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What should a good medical exam consist of ?
December 12, 2007 4:18 PM   Subscribe

What should a good doctor check for when giving a physical/basic medical exam consist to a 26-year old male.

I haven't had a physical in 15 years, so I had one today and it seemed brief--20 minutes max. Here's what we did:

-asked for family medical history and personal medical history
-laid down on my back and she squished/kneaded my belly area
-checked for scoliosis
-checked hearing
-checked vision
-checked ear wax
-checked vitals
-listened to breathing
-checked in my nose
-examined some suspicious moles
-Held out her arms and asked me to push and pull her
-Had me squeeze two of her fingers as hard as possible
-She examined my complete blood count and found nothing alarming

Does that seem like a pretty average physical for a healthy-looking 26 year old male? I told her I'm gay just in case that would alter the questions she needs to ask or what she needs to check on my body.

I told her I had hernia surgery 2 years ago, but she didn't even look at my genitalia, nor did she look at my buttocks or anus. I assumed she'd be checking for hernias or testicular cancer.

She is a Muslim, so perhaps she feels she is forbidden by her religion to look at those parts? Not likely because why would she choose a profession that conflicts with her personal religious beliefs? And there are many Muslim doctors whose interpretation of the Quran does not prohibit them from doing their job.

Your thoughts?
posted by GardnerDB to Health & Fitness (19 answers total) 3 users marked this as a favorite
 
Normal. The only thing missing would, perhaps, be the "turn your head and cough", but otherwise almost identical to the last physical I had. I'm 32.
posted by Pantengliopoli at 4:23 PM on December 12, 2007


As you didn't have a specific complaint (right?), this doesn't seem too strange. If nothing in your history indicated a hereditary problem worth checking for, this exam seems about right. If it's been two years since your hernia surgery and you didn't have any problems with it, I doesn't seem that unusual for her to not follow-up with that explicitly.

... why would she choose a profession that conflicts with her personal religious beliefs?
That's what I wonder every time some pharmacist refuses to dispense birth control because of their religious beliefs. Tragically, it seems they do not have the same curiosity.

posted by Nelsormensch at 4:28 PM on December 12, 2007


That sounds like a fairly normal physical if you didn't ask her to check something specific. The extent is often limited by insurance coverage or your ability to pay.

If you want a more complete physical, ask for it... it could include CT scans of the heart, liver, kidneys, more specific blood work, etc, etc... be prepared to pay, however, if there is no prior indication that it is necessary.
posted by HuronBob at 4:36 PM on December 12, 2007


Part of having medical work done is setting expectations about what it is that you want to get out of it. If you are not going to tell the doctor what you want, there is no way that they will be able to read through the lines and know where your concerns lie. Of course there are always further tests and screens, but at some point it's up to the discretion of the doctor to decide what you are at risk for. But it's up to you to ask for more if you are not comfortable with the level of care that you recieve.

Next time, tell the doctor what you want. If they are not comfortable with it, they will refer you to someone who is. What's this got to do with her being Muslim?
posted by |n$eCur3 at 4:50 PM on December 12, 2007


Doctors don't go for the anus without your asking until you turn about 40
posted by Megafly at 5:00 PM on December 12, 2007


Every physician has their own particular idea of a "routine" examination and these very a fair bit, but I don't find yours particularly bizarre. I'm somewhat surprised they even bothered to check a CBC.

As far as genital examination, the latest 2007 US Preventive Sevices Task Force Guidelines recommend against routine screening for testicular cancer in asymptomatic young adults. It also makes no firm statement regarding chlamydia or gonorrhea screening at least in men. It does however recommend routine HIV screening in at-risk patients (by their standards, men who have sex with men do qualify as at-risk).

There is no end to the number of tests and physical examination maneuvers a doctor can put you through. I agree that if you have a particular concern you're going to need to voice it if you think it deserves further attention. For example, "I think it's fine but would you also mind taking a look at that old hernia site to make sure everything's ok?" I'm sure most doctors would oblige a request like that.
posted by drpynchon at 5:07 PM on December 12, 2007


Normal. It's almost an exact replica of the last physical I had (I was 27).
posted by purephase at 5:13 PM on December 12, 2007


Only difference from my most recent (I'm 26 and straight) was that he checked my blood pressure and did some asthma tests. The latter being because I had specifically requested some testing.
posted by Octoparrot at 5:15 PM on December 12, 2007


I'd say standard, except no way do you escape without the boys getting a good fondling in a typical male exam in my neck of the woods. Let's face it, what's more likely, that you didn't know your grip strength was fucked up, or you missed a pebble sized malignancy on your nuts?

I agree w/ drp, a la the CBC. A lipd panel at least might pick up some familial dyslipidemia you need to know about.

You might want to get a male doc or at least a female who does a real exam - in my experience one of the more common reasons males in their 20's come to the doc is because of perceived problems with the genitals. They might have a third nipple growing from their nose that doesn't perturb them but anything amiss from the waist to the knees gets dealt with right quick.
posted by docpops at 5:41 PM on December 12, 2007


You look for your own testicular cancer, in my experience. Most docs, and I have seen many, avoid touching this area on guys. As you get older, you will get you prostate probed, trust me. The indignities don't stop there either. It's OK. As for your age, you got what you need. If you really want a full blown physical with every test known to mankind you need to ask for it, and this is true even as you age. My father is doctor and when he tells me what they check on him it amazes me. I can not believe that insurance pays for all that. He is 83 and in such good health that he takes NO medicine. How many 83 year olds can say that, and he pulls his clubs rather than riding the cart on the golf course. I have my fingers crossed that this health is passed down. Anyway, if you want more tests, do your research in advance and show up with a list. If you are willing to pay, most docs are all for it. More info is better.
posted by caddis at 5:44 PM on December 12, 2007


