Old versus new school preference

I don't have enough experience with younger docs to say. My docs have almost always been older. In their 50s or 60s. I had one physical from a young PA who was almost as thorough as my older docs had been. He was maybe in his 30s. Had me strip to my underpants only, no gown. Did a rectal exam. So no difference that time in the level of modesty. Even older docs are not all the same. I have been in exam gowns only with older docs and in my underwear only with other older docs. Once I was 40, I got a rectal exam every time and even got them in my 20s and 30s although not every time.

But as the older docs retire, I will have younger docs and will be able to see if the practices change much. I don't know about geographical differences as it has been years since I have lived elsewhere. When I was a kid, all the docs seemed the same to me and the routine was the same. I've have been curious about the practice differences between male and female docs but have not had a female primary care doc so no experience there at all. There have been male posters on this board who have claimed that some of their female docs don't provide gowns and do physicals like a male doc would.

I've only had male doctors for my physicals, but from my experience, age isn't a good indicator of the thoroughness of my exam. My pediatrician who was in his early 40s to mid 50s while I was growing up always performed a fairly quick physical with little time spent on history. An internist I had who was in his early 40s performed the least comprehensive physical I've had and was also brief on the history portion. My current doctor who, like my pediatrician, is in his 50s is by far the most comprehensive, especially with lab results and history.

Basically 3 doctors nearly the same age who had very different approaches.

If I were to ask my doctor, or some of you did, we might come to an understanding as to whether it's training or experience/personal decisions which make some of the differences in approach. My doctor wants to see all of his male patients, but why?

I've gone to an "old school doc" for years, although I think he's going to retire sometime in the near future. That said, several years ago, I showed up for my annual exam at 7:30am, only to be told my doc had a family emergency, and would be unable to see me. However, the practice had brought in another doctor to fill in that day. Not wanting to reestablish an appointment (well, I was there at the time), I agreed to see the substitute doctor. After the nurse did all my vitals, and I waited over 20 minutes, the doctor arrived. He was all of 30 years old (at best), introduced himself, and commenced with exam. All he did was ear, nose, throat, heart, and lungs. Typically my regular doctor has me undress completely and examines every square inch of my body. I asked the substitute doc whether he was going to check my prostrate, only to be told it really wasn't necessary "at my age."

Several weeks later, I contacted my regular doc and told him of my displeasure. He had me come in the next week for a complete exam.

I would like to find a younger doctor when my guy retires, but it might be difficult. At least a younger doc could probably outlive me.

It seems that there is now few differences between the examination by an old school doctor or a young one

May be because there are now a very few old school doctor still performing examinations

The differences were much more important in the past ( from 60's to 90 's ) when you were examined by an old school doctor or not, either male or female

The old school doctors were much more thorough in the visual examination of the body and required generally nudity from the start sometimes or at least at the end of the examination while younger ones were less strict about nudity except in mandatory examinations where they had to follow a protocole of examination.

Now the visual examination is not the common rule, since a lot of doctors are asking labo results

In the last five years I have seen both new and veteran doctors. Only one veteran doctor actually checked my testicles during the physical. This was done while laying on the exam table after palpating my abdomen. The younger doctors had me in a gown. They used a stethoscope on the outside of the gown. They never checked anything under the gown. They did check EENT. Seems like they are more interested in reading lab results and prescribing medications. I think may we are headed the towards a Star Trek hologram type of health care in the future. A tri-corder device will be waved over you, and medications will be prescribed. An actual physical by a person will be a thing of the past.

I will like a younger doctor at this point in life. I have had older doctors at times. Maybe just getting set in my ways at this point. I have found older doctors know more; but can be more standoffish. Younger doctors up up to date about what's going on in medicine today. I guess there is a trade off someone. To each his/her own.

Obviously the best combination is a doctor who has plenty of experience but is proactive in keeping up with new developments in medicine and is humble enough to continue his or her education and not get stuck in his or her ways.

