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

I believe the standard of practice in the United States has changed from a full physical to a so-called "Wellness Exam" that pales in comparison.

Last year, I had a disappointing experience when the doctor did not exam me at all and just ordered blood tests. The funny thing is he spent a long time explaining how the wellness exam worked and why doctors no longer feel the need to do a thorough exam... He did not check me at all.

This year, I decided to go back to a doctor that gave me a complete physical before. During that first physical, he started with my medical history, then handed me a gown, told me to "change" and left the room. Since he didn't specify, I just got naked and put on the gown. When he came back, he did a regular physical exam mostly over the gown, then told me to stand up, lift the gown and did a hernia test. No prostate exam, but I considered that appointment satisfactory because at least I got a genital exam.

Today I expected something similar, but immediately noticed there was no gown on the table like before. He came in the room, took my history, then quickly checked eyes, ears, throat, nose, heart and lungs. I was fully clothed the whole time. He sat down, ordered the blood tests and the exam was over.

Apparently this is the new normal, since the very same doctor changed his routine.

This is in Michigan and I'm curious to know what other male patients experience during a physical in the US.

Essentially the same in Southern Ca. No gown, did the usual nut did a dre and prostate exam. I e mail him ahead of the appointment to have the lab studies done before I see him so it's one stop shopping. Have the colonoscopy scheduled for 2 weeks, with sedation.

My female doctor still does what I would consider a comprehensive annual exam. It's billed to my insurance as a "wellness visit" but it's pretty much a head-to-toe, hands-on exam. If she did suddenly cut this down to something much less than that, I would have a long discussion with her about it, and then might move on to a different doctor if she continued to skimp on my exam.

I really think this depends on the doctor and their particular practice. I agree with you that the trend is probably not looking good for comprehensive exams in the future. More and more doctors will likely be pressured to see more patients per day, and that means each one will get less time. But in the mean, I'll keep looking for doctors that still conduct a complete exam.

Same here in New Jersey with a younger male doctor maybe he is in his late 30s to early 40s. The annual exam is more of a conversation with very little actual hands on the patient. He explained it is more about talking about your lifestyle: physical activity, what you are eating, stress levels, bad habits (smoking, drinking, etc) and no longer on actual examination of your body physically. He did check my blood pressure and listen to my heart. What did impress me was the conversation about my cholesterol level. Although he was borderline high when he took into account my exercise routing, being a nonsmoker etc his decision was that the risk to reward ratio for being on a Statin drug was not necessarily worth it for me at this time. I much prefer this type of decision rather than "your number says...so you are on this drug"

I never had this particular problem but I would say if I schedule an appointment for a physical exam then I expect a physical and not (what I would consider) some watered down check the vitals and have a conversation "Wellness Exam". I would find another doctor.

I didn't get regular check ups until I was early 40s so the abbreviated exam, ears, nose, heart, lungs and discussion of lab results is about all I've ever had.

I had the same kind of "wellness exam" at my PCP just this morning as a matter of fact. I needed to renew my blood-pressure medicines, and he simply took my BP, a very quick listen to the heart and lungs through my shirt and that was it. He hadn't even been aware that I had hurt my shoulder last summer and after it didn't heal properly, surgery a couple of months ago.

I had the same kind of "wellness exam" at my PCP just this morning...I needed to renew my blood-pressure medicines

But if you were there for a targeted reason -- in your case to renew your BP meds -- I don't consider that a wellness visit. And neither does your insurance. A wellness visit (according to most insurance companies) is a visit to review your overall health. And in fact, if your doctor uses the diagnosis codes for your hypertension when they submit the bill for this visit, it's likely that your insurance company won't pay it completely -- simply because it's not a designated wellness visit.

Crazy I know, but there really is a big distinction between the different kinds of visits. That's why when I go for my annual wellness visit, I make sure that my doctor only uses the diagnosis codes for that kind of visit. Otherwise, I'll end up with a bill.

"Wellness exams" SUCK.

A close childhood friend of mine with no symptoms or complaints about her health had her yearly comprehensive exam with full blood work and this time it came back abnormal. She went in for testing and they later diagnosed her with leukemia! She spent two and a half months in the hospital getting treatment and finally a bone marrow transplant.

If they just did her vitals and the quick look, she would be dead soon.

We are still worried about her and the ultimate long term success of the bone marrow transplant.

Had a "wellness exam" two days ago. Was weighed, temp., BP, pulse, blood draw. My Doc did a chest auscultation, didn't feel my abdomen, nor do a DRE. He spent over an hour with me discussing my weight loss, sleeping problems, no appetite. We both decided I was in a down cycle of depression and he Rx'd a different antidepressant, told me to start taking Vitamin D, B complex, exercise more and force myself to eat. He is an excellent Fam Pract. physician. I chose him carefully, after calling on him for a few years. He was as sharp as many specialists about antibiotics, stomach acid suppressers, hormonal therapy and he had a likeable personality. He even got me tickets to a sold out Jimmy Buffett concert.

