel comfortable with him, which is huge, as I'm sure those on here can understand. 😃

I have this problem with my doctor. I've been seeing him my entire life (literally, he was the doctor that delivered me) and I can't think of a time where he's listened to more than two spots for my heart. Lungs he's pretty good with. But I don't think I've ever had a doctor listen at my apex or at tricuspid. Not even the cardiologist I've seen has listened any lower than just below my collarbone. I'm actually going for a physical on Monday with my GP.

PecheMama, It isn't clear from your post why you think your doc isn't thorough enough. You said the visits were for depression, not for a cardiovascular concern or your lungs. Longer more comprehensive visits are available, but they cost more. If not medically necessary, you may be paying the extra cost, not the health insurance company.

If you want a thorough work up on your heart, find a cardiologist.

A good exam of the heart can be obtained by getting a good history first and then listening. In the absence of cardiac pathology it's simply not necessary to listen to multiple sites. While I don't ever recommend listening over clothing for a screening exam for prescribing anti depressants it's simply not necessary to do more.

PecheMama and Brooklyn, Let me try to address some of your issues here.

As I have mentioned before 90 percent of the time the doctor can make an accurate diagnosis just from your history. And if I had to put a number on it I would say probably another 5 percent on top of the already 90 percent the doctor can make the accurate diagnosis from just looking and listening to you. So 95 percent of the time the doctor can make the right diagnosis before he even touches you at all. Then when the doctor examines you he really is just confirming what he already knew.

Okay so you come into the office for a regular healthy physical. Your history says that you are not a smoker and you have no history for example of asthma. And currently you are not having any complaints of respiratory issues. The doctor can tell just by looking at you pretty much 100 percent of the time if you are having respiratory issues. If your color is good, you are talking without being out of breath, lips are pink, nail beds are pink, he hears no wheezing and you are sitting up erect and are not guarding then he can pretty much know 100 percent that you are not having any respiratory issues at the moment. When a patient is having respiratory issues we are taught to listen to all 5 lung fields, as nurses anyway, to help form our assessment. If you are healthy and all of the above is normal then the doctor doesn't really even need to listen to your lungs at all really. He does so because of 3 reasons, 1) because he should probably. But that's probably the least reason he does so. 2) Because if he doesn't patients who are laymen like yourself complain and bitch that they are not being examined properly. Nor offense. And 3) Because every time he examines a body system the amount he gets paid for that exam goes way up. Now that may not be what you want to hear, but it's the truth, plain and simple.

Now onto your heart. Again for most of the reasons I mentioned above your doctor can pretty much determine a lot about how your heart if functioning just by looking at you and from your history. Unless you are having cardiac issues there really isn't any reason to listen to your heart in more than one place. Forgive me because I can't remember what that place is called, it has a name though. Maybe Liquid or Susie can fill this detail in. But if YOU look down on your chest the area just to the left upper edge of your heart basically, or to the right of your sternum is the spot I am talking about. You can listen and hear all 4 valves on that one spot. That's really all you need to listen to if you don't have any cardiac symptoms or history of such.

Now as far as listening to your heart over your clothes well that's not really the doctors choice for the most part. People have gotten so touchy about their bodies. People don't want to disrobe anymore for the doctor. A lot of doctors have no choice but to listen over clothes because they are afraid someone might call them a pervert. This is exactly one of the reason electric scopes are so popular. You can hear a heart clear as a bell through multiple layers if you have to. But speaking on the doctors side, they don't want to listen to your heart over your clothes, they weren't taught that way but society often dictates what is and what isn't acceptable.

So there you have it, the plain naked truth.

Mashie

Mashie, I'm not necessarily complaining. I find it at least a little bit strange that I've never, not even once that I can remember, had the lower spots listened to. On two separate occasions I was in with my regular doctor for a cardiac issue. Once as a young teenager and once last year. I was in last year because my heart had started skipping WAY more often than I'm used to. (I would count 50+ skips that I could feel just while getting ready for class in the morning.) Plus my heart would start racing out of nowhere and then suddenly slow back down without warning. I was even referred to a cardiologist after that and he didn't listen for more than 15 seconds total, and just one or two spots. I was in the hospital with tachycardia when I was around...14? I might have been 15 already at that point, I don't remember. And I don't remember the ER doc listening either. I understand that if you're going in for either a checkup or completely unrelated issue why they wouldn't take the time to listen. It's not necessary. But when you're in specifically for something regarding the heart? That's where I find it strange. Not disappointing, but strange. Oh, and they almost always listen through clothing unless I'm wearing a low cut shirt.

Well then that my friend I can't answer. I am not a doctor so in this case I can't comment. I see where you are coming from though.

Mashie

When dealing with a case of tachycardia or irregular beats the cardiac exam is not nearly as useful as the cardiogram. The area to listen to is the apex. Even with an electronic stethoscope the artifact produced by clothes makes it difficult to get an adequate exam. As I've said previously listening through clothes is like enjoying a fine view with the curtains drawn. In fact heart murmurs are usually associated with other abnormalities such as valvular abnormalities heart failure and metabolic abnormalities such as thyrotoxicosis. Thus for arrhythmias listening to the heart is the least useful exam. Also without murmurs multiple listening areas don't reveal any new information. As for the lungs,

I routinely listen to both sides apex and bases and anteriorly if necessary.

Brooklyn please let us know how your physical goes?

Liquidsky makes a good point, he usually does. With tachycardia, it isn't necessary to listen all over the place. One listen and you get the drum beat, fast, slow, irregular, or whatever.

I have been to the ER three times with supra ventricular tachycardia, a heart rate of about 200. The first time I didn't know what was going on, but as soon as they put a monitor on me, they knew. The second and third times I knew the symptoms and walked in and simply told the intake nurse that I was in SVT and they had me on a bed in less than a minute. So from a clinical standpoint, it isn't always necessary to listen at multiple points,

My Cardiologist doesn't really listen to multiple points. He might listen to 2 points and that's about it for my heart. However, he always listens to multiple points on my back when he's listening to my lungs. I don't feel like I'm not getting a thorough exam from him as that is his specialty and he's used to hearing heart sounds.