In the past, doctors had to rely more on physical examination to gauge health while nowadays lab results and high-tech tests can greatly assist with assessing the status of a patient's health.

So in my view, an ideal physical, which I'd say is what my current doctor does, is a thorough review of lab results and diagnostic tests and then a quick, but fully complete physical with an emphasis on the areas of concern (if any exist).

I agree with "Redtail" : the younger doctors are generally ( of course some can be different) more interested by reading and prescribing medications than to perform a complete visual check, they do not think that the visual examination of the body of their patient is useful on the reverse of most of the old doctors who did it.

may be the best doctor would be a mixed of the two categories

I dislike particularly the fact that some young doctors are asking you immediately after your entrance in the examination room for what reason you are here and seems very pleased if you can answer and sometimes do not ask you to undress but writes a prescription of medications without a real visual examination : you must know what you have and they know what to give you!

I called on a bunch of old school Docs. Many of them thought ampicillin and Keflex were the latest, cutting edge antibiotics. When I introduced Imitrex for migraines, some of the old school docs would ask, "Is this a narcotic?" This was AFTER I had done a detailed explanation of how this drug caused vasoconstriction of the blood vessels only in the head; that it reversed the physiology of what a migraine does and an analgesic was not needed.

Younger, new-school docs are more up-to-date on everything. The amount of new knowledge in medicine DOUBLES EVERY 3 YEARS. Someone who graduated med. school even only 10 years ago, needs constant continuing medical education to stay current.

Time demands on docs are horrendous. With managed care and gov't. pay plans the doc has to see way more patients than he used to, in order to break even. While physicals used to take at least an hour, or more, they have to cram it into less time. Some gov't guidelines call for a physician to see another patient every 7 minutes. And folks wonder why their Dr. doesn't ask them to undress? They listen to lungs through the shirt, to save time.

Medicine is not nearly as appealing as it once was. I knew a Dr. who talked his daughter OUT of going to med. school. Everybody telling you how you could practice, what meds. you could and couldn't Rx., how much money they would agree to pay you, etc.

THE TIMES, THEY ARE A-CHANGING

I knew a Dr. who talked his daughter OUT of going to med. school.

There could be many reasons for this.

As a doc, he may have sensed something about her that she just didn't have. Whether it be a hesitance to cut someone open, or whatever.

He may not have thought she would have the stick-to-it-ive-ness to endure and survive med school. It's no easy program, and he may have sensed she didn't have it in her to make the sacrifice. He may have been sensitive to his instincts, especially if he were to foot the bill for her education. Earning what doctors do, they may have been granted little or no financial aid for college, especially if her mom was also working and making good money.

Increasing malpractice lawsuits may have been another concern. How many people here reading this have been called to jury duty, whereby potential cases you could be called to serve on involved medical malpractice.

When a parent in the profession discourages his child from pursuing his/her career, these are the things you have to consider. And for the possible things i did mention, there are all the other possible things i did not mention.