Since I now also see a urologist every 6 mos. and a vascular surg. every 6 mos. and a derm. once a year, I'm sure he feels there are areas of my body that are well covered by specialists. Even though I never disrobe in his office, I have complete confidence in him. So does my other half, with type II diabetes and COPD.

My doctor does the full physical.

At my last 2 "adult" physicals with 2 different doctors, I got weight, height, and vitals done by the nurse, an exam by the doctor, and blood work done (plus urinalysis at the first physical). The exam portion for both exams consisted of a HEENT, auscultation of chest and back, an abdominal exam, a testicular exam, and a hernia exam. My most recent physical also included a brief skin check, a check of a couple pulses and lymph nodes, and some arm and leg strength/flexibility exercises.

Doctors (in general and from my experience) can't seem to settle on what should be included in a thorough physical. I remember when a "full physical" was just that. One spent quite a lot of time with the doctor checking you out completely and ask you questions regarding how you were feeling, when this all started with you, was it associated with anything you can think of, etc. The last physical I had was about a year ago and consisted of having blood work done and about a fifteen minute consult with the doc. I think that they should go back to the old way of doing things. Just take for example, Susie's friend's experience. You can see from that that many lives were probably saved because of careful examination of the patient. Perhaps modern day docs are overly concerned about the "CYA" factor with regard to frivolous law suits. (Enter the real culprits ; LAWYERS)

My recent physical with a new doc was the "health discussion", and then she did a pretty thorough exam. Beforehand, she "suggested" because of my age & family history that I get a DRE "if that's ok with you". And when i agreed, that may have been the time she grabbed the gown from the cupboard.

I was quite surprised that she didn't do a hernia check. I figured maybe they only do genitals now after asking you very general questions about whether or not you have any issues. And then unless you speak up about something.... But, I agree I think they should be more thorough.

Maybe next time I should be like "Doc can you check my testicles? I wanna make sure they're still there because I don't have the balls to insist you perform what I would consider a complete physical". LOL. I do like her a lot, though.

"Wellness Exams" are a waste of time.

In my opinion it is a waste of time to schedule a physical exam but only get the wellness exam. (Something that has happened to me before).

Docs, here in the US, seem to be in a C.Y.A./time is money + assembly line medical care mandate of the insurance companies. Makes me want to just give up and wait untill something to falls off, or i can't breathe, before i go back to the doctors office.

Could someone give a more thorough explanation of what a wellness exam actually is? Obviously it is not very thorough and sounds like a marketing stunt being promoted with a trendy sounding name, but other than that ...

Could someone give a more thorough explanation of what a wellness exam actually is?

You might look at the medicare site (government health plan for seniors) since they use the same terminology:

https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html

In fact, this may be where wellness exams first got their start, and then the idea trickled down to private doctors.

You might look at the medicare site (government health plan for seniors) since they use the same terminology:

Thanks for the link. It seems a large number of items are something you could take of yourself, weighing, measuring, calculating body mass index ...

We are required to go for an annual physical or pay some additional money towards our health insurance if we choose not too, which isn't the worst idea/incentive. After the first time I went I thought this sure isn't the way it used to be and wondered if it was just who I had gone too (new doctor for me). So I asked our insurance provider if they had a form that I could take along explaining this same thing to them, that it seemed like a waste of time and money and the answer I got was "no they didn't and that the exam was to based on age and gender". Seems odd to me that an insurance company isn't concerned about what they are paying for ? I guess if coded right they don't care ????? I've asked tis before .........how do find a doctor that ask questions AND gives a good look ? Skin cancer is suppose to be a concern but don't take your clothes off for your physical...............

Malephysicalexam:

What you describe as your abbreviated exam, has been my experience for the last 58 years.

I'm getting a physical in a couple of weeks and I just checked the language that was used on the appointment details. I'm getting a "physical exam". I would be wary of any other titles such as "wellness exam" or "health screening". I've received what I'd consider a fairly complete physical every time I've gone for such an exam which in opinion should include at minimum a health overview and interview, a physical exam of the entire body, and blood work.

I'd be less than pleased if all I got was a brief interview and a quick check of height, weight, blood pressure, and temperature since I can do that at home.

Best of luck!!!

