Physical

Also, for people who go to a regular PCP/GP... what is a typical physical exam supposed to include? (Being a nurse all the exams are inpatient, hospital exams specific to the procedures). I've been to lots of doctors- specialist, OB/GYN, etc. but my regular doctor I usually only see if I'm ill, need labwork done, or need a med refill or a referral. He doesn't do a regular yearly exam since usually my other doctors cover that. When I was younger my pediatrician (well, the nurses would do weight, height & vitals) would usually check eyes, ears, throat (the usual), listen to my heart and lungs, exam my abdomen and that was about it. What is considered a "yearly physical exam" for adults?

These days, in the US, height and weight, vital signs, annual EKG, eyes, ears and throat, heart and lungs, maybe abdominal palpation, maybe reflexes and, since I'm diabetic, a quick foot exam.. Shirt off only for EKG.

Incomplete at best.

For years, my exams by the VA were far from adequate. This is because I was being seen by residents. I have since been assigned my own PCP, a Nurse Practitioner. I am now 50, so things have been altered.

I see her every 6 months. (My next exam is September) This is the "Check-up." Basic, height, weight, heent, heart, lungs, abdominal, basic genital exam, possibly an ekg, basic labs. Clothing level, like all VA exams is "strip as you go.

My next visit, after September, will be "The Physical." This is all of the above, but add a more detailed genital exam and a DRE. It is a very complete exam. My next colonoscopy isn't due for another 4 years.

It should be height, weight, listen to your heart and lungs, look in your ears, look in your eyes, abdomen palpation, reflex check, basic blood work and, for me, genital check and DRE. i've found that a lot of GPs skip some/many of the above. i can't believe how many don't weigh and measure your height. that is so basic and, to me, an instant deal killer. many skip the genital check too. i wonder how many actual hernias have been found from hernia checks (my guess is none) but testicular cancer is a real issue so a testicular exam should be included.

i'm curious if GPs do genital checks on women or do they just defer to the OB/GYN?

I don't use a regular primary care physician or general practitioner for that reason. They don't have time to do much other than the basics. Not bad for a grown-up who just needs minor treatment or a kid who needs a quick exam for school but not for a thorough physical exam. The last time that I went to a general practitioner for a physical was many years ago. From what I remember, it was a quick "shirt off at the beginning, drop pants and underpants for hernia exam, leave a urine sample and maybe a blood draw" type exam. I have gone to internal medicine doctors for my physicals because they have the time to do the job right.

Well, it will depend a little bit on your age as to what it will entail. I am guessing that since you do see an OB/GYN regularly that you are not a pediatric patient. Other than that educated guess, I do not know your age, so without that I can just give you some possibilities:

If you are young (20s-30s) you will probably just get your vitals checked (like you do when you go in when you are sick or injured), you will most likely be asked more questions than anything, especially if this is your first routine annual exam, and even more so you are a new patient to this particular GP. Things like your medical history, your family medical history, what medications you are on, what substances (tobacco, alcohol, drugs, etc.) do you use and if any how much and how often do you use them. They will probably throw a few questions in there to check and make sure there is nothing from a psych standpoint going on (case of depression or anxiety, etc.).

Most cases they will ask you to walk (they want to check your gait to see if there is anything off about it that may lead them to want to do any X-Rays or tests to check your bone and joint health). They will check your reflexes, muscle, eyes, etc. They will have a look at your eyes, ears, nose and throat. They may check your glands and lymph nodes. And palpate (feel and push around) on your abdomen). They will also listen to your lungs.

As long as there is nothing alarming, then this should wrap it up. Now if you came in presenting with a pulse rate or blood pressure level that was a little high, or they notice anything else, then they may order up some routine blood work, such as a CBC, hematocrit, chem panel and a metabolic panel. If you are in your 30s and have family history of certain things like high blood pressure, then they will probably perform the above blood work even if you do not come in presenting with any elevated BP levels or other abnormalities.

Now when you start getting middle aged and especially close to 50, then these physicals/annual exams will usually become a bit more involved, because for one, at this point most people are on some maintenance medications which need blood work for monitoring purposes, as will the risk for things such as Type II diabetes increase, so they may add a Hemoglobin A1C as well as a few other tests to your blood work. They may also order a urinalysis as well (not for drug testing) but for testing of kidney function (like BUN/Creatnine ratio, etc.). Then they will start wanting to have you get mammograms and colonoscopies and some other more invasive procedures, however in most cases these will not actually be performed as part of the annual exam by the GP, but you would instead be referred to another place for such procedures.

Thanks that is helpful. As a nurse (albeit a surgical one) I know what SHOULD be done more or less, but I have never personally experienced it. I see a variety of doctors as I mentioned, and my OB-GYN I suppose sort of serves as my GP/PCP in that she checks most of those things along with the typical gynecological stuff. I do have a psychiatrist as well so that topic is covered by her. Mostly I see my GP for labwork for other doctors and if I feel ill, I don't really have regular checkups and I'm not so sure its all that necessary for me. My husband swears by seeing a doctor once a year, but he has no major health issues so he's not getting things (other than BP which I check for him occasionally) done by another other physician. Just was curious as to what your GPs actually do.

My primary care physician knows I see a dermatologist and urologist regularly so she doesn't duplicate those exams. She does typical blood work for diabetes, liver panel, etc. In the physical exam she checks ears, eyes, nose, throat, heart and lungs. She palpates my abdomen, checks my pulse in my extremeties, checks my legs for swelling and varicose veins, and checks for nerve damage in my feet by poking them with a sharp stick. She will also check out anything that I have mentioned is giving me issues. She asks me if I have had sex with multiple partners since my last check up, if I have she does STD tests. I heard a report on NPR the other day where a medical professor was criticizing the lack of hands on medicine these days. A lot is driven by time pressures due to heavy patient loads. I like to schedule my exams first thing in the morning before she has had time to get behind schedule and the environment is more relaxed. I chose this doctor because she is willing to spend more time with her patients.

I've had the same problem with my primary care physician---he does the basics: eyes, ears, throat, heart, lungs, blood work, urine sample, height and weight. No abdominal exam, no testicle/genital exam, no prostate exam, no ekg. I have a hydrocele on my left testicle that was removed when I was 16. I'm 48 now and it's never grown in size and has never been a problem, but you would think that a physician would examine it to be sure everything is ok. I'm switching to a internist---it's a matter of who and which office. Going back to my family practitioner for another annual exam this year is a waste of time and a co-pay. They simply don't have enough time---or they don't TAKE the time---to do a complete exam.

Temp and rectal exam from time to time