Physicals

Back in the stone age when I went to medical school, the “complete physical” was a full course in first year. We were taught where to poke, push, prod, palpate and percuss. We practiced looking at fingernails, eardrums, nipples and the back of your eyeball. Then the stethoscope came out and we auscultated (doctor for “listened”) to every sound your body might offer. I never heard any farts in the exam room, though I imagine they could tell me something.

In our second and third and fourth years we were sent off to the wards to be the fifth or sixth person to examine a tired and sick patient. We were supposed to find things. So, if we had little mercy and were as worried about our grades as they wanted us to be, we prodded and probed the poor wretch with our inexperienced fingers. I always appreciated the patients’ patience, for their generosity gave me experience, a wonderful gift.

As I watched the more experienced physicians, I noticed their physical exams were often very abbreviated. I was listening to a sweating man’s heart in residency when the attending came in and said, “Get him up to the cath lab!” without even getting his name or saying hello. The EKG told the story. The expediency probably added some years to the man’s life. Time can save tissue when it’s dying.

But then I go into the office and see patients every day and wonder, just what do people expect when they schedule an “annual physical”? Do they know that no study has ever shown that such “annuals” are cost effective? We add some screening blood tests, consider some other tests, but the true value of seeing the doctor comes in developing a relationship. It is so I, or your doctor, can know your values, so when the tough times come, we can help you decide on a course of action that will support you and your values.

Five times in my medical career, with the patient undressed I noticed a mole that I thought suspicious that turned out to be stage 1 melanoma. A few times I have felt lumps that didn’t seem right. But of the thousands of physical exams I have done, most were on very healthy people. But that teaches you something too.

I decided to quit the medical group I had been in for the last 17 years, so I was surprised to see a “complete physical” on my schedule the last week I was scheduled to work. Our office had shifted to an electronic record about five years before and this 50-year-old man had no entries in the electronic chart. “Why is he scheduled with me?” I asked my nurse. She shrugged.

So, I went into the exam room. “Hello, I’m Dr. Schmidt. Who is your regular physician?”

He looked up at me and smiled. “You are!” he said.

I’m puzzled because I don’t recognize him. Indeed, he looks well, taking no medicines, blood pressure, weight all normal.

“I’m sorry,” I stammer. “When did I last see you?”

He grinned. “It was about five years ago. I came in for a physical. You told me to exercise, lose 25 pounds and come back in 5 years. So, I did, and here I am!” Not many patients take my advice. I appreciated that last complete physical.

High school sports physicals were another wonder to me. I came to see them as school districts shifting liability. If a student athlete keeled over, they could say “Doctor cleared him!”

But I came to view this opportunity to examine and visit with a young teenager and their parent as precious, though the form the school required to be filled out, boxes to be checked were pretty silly. More on sports physicals next week.

So go ahead and schedule a physical with your doctor. If you’re planning to stay put, that’s what you should be asking them, because the value is in continuity, not poking or prodding.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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