J9999 mentioned,"Skin cancer is suppose to be a concern but don't take your clothes off for your physical." Skin cancers like Basal Cell Carcinoma and Malignant Melanoma are two dangerous skin cancers. Malignant Melanoma is deadly and if left untreated Basal Cell can be also. A total body skin exam is best carried out by a dermatologist. Both of these cancers are usually caused by sun exposure and now both are known to be linked by enviornmental toxin exposure. Which are dangerous man made chemicals that can be inhaled, swallowed or absorbed through the skin. Basal Cell cancer is found on the sun exposed areas of the skin. It may take years to expose a Basal Cell cancer but once exposed it will be a life long problem. A Malignant Melanoma will appear anywhere on and in the body. Not just sun exposed areas! It may start on a sun exposed area and then travel through the blood all over your body. A dermatologist will or should look all over your body, toe and finger nails, under the scrotum and often in the mouth and gums. It takes the trained eye and a illuminated magnifying glass to find some of these cancer spots. Should a Malignant Melanoma be found at stage 4 the outlook will be a life ending in two years or less. It travels all over the body and there is no cure. What's the point here?

When you see a doctor, any doctor, you are asked questions. When the topics of sun tanning, going to the beach or using a tanning booth come up know this will go into your medical files. Should your doctor make you aware (They Should Make You Aware) of the possible dangers of sun exposure please listen closely. When a person has had multiple warnings and continue to sun tan or use tanning booths and you get skin cancer you may be in more than one type of serious trouble. One is medical and the other is insurance. Most insurance companies today would not take a person on as a client knowing they sun tan or use tanning booths. Those that already have insurance can have that insurance revoked with the company knowing a client had been warned but did not take the warning as a request to stop for their own good. Should you be a sun lover, ask for that total body skin examination. Then re-think what will be best for you in the future. These cancers cost millions or maybe more for care and insurance companies will raise your rates to unimaginable amounts to keep you as a client, Insurance never loses but people do.

Most insurance companies today would not take a person on as a client knowing they sun tan or use tanning booths. Those that already have insurance can have that insurance revoked with the company knowing a client had been warned but did not take the warning as a request to stop for their own good.

Do health insurance companies check that you go shopping with a hat on or with sun block, should you live in the southwest?

I know I am making a smart-alec remark, but after a while you do wonder if there is anything they will NOT revoke your insurance for ... soon they will be checking out your food purchases at the supermarket via credit card info and docking you for not eating enough veggies and fruit or buying too many soda drinks ...

And you know they would if they could.

I'm getting a physical in a couple of weeks and I just checked the language that was used on the appointment details. I'm getting a "physical exam". I would be wary of any other titles such as "wellness exam" or "health screening". I've received what I'd consider a fairly complete physical every time I've gone for such an exam which in opinion should include at minimum a health overview and interview, a physical exam of the entire body, and blood work.

I'd be less than pleased if all I got was a brief interview and a quick check of height, weight, blood pressure, and temperature since I can do that at home.

I hope you will post about your experience after this upcoming examination.

I hope you will post about your experience after this upcoming examination.

Will do! I had my last exam with this doctor just last year so I'll be able to recall what was similar and what was different. I wonder if the disposable exam shorts will make a return?!

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. If I do ever go for a physical in the future I will either move to Germany or play "old time doctor" with my soul mate. If these skimped exams really are the new normal, then no more visits to a primary care doctor when I am not sick for me.

Just had my annual physical aka wellness check from my PCP. Medicare pays. Gowned almost the entire time so no real look at my skin, palpitations done through the gown. Great pains taken to ensure modesty. No hernia or genital check (didn't have to cough), and there wouldn't have been a DRE if I hadn't insisted; my PSA is in the normal range but has been increasing over the past three years and I have some urinary function issues. Maybe just due to aging, but maybe not. When the doc suggested the DRE could be uncomfortable I responded that so was dying of prostate cancer. I know, because thats what got my father.

You have to be proactive and insist that things be checked within the 45 minutes the insurance allows. I have a standing referral to a local dermatologist and see him every sixth months for a thorough going over. I grew up in southern California in the 1950s-60s and we practically lived in our bathing suits at someone's pool or the beach, tanned as dark as we could get. Paying the price for that now, having pre-cancerous lesions removed as they're found. I can't depend on a PCP/GP to look after that aspect of my health, especially when lesions can't appear anywhere on my body including places I can't see.

Compared to when I was growing up, this aspect of modern health care is a total sham.

This is not a distinction that has been my experience given my doctor. The first time I met him, he just conducted an interview, had the nurse take vitals, and just listened to my heart and lungs. I didn't disrobe except to unbutton my shirt and ended with having to get blood tests. He had me return in two months for a "Physical," which did result in my stripping to my briefs and then removing them during genital, hernia and DREs. He has had me return in like 8 months and given me a brief exam; no undressing but often schedules a follow up whereby I am required to disrobe!