The Wellness Exam in the US: No Longer a Complete Physical

I haven't had a full physical in probably about 17 years. The last one, my dr did heart/lung auscultation and a PAP. I think maybe breast exam, but can't remember for sure. No abdominal palpation (maybe because I'm a fat chick?) or bi-manual. I've never had a rectal exam. The exam was at her suggestion, not mine. She's never suggested it again and I haven't volunteered. Of course now I couldn't do it unless someone helped me on and off the table due to my mobility issues (arthritis).

I remember one women's clinic I used to go to in a big city. My first appointment, the dr took a *very* detailed history, that has never happened since. My dentist asks for more history than any MD has recently.

I don't think the "complete physical" is really that much better or more thorough than the "wellness check". Major differences are the wellness check has no EKG, DRE, abdominal palpation, ear and skin check. I asked my doc about the EKG and she said she could order one if I want - I talked to a cardiologist about the benefit of an annual EKG and he said that without other symptoms, they don't tell you much. You could have a 90% arterial blockage (i.e the "widow-maker") and it wouldn't show on an EKG. The DRE is pretty much dismissed by the medical community (given absence of other symptoms). I see a dermatologist once a year for a complete skin check. If I had abdominal pain or an earache - I am sure my doc would check those areas. I check my testicles for limbs almost daily in the shower, and if I saw warts or pus I would surly schedule an appt. My doc would most likely refer me to a specialist (urologist, cardiologist, dermatologist, arthropod, ,gastroenterologist, nephrologist....) who is more qualified and up to date to treat medical issues. Medicare will only pay for the wellness check. If your doc needs more tests that aren't included in the "wellness check" they will refer you to a specialist or schedule another appt. That's the way the insurance works.

My doc spends a good 30 minutes going over history, complaints etc. We come up with a plan to address each complaint - referral, PT, follow-up visit, or let's monitor it for x number of months and check back. Full set of bloodwork labs. I don't feel "cheated" at all with the wellness check.

@gwhap said

My doc would most likely refer me to a specialist (urologist, cardiologist, dermatologist, arthropod, ,gastroenterologist, nephrologist....)

WHY would you be seeing an invertebrate animal with an exoskeleton of the phylum Arthropoda, such as an insect, spider, or crustacean?

Orthopod. Often confused with an arthropod, an orthopod is a vertebrate animal, usually a Homo sapiens with an endoskeleton that diagnoses and treats diseases of the bones and joints.

😁 😁 😁 😁

Orthopod. Often confused with an arthropod, an orthopod is a vertebrate animal, usually a Homo sapien with an endoskeleton that diagnoses and treats diseases of the bones and joints.

Very funny!!! 😄 I have been called a roach before!

My brother in law is an orthopedic surgeon and the common short version is that they are orthopods! Plus it is easier to spell!

I have come to the conclusion that once you go on Medicare, the government, insurance companies and medical providers figure you have one foot in the grave and the other on the edge. My wife and I went for our first medicare "Wellness" check with our new primary care physician (our old one retired the end of last year and I have posted several times about the thorough exams she use to give) recently. We got some good recommendations about the new doctor from friends even though I think the ink was still wet on her diploma. We were ushered into a examination room and told to sit in the two chairs in the room. The nurse started asking questions about medication and health history. Then she asked each of us in turn about history of falling and administered some cognitive tests. Because my wife has a history of falling, she had her get out of her chair, walk over to the door and touch it and return to her chair all while being timed. After completing all the paperwork, she weighed us, checked blood pressure, temperature and oxygen level. She then had us sit back down and said the doctor would be in soon. The doctor comes in and looks over the answers we gave and reviews medication. She then gets up and goes to my wife and listens to her heart and lungs, while my wife is still sitting in the chair. She does the same to me. My wife is diabetic, so we spent time getting all her blood sugar readings together for the past month but the doctor didn't ask anything about her diabetes. There is a sign in the room that if you are diabetic, your feet will be examined but this didn't even happen. The doctor asked if there were any other issues we had to discuss then wrote out some lab requests for both of us and a mammogram request for my wife. She said she needed to see my wife back in three months because she is on a controlled substance but didn't want to see me for six months. The doctor was very pleasant and nice but now that we are "ancient" is this what we can expect for the rest of our life as far as health care? My wife still has two lovely breasts and an active vagina and anus that can all get cancer or have other medical issues but if we amateurs don't discover it, is she condemned by the medical and insurance establishment to suffer because of her age? Yes she sees an Endocrinologist once a year, yearly mammograms and a colonoscopy once every 10 years but is this suppose to now take the place of the comprehensive health care we enjoyed the first 64 years of our lives? End of rant, just very, very disappointed in our yearly examinations this year.

