Physical coming soon: help me choose my doctor

So I need to have a physical before the end of the year. My last physical was from a seasoned family practitioner in his mid-60s. It was pretty good, and I'd go back, but I want to try something different.

I want to try a really young doctor, or even a physician's assistant. Thoughts on a physician's assistant? Are they at all thorough?

I LOVE the idea of a female doctor giving me a very thorough exam, but I don't think that's very likely. I've only had one female physician, and she gave me a DRE but while I was fully dressed. My jeans and briefs just went down a bit. Very odd physical. Never examined my penis and testicles. Bummer.

In reviewing my options, there is a clinic fairly close to home that appears to have several medical residents in internal medicine practicing there. There are two guys in their late 20s who are pretty cute. In Googling their names, they both are athletic -- one played college soccer.

So for a variety of reasons, I might give one of them a try. Thoughts on getting a physical from a medical resident in his 20s? Any chance a more seasoned doctor would be in the room too ?-That would be hot.

I don't really have any pressing health concerns. I have prostate cancer in my family, so I watch that. It also gives me a good explanation for why I get a yearly physical.

Thoughts on a physician's assistant? Are they at all thorough?

I've received full physicals from a number of PAs as well as NPs. Just like doctors, some are thorough and some not so much. But keep this in mind: Generally, a PA or NP is allotted more time to see each patient -- at least it always seems that way to me. I'm guessing that's because they're just not as expensive of a resource for the practice. My own experience is that a good PA or NP is capable of giving you at least as complete of a physical exam as your average doctor. In many cases, much more thorough. As always YMMV.

I LOVE the idea of a female doctor giving me a very thorough exam, but I don't think that's very likely.

As always, it just depends on the doctor. I currently see a female internist as my primary care and she is very thorough, examining my genitals, doing a hernia exam and (of course) a prostate and rectal exam.

Thoughts on getting a physical from a medical resident in his 20s? Any chance a more seasoned doctor would be in the room too ?-That would be hot.

Getting an exam from a young resident (either male or female) would indeed be very hot. But I doubt they'd be accompanied by another doctor unless this was a teaching hospital or some other situation like that. It's just too costly for a practice to send in two professionals just to see one patient.

I want to try a really young doctor, or even a physician's assistant. Thoughts on a physician's assistant? Are they at all thorough?

I have never been examined by a physician assistant or nurse practitioner but I have spoken to a number of men who have been examined by one or the other. Their experiences were that the exams were thorough and included genitalia and rectal. I would enjoy having an exam required by an employer or insurance company done by one of these practitioners because I think it is more humiliating having a less qualified individual checking out your genitalia and violating your anus. A younger male or a female would make it even more embarrassing.

I was examined once by a nurse practitioner when my company had downsized from having a plant physician doing annual physicals to having just a nurse practitioner doing them. So it's like Jimmy says, they're just not as expensive.

Put it this way. It was THE only time I was ever offered an examination of my penis. And she did testicles & DRE too. So, thorough ? Yes, she was. Very.

I'd flip this up and ask you to think more about why you want to change. Medicine is a profession and a mix of art and science. If you have a doctor who is good and who you work well with there is value in staying with that doctor.

One reason to consider change would be that your doctor is probably close to retiring, and if you find a younger doctor who is good and you work well with there would be a longer term relationship there, as well as not having a rush to find a new one if something happens to you right after your doctor retires. Another reason that I have unfortunately come across both for me and for friends is doctors that won't do their job - don't check things out they should and don't ask the right questions.

In any case if you're changing your doctor there are important things to be considered that aren't on your list. Especially if you are 50+.

It has always been my experience that a PA or NP gives a better exam than a doctor especially an older doctor. Usually the more experienced doctors go for the important things (heart, lungs, etc.) and skip the extraneous stuff (genital exam).

This is great feedback! Thanks.

In answer to why I'm "changing" ... here's the deal.

I no longer trust the doctor to whom I've gone the last several years because of billing/referral issues. He started in a small local internal medicine practice, which is why I went in the first place (also, because he was very cute). Well ... that practice merged with a very large conglomerate. Each time I've gone, he wants to do more and more tests and to refer me to a variety of specialists.

Look ... my main concern is prostate cancer because cancer is in my family. I am really fit for my age and a long-distance runner. He noted high/low glucose, concerns about my white/red cell count, and elevated liver values. His suggestion was to not run a race that I had been training for for months. Sorry, doc, you're not listening to your patient ... but I'm sure there's an "acted contrary to medical advice" note in my file.

He wanted to send me to THREE specialists after the race. If he had done some Googling, he'd know that these are common issues with runners. So I went to a young MD who was a runner and specializes in that stuff, and who practices in an independent clinic. He told me to ignore the data but didn't really do much of a physical at all -- including no DRE. He did help a lot with a running injury. And he did check my PSA, which is all normal. But most of the time we talked about large medical corporations and how his charge to my medical insurer would be less than a physician's assistant at a large facility. I really didn't get much of a physical though.