I go to a doc in his 30's - 40's for my annual physical. Although he has never done a hernia exam on me or examined my genitals, since I started going to him I have never left his office without him giving me a digital rectal prostate exam. Other docs around his age who I have gone to have relied solely on the PSA blood test even when I told them my dad and grandfather both had prostate cancer (I've noticed the younger docs generally don't like to get too "invasive" vs. the old school docs who I have had in the past...also the younger docs are being taught that the old school prostate exam isn't that necessary anymore). When I first went to my present doctor he had a younger male present during my exam who was a PA or a PA in training or something like that. In fact, before I even saw the doc, the PA came into the exam room, asked me a series of questions and listened to my heart, looked at my eyes, ears, mouth, etc. and did a general overall preliminary physical exam. It was a normal exam for the most part, however, at one point as he was examining me, the PA pulled his stool up so close to me that his genitals were right against my leg and he kept them there for several seconds. After the PA had completed his part, the doctor came in (together with the PA) for the remainder of the exam. It was then that I told the doc about my family history of prostate cancer. The doc told me, "Well, we can do the blood test....or we can 'do it the old fashioned way'." Wanting to be on the safe side (as I had read up on the benefits of both the PSA and the DRE), I opted for both. It was kind of funny what happened next. The doc first looked in a drawer for something and then (I kid you not) almost bounded out of the room as he said, "I'll go get some lube." So there I was alone in the room with the PA who obviously wasn't going anywhere. I thought for a minute he was going to pop some popcorn since he had already pulled up a ringside seat. I can't remember exactly what I said to ease the tension in the room. "So how 'bout them Knicks?" or something like that. The PA didn't say too much. He seemed much more reserved than he had earlier when he was examining me...maybe he was embarrassed himself, or maybe (in light of what I encountered earlier as he was examining me) he was a little excited and didn't want to let on (I'm now in my 40's, but keep myself in good shape, have a great lower body and glutes and am always mistaken for being at least 10 years younger than I really am, so who knows?) The doc came back in and told me to lower my jeans and underwear. As he told me to bend over I said, "I guess this wouldn't be a good time to piss off your doc!" There was a chuckle and then without even so much as a glass wine or a dozen roses the next day, his finger knew me very intimately...and has continued to each subsequent year since that first visit.

I graduated from medical school in 1973. Five years of internship/residency/fellowship. I practiced about 2/3 general internal medicine and 1/3 endocrinology simply because it was difficult to make a living at just endocrinology alone and it was kind of boring......mainly diabetes and thyroid disease. In the course of my training I became competent and comfortable managing ventilators in an ICU setting as well as passing Swan Ganz catheters and placing temporary pacemakers. Did a lot of intensive care work and loved it.

My point, though, is that in my training and early practice ultrasound didn't exist and CT imaging was a rare and exotic methodology. No MRI. In my training I learned to take a thorough history (80% of the diagnosis generally), do a high quality physical exam including careful ausculation (with percussion, I might add) which was another 15% of the diagnosis. Labwork was the remaining 5%.

My how it has changed. My own internist now didn't even lift my shirt before auscultation at my initial visit. Compare that to my last "old school" doc who heard a diastolic blow that even a cardiologist couldn't hear but very mild AI was confirmed on echocardiography. Anyway....lots more resources now. A very different world. Costs are exponentially higher and the personal connection seems to be nearly extinct. In with the new...out with the old.

Jake, welcome to Zity. Good move to go for both, given your family history.

My dad also passed away from prostate cancer, and so i want to have both the PSA & DRE done as well, as much as i do not particularly care for having anything inserted in me anally.

Not sure if your doc or anyone ever told you this, but frequent ejaculation is good for your prostate.

My own internist now didn't even lift my shirt before auscultation at my initial visit.

Whenever a doc goes to listen over my shirt, i just lift it up to give access to my bare skin. I wonder if my "come on & do it right" attitude shows through. I've really become someone who says a lot with non verbal cues. People can tell what i'm thinking by a combo of the way i act and what is happening around me, that i don't have to say anything, which is the beauty of it.

After all, silence is golden (duct tape is silver 😉 )

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For many this might be hypothetical, would you be more comfortable with the old school, master of the universe, always male doctor who ordered, directed, requested, did everything concerned with a physical exam, or the new school doctor, who might be male or female, tries, at least, to involve a patient in discussions, examinations, conditions, has a nurse or other staff member doing some of the basics? With the old school doctor, it was a matter of showing up and letting him work on you, look over you silently without explaining anything. With the new school doctor, you always are told what he or she is doing, and why, often with permission sought before doing anything. The old school doctor would have come into the exam room in the infamous white coat, finding a male patient in underwear only, whereas the new school doctor would likely offer a gown.

would you be more comfortable with the old school, master of the universe, always male doctor

If those were my only choices, I'd have to go with new school. The most basic reason is that I've come to prefer and appreciate female doctors more than male. That being said, I prefer some aspects of the old school doctor, such as, generally, what I perceive to be a more thorough exam, starting out with me either in just my underwear or even less. But at the same time, I prefer a doctor (new school) that takes the time to talk with me and fully understand any issues that I'm having. They also take more time to explain the recommended course of treatment (why I need to take such and such pill). And I like that.