For the last few years I have felt that I could have phoned it in.

From what I’ve been told, medical schools and insurance companies want doctors in with patients for seven minutes.

This has been an issue for years...and now with telemedicine catching on it will be worse. I remember going to a new doctor a decade ago...no undressing at all. At one point he said oh, you're here for a physical--don't think it changed anything except how he billed it

The "wellness" visit is an income booster for the doctors and provides an opportunity to promote additional billable services. If they do more than that, they will bill more for your "free" visit.

I have an academic internist. As such, my internist spends no less than 30 minutes with me. He is able to spend this amount of time with me because he has a very low amount of patients (academics only have 500) on his panel due to his teaching responsibilities. The average non academic physician typically has a panel size of 1,500 to 2,000 and sees 25 patients a day.

I saw my internist in June and had a very complete physical as I always have since birth (37 years ago). My internist does use telemedicine as well.

If you are seeing a physician who does not do a complete physical, go see someone else who will.

Yes it is interesting to see all these nursing students doing their head to toe exams in the youtube videos. Thats probably the last time they actually do that. I have never in my life had a head to toe exam.

You read about a full exam in the Bates Physical Exam Textbook but I have never had a doctor do at least 30% of it. If they did, the exam would probably cost $1000. Insurance companies are not going to pay for that. It all comes down to $$$. My husband and I joined VIP med and thought it was better but it was not. Yes, the doctor spends a little more time with but you still had to pay for everything. The $1800 per person per year just gave you the privilege to a patient of VIP Med doctor.

I have certainly experienced changes in physical exams from my internist. He used to perform a prostate exam every year once I turned forty. However, the last several years, he has skipped it. I do not know whether it has more to do with the fact that some literature suggests that regular prostate exams do not improve outcomes, or whether it is because of cutbacks from insurers, etc. In any event, it is strange to go in expecting it and it does not happen.

The closest I have come has been testing prior to bariatric surgery; colonospsy, endo, ultrasound of bladder, heart kidneys

ekg, eeg and sleep apnia testing...do not get me started on how much blood I gave

that aside even physicals as a teen in the 70s were heart, lungs, turn and cough and done

I had a physical yesterday and was surprised at how basic it was. Nurse brought me back, weighed me, and reviewed my information and got vitals (BP, pulse, blood oxygen...skipped temp, presumably to keep masks on unless there's a reason to check temp). Resident came in and reviewed my medical history and asked some questions. She listened to my heart and lungs (putting stethoscope under my already-untucked polo shirt), and checked my reflexes, though she said it's not that important for them to do. Looked in my ears and checked my eyes. My doctor came in and we chatted a bit - the usual lifestyle questions on how much I drink and if I'm staying active (actually down a few pounds from last year, presumably because I'm not traveling for work), compared notes on stress levels during the pandemic, etc. Then she did a quick stethoscope exam, palpated my abdomen and kidneys and lymph nodes, and basically that was it. I left with a renewed prescription and a lab order. She definitely invested the time in talking and didn't feel rushed, but I was surprised that the exam didn't go further - didn't even have to take my shoes off. Both the doctor and the resident made mention of the fact that I'm approaching first colonoscopy age, which I thought was interesting, particularly since they didn't do a testicular or prostate screening.

I saw the same doctor for the first time last year for a new patient visit and had an extensive medical history discussion, and at the end of that visit she did have me change into a gown and did more of a quick general exam and did a genital/ hernia exam and prostate exam (my first and still only prostate exam in a doctor's office) as I had mentioned an issue that she wanted to check out.

I'm not sure if this is their standard practice or perhaps they're making some exam thoroughness trade-offs during the pandemic. Anyway, I had visions of the nurse telling me to change into a gown and then getting a really thorough exam, but seems that's only if there are reported symptoms or if the conversation with the doctor drives a risk-based approach to what needs to be examined.

Funny but in Michigan, over the past 4 physicals from 2015-2020, 3 were with a gown and only one included a genital and prostate exam. Then I moved to Arizona and my wife and I go to Naturopath MD. She is very thorough and does a complete exam. Total time was 2 hours,, 1 going over labs and verbal history the other hour going over my body head to toe, in my underwear or in the nude.