So next time, I went to an older doctor in a small practice with no affiliation to any conglomerate. He was good and, although not a runner, complimented me instead of berating me. He did a good DRE, PSA, etc. He sent me my labs, which were a little high there and a little low there -- but said "Don't worry, you're doing great."

I'd go back, but the deal is that my employer is now changing medical insurers as of January 1 and I have no idea what my network will be. So I thought I'd slide in for an exam before the end of the year ... and use the opportunity to explore options.

If I had a serious medical issue, I do have a substantial file with the large conglomerate. But at this point, I'm not about to feed the monster of medical referrals, etc.

Here's what I'd do (though, to be honest, the cuteness of the doctor has little to do with how I pick one):

I'd go ahead and drop the big conglomerate. Sounds like they're more interested in profit than you. Get a general doctor that you trust.

Since you like the guy you went to last call up your company, find out who they're switching to, and then call that insurer and see if the doctor is on their list.

If not, pick a few candidates and contact the office of they guy you like and explain the situation (probably leaving out the fetish bits). Give them a few names of docs you're looking at and see who they recommend.

Regarding the DRE (and maybe even PSA) - you'll probably have to bring that up. Many doctors don't do them because many people don't like them and (those patients) don't think that the added information is worth putting up with the process. There's also a movement saying that prostate cancer generally isn't a big deal and having a patient panicking after hearing "high PSA" or "irregular results" might be worse than not doing anything in some cases. I go for "go ahead and get the data so I can make an informed decision" personally, but you might need to push a bit for that.

... that practice merged with a very large conglomerate. Each time I've gone, he wants to do more and more tests and to refer me to a variety of specialists.

I have a friend who does internal medicine in a small group. They were acquired by a hospital and he is encouraged to order a lot of radiology studies and refer to specialty practices that are owned by the same hospital. Long time patients are fleeing the practice because it has lost its personal touch. Also, the hospital manages their office and hires employees with the quality and motivation of the staff going down a lot. Your idea of leaving the big practice is probably right.

Regarding the DRE (and maybe even PSA) - you'll probably have to bring that up. Many doctors don't do them because many people don't like them and (those patients) don't think that the added information is worth putting up with the process..

You are likely correct about having to bring up the rectal exam to some primary care doctors which I think is too bad. In my opinion, it detracts from the exam experience if the patient is not kept guessing about the thoroughness of the exam. You still want him to get that finger in your anus, but it is better if it is his standard protocol rather than your request.

He started in a small local internal medicine practice, which is why I went in the first place (also, because he was very cute). Well ... that practice merged with a very large conglomerate. Each time I've gone, he wants to do more and more tests and to refer me to a variety of specialists.

@sfcfml This happened to me once too. I needed some kind of medical clearance prior to my knee surgery. I went to a doc that was local to work, since I was still trying to attend work and needed someone conveniently close by work. He asked if I needed lime a bare minimal to have the surgery or if I wanted a "full exam", and I figured since I hadn't had one in a few years (due to my employer's usual, annual physical being lost due to downsizing, etc I figured "fuck it - yeah let's do a full physical"

Unbeknownst to me, i found my blood being drawn for several minutes into a rack of test tubes for various tests, appt to return to see various specialists for various tests using new various toys (high tech equipment shit), and referrals to go see other specialists for other tests in neighboring towns. It was way over the top, and I found myself cancelling appts after having gone through the first few.

And even with my recently found primary care physician, I hadn't been put through that much detail for a desired routine annual physical. Leaving myself to think: "What the fuck was up with that scam?"

@JTMac ... yeah "scam" sums it up I think. The medical machine keeps itself fed it seems.

Thanks for all the feedback. I'm going the medical resident route. I made the appointment. It's set for next week. Male doctor, cute, 2016 med school grad, so the doc will be age 27-28 and halfway through his residency I think.

One reason was length of appointment. At the clinic I'm going to, the physician's assistants have 20-minute appointments and the non-resident MD's do too. The medical residents have 30-minute time slots. Interesting. I'd love for my physical to be a teaching opportunity ... but that's probably unlikely. In the notes, I did make it clear that there is cancer in my family and that is a reason for the exam.

I'm going the medical resident route. I made the appointment. It's set for next week. Male doctor, cute, 2016 med school grad, so the doc will be age 27-28 and halfway through his residency I think

So were you able to select to have the physical with a resident? Were you able to select the resident who was going to see you?

You should always make sure the doctor or physician you are seeing is well qualified and knowledgeable. It might be tempting to select a physician based on how he looks etc (I know I've been tempted) but it is probably not the wisest choice.

You should always make sure the doctor or physician you are seeing is well qualified and knowledgeable.

AND cares enough to ask about things that come up. I've had that with a doctor who couldn't be bothered to get all the information he should have gotten. Fortunately it wasn't something that would have had lasting consequences.