"Doctors don't go for the anus without your asking until you turn about 40"
I'm sorry, but this is without doubt...very, very, true...

and, once you hit 40, they go for it with a vengence! watch out!
posted by HuronBob at 6:00 PM on December 12, 2007


caddis, no offense, but that's completely insane. If I ever missed an undescended testicle in a kid or a tumor in a male over 15 on a physical I could kiss my career goodbye. A thorough skin exam and testicular exam is basic stuff on a male physical.
posted by docpops at 6:12 PM on December 12, 2007


Sorry for the derail but...

docpops, insane seems a bit strong if you ask me. While I would personally include it in my routine examination of young men (and keeping in mind that I don't see kids), I'd say that's based on my own OCD, a bit of old-schoolery, and unfortunately medical-legal reasons. It certainly isn't evidence-based pracitice as the latest guidelines suggest. As they note, even catching a small testicular mass early is unlikely to change the medical outcome. Based on those grounds, and the sad fact that we only have so much time with each patient, you could make the case that that time would perhaps be far better used if substituted with extra counseling on sexual health and drug abuse (in male young adults).

Consider for example that the relative incidence of testicular cancer is actually comparable to that of soft tissue sarcomas if I'm not mistaken, and I'd assume that you probably don't do an excessively careful job of screening for the latter. I know it's not a perfect analogy, but...
posted by drpynchon at 6:54 PM on December 12, 2007


drpynchon,
I agree it's mostly medico-legal. I suppose part of it also is that since I'm always sort of perplexed at the whole idea of anyone under 35 coming in for a physical, I try to make it worthwhile. In general, people that self-select for screening exams usually already make pretty good choices. But I agree with everything you've said. It's just that I've tried, diplomatically, to explain to healthy young people how silly the idea of the "routine physical" is, and they look at you like you are the biggest dumbass on earth. But yeah, I'd be happy never to do another one.

I have, though, picked up an undescended teste and what's even more surreal is that in the first week of residency they made us all get physicals and one of my fellow residents was diagnosed with testicular cancer when they picked up a mass.
posted by docpops at 7:14 PM on December 12, 2007


GardnerDb,

As you can see, there is considerable controversy among doctors as to what makes up a proper "complete physical." We just went through a huge ordeal trying to come up with a consensus within my 80-physician group as to what constitutes a minimum basic physical. There is no evidence whatsoever that a comprehensive physical examination makes a lick of difference in detecting occult (asymptomatic) disease at any age.

At age 26, the preventive interventions that basically make sense in an average risk person (have at least some evidence) include: blood pressure every year. Cholesterol every five years. Screening for drug/alcohol abuse, screening for depression, discussing cigarettes with smokers, checking a BMI, screening for STDs in those at risk, and as I understand it, universal HIV screening (although controversial), going over any immunizations, and Pap smear if you have a cervix.

Beyond that it is all style, and tailored to the particular patient's concerns. I believe most patients want to feel like their body has been examined and because you never know when you'll find a suspicious looking mole or something like that. I also like to go into a detailed medical and family history because you might find other particular things that are worth discussing, ie strong family history of colon cancer, diabetes, etc. If someone is really truly healthy and nothing comes up after all of this and they don't need a Pap smear or a medication renewal, I tell them not to come back for five years unless they get a new sex partner, or have some other substantial change in their medical history. I can do all this in 30 minutes and have time left over.

Checking your nose? Even a blood count, that seems a little weird unless you told her something specific, but whatever. If you walked out with unanswered questions or felt unsatisfied then go somewhere else next time.
posted by Slarty Bartfast at 9:39 PM on December 12, 2007 [2 favorites]


One of the reasons that there's no evidence for the complete routine physical exam picking up occult disease is that the study that would provide that evidence just hasn't been done. That said, in order to bill for a comprehensive visit under HCFA (Medicare) guidelines, I need to document that I examined the patient's heart and lungs. Since I won't document anything I didn't actually do, that means I listen to the patient's heart and lungs.

Because I am a neurologist and therefore dealing mostly with neurological complaints, that means I'm listening to a heck of a lot of healthy hearts and lungs, and I honestly can't recall the last time I picked up something with my stethoscope that some other doctor had missed. In fact I am not sure I ever have, meaning all that time spent listening to hearts and lungs was essentially wasted for the purpose of diagnosis. On the other hand I find that a lot of people like to have the doc put the stethoscope on them, and it also gets me very physically close to them, where I can learn about things like nystagmus, tremors, and oral hygiene that I might have missed from the other side of my desk.

I agree with docpops, drpynchon and SB above, and where they disagree with each other, I think I agree that there's room for their disagreements in the normal day to day variability of practice.
posted by ikkyu2 at 11:17 PM on December 12, 2007 [1 favorite]


Honestly, if you told the doctor you were gay, she should have asked about anal sex &/or done a rectal exam to check for HPV. HPV causes rectal cancer, not just cervical cancer. Although the vaccine is not yet approved for use in men, I'd consider getting vaccinated if you engage in anal receptive sex, or plan to. I'd have done a testicular exam as well, even though the evidence suggests it's not worth doing.
posted by pammo at 2:54 AM on December 13, 2007


A BBC piece about vaccinating men against HPV.
posted by pammo at 3:00 AM on December 13, 2007


I talked with my wife last night, who does primary care exclusively for MSM at an inner city hospital, and she also mentioned the rectal exam for HPV/rectal cancer. Also rectal swabs for gonorrhea routinely. Again, this is a risk-based policy, and depends on one's sexual history.
posted by Slarty Bartfast at 7:59 AM on December 13, 2007


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