The ultimate, for me anyway, would be to have a female doc who's old school.

"Old school" in that it's underwear only, no gown, for starters. One of my favorite parts of old school is when the doc goes to do the genital & hernia exam, as WrestlingPoet described:

silently without explaining anything.

when lowering my underwear, touching, etc. Only words said: "Cough for me". If nothing is said signaling the doc is about to lower my underwear, then it adds an element of spontaneity, and makes the experience a bit more dramatic in a positive way. It's certainly more secretly arousing than the alternative of having a narration as the exam goes along.

Some of the new doc approach, the discussions, etc may be important for health areas to be careful of, etc. I wouldn't exactly want to go in & out of there clueless about my own health.

From a health standpoint, we're probably better off with new school. From a medfet standpoint, old school would likely be the preferred way.

I really hate to say this. I've spent the last several years trying to have female docs for everything. Gastroenterologists, dentists, dermatologists, and perhaps unfortunately primary care physicians, because I am old school. Had i focused more on trying to find a doc who would likely be old school (thus male) would have perhaps given me better "old school" experiences. I probably wouldn't be having to wear a gown, and I may still be getting my genitals and hernia checked.

Instead, I have a female doc who kind of insists on me wearing a gown, and won't examine my genitals routinely at all. And she and her husband both harp way too much on weight, which I've basically maintained as a constant in the last 4 years. And I'm not exactly someone who requires a flatbed truck to be transported around. I'm still athletically active, including jogging and running, right up until I tore my quads last summer.

I prefer a female doctor, female nurse or female PA over any male doctor. The ladies listen better and are more thorough. I’ve yet to have one who’s squeamish about touching my man parts, anus or rectom. I did once have one tell me that I “have excellent rectal tone.” I courteously replied by telling her that I was “sure that she likely had excellent rectal tone also.” That’s the only time I’ve managed to embarrass a female nurse. Ha ha!

I've never had a female doc and the guy I grew up with retired a few years ago. I have a new young doc and he has all the bells and whistles like web based communications and he is really up on new meds. I haven't had a physical from him yet but so far so good.

I would prefer old school doctors as they tend to give more complete exams and are less concerned about patient modesty.

For more than 3/4 of my adult life, I have been fortunate that I have had only two primary care physicians. The first of the two was my doc for 28 years until I moved out of state. One year older than me, he was newly out of his fellowship when I became his patient. He was thorough, listened and was careful to the point of repeating blood work that were even 1 or 2 points out of range.

The second of the two, is maybe 15 years younger than me and is a mixture of old school and new school. I still have a doc that listens and who is thorough in his exam, even though he is part of a group practice that operates in the new paradigm of medicine.

For three years, due to insurance constraints, I did have a primary care doc who was of the new school and I was not comfortable with that relationship at all. I definitely prefer the old school mixed with all the benefits of modern medicine, such as the new knee prostheses I have.

I think I would prefer a mixture of both old and new school approaches in a real medical office. Today, medical professionals are very concerned with modesty. On the other hand, I found that a number of medical professional from the old school did not actively listen to patients.

I've been seeing the same doctor for around 30 years and we are about the same age.

At this point, other than interacting with a young surgeon, I have not had the opportunity to see many young doctors. I was impressed with my surgeon who is pretty young - he was thorough and answered all my questions. He took time to listen to my concerns. And when it came to examining me, he was confident and on task - no hesitations on his part.

As for a MedFet doctor, I would prefer an old school manner and approach.

I don't know if this assumption is truly accurate but if that is one's experience, it's hard to refute the difference between old versus new school. I have had both; the end result has been being exposed for a genital and rectal exam. So from my perspective, it doesn't much matter how much clothing I have on as the exam begins but what happens towards the middle or end. I fully expect that there will be a genital and rectal exam; it has been done even when I am feeling a bit self conscious with a new doc!