Several people on Zity told me since I have rectal cancer that I should be prepared for a lot of rectal exams. Well, I only had two back in October when my cancer was discovered. Since then it has only been scans and blood tests with only a quick chat with doctor. Back in my 40’s, my husband tried to tell the doctor that he felt something in my rectum. The doctor dismissed as probably a hemorrhoid. He said we don’t do rectal exams until you are 50. Pandemic hits and doctors are not doing wellness exams. Now, I have rectal cancer.

@medfedcouple That is really tragic. It goes to show that we often know our own bodies better than anyone else. I wish you all the luck in the world dealing with the cancer.

Yeah it seems that younger doctors that will do thorough physical exams are few and far between nowadays. If this trend continues, then I might as well stop going to the doctor for "physicals" for the rest of my life and only go to the hospital to see a doctor if get seriously ill.

That is generally how things work where I live. Doctors don't do the yearly physical thing unless of course there is a clear condition that warrants one, say a permanent condition or post-op/treatment and follow-ups.

But in general, people do indeed go to a doctor when they are (or think they are) ill, not otherwise.

Yes, I have seen the younger doctors not as hands on as the older doctors. It is like the younger doctors have no hands on assessment skills. Now, it is all lab work and scans.

I think that medical care in the U.S., has become more of a corporate enterprise today, as opposed to the patient-focused care of the past. Money, or lack of, literally decides who lives or dies. The politicians have made some serious blunders as well, with false promises of creating programs to serve the poor and middle classes, in this regard. I've personally seen a huge disparity of competence also among doctors. That happens in every industry, when they lower the standards, for entry. Would you want to be a passenger on a flight, where the pilot was chosen based on hiring quotas, as opposed to demonstrated competence ?

@malephysicalexam ………….took my history, then quickly checked eyes, ears, throat, nose, heart and lungs. I was fully clothed the whole time.

I recent got my med insurance EOB from my last doc visit saw it was paid it in full as it was called my annual wellness exam. My visit was just like quoted above. I was basically fully clothed… Interestingly, the nurse practitioner was more thorough than my doc in following up on various questions.. Perhaps that's what the doc wanted - for her to do most of the work…

My doc does the wellness exam - but if I bring up any issues that need to be looked at outside of the “wellness” parameters, she is willing to accommodate it or refer me to a specialist. Since they plan appointments based on the shorter wellness check, more often than not we'll have to schedule another appointment, or have the NP called in to check it out. I think a lot of what was done in the “old school” exams wasn't necessary and didn't result in actionable diagnosis very often - so I am happy with the level of medical care I get even with the wellness checks..

@gwhap I agree. I have had many ‘thorough’ physicals, none of which led to the diagnosis or treatment of ANY, and I do mean any of my health conditions. This includes hearing, vision, deviated septum, hernia, excema, low testosterone, knee problems, and asthma. That is why I think they are really of little value. My wife continued to get physicals long after I ended the practice. Her doctor missed her declining kidney function lab results. He did thorough exams though for the little good they did her.

If you enjoy them and can afford them then go for it.

My wife and I now examine each other as we know our bodies better than doctors do. We both still see our PCP regularly but only for specific reasons, not for physicals.

I think a lot of what was done in the “old school” exams wasn't necessary and didn't result in actionable diagnosis very often - so I am happy with the level of medical care I get even with the wellness checks..

In many cases that's true - blood and urine tests tell doctors much more than a physical exam ever did - BUT… this new model requires that the patients become much more involved in self diagnosis and care. And if patients are ignorant of issues/symptoms, think that those symptoms are normal, or are afraid or embarrassed to bring them up - then minor problems can become chronic or even fatal.

@Srgfgahs I see my PCP twice a year - primarily for lab works and to discuss any new aches and pains. We do monitor my PSA and look for any other irregularities in my blood work. Recently, my platelets dropped off the chart so she sent me to a hematologist/oncologist. Another blood test with 3 months and they skyrocketed into the high normal range. So he sent me to a gastroenterologist to check for liver/spleen issues. I also get referrals for physical therapy due to aging joints!

I don't “enjoy” going to the doctor, but I do think the visits are important.

While I'm “OK” with the level of doctoring I get with the current state of medical care - if there is ANYTHING that you are concerned about, or just don't feel that something is right - be sure to discuss it with your doctor. You own that body - take responsibility for it! Bring a list of items you want to discuss - don't rely on your memory because invariably you will forget to bring something up. My doc takes the list and works her way through it.