How does your doctor "doctor"?

[sheryl]

DH and I were blessed to have the best family physician for about 23-25 years.  Then he retired last Oct 1; he's roughly 55.  I respect him so much (he's well known and respected in his profession) that I asked for recommendations as a replacement.  He referred us and others to "his" doctor.

Our former dr - K
Our current dr - M

Dr. K was thorough.  During annuals he would check: eyes, ears, mouth, reflexes (you know, tapping the knee and/or ankle bone), listen to heart/chest, back/lungs, carotid arteries, manually check 4 points on abdomen, labs.  I don't think I'm forgetting anything.  If so, I'll update.  

Today at DH's annual, Dr. M did NOT check eyes, ears, mouth, reflexes, 4 pt abdomen, carotid arteries.  I'm not sure if M checked heart and lungs!  WHAT?  He did check prostate and ordered labs in addition to nurse checking temp, bp, oxygen.  Again, standard!

I thought about this and decided to pursue it.  I texted my neighbor and she said she has not been checked like that for years.  I called my sister in MI and her dr stll performs this procedure - he still checks those areas.  

Afterwards I called M's office and spoke with a male nurse explaining our situation.  I told him that I don't want to finger point but kindly mentioned K "checked" those areas.  The nurse said patients need to be their own advocate and we can "ask" to have the dr. "check".  I followed up with the fact that those areas are very basic and many doctors cover them.  A patient may "ask" if there is something else to consider like dizziness, racing heart or whatever.  But, to check the above areas are basic.   It's standard and we should not "HAVE" to ask.  Nurse said he would talk to M and call me back.  He did but I was out.  Took Shi to vet.  Nurse said M said DH can accompany me at my annual and he will "finish up" with dh to check those areas.    

We will finish this year's annuals with M but I may look for another dr for dh and I.  

So, I'm curious - what does your doctor do?  Not referring to pap, mammogram and other specialty annuals.  Only referring to annual physicals.  

And, yes, we have an eye dr, dermatologist.   Are we suppose to find a reflex dr so he/she can check that specifically?  And, same for the other areas!  

Edited August 19, 2022 by sheryl

[Melissa in Australia]

In my country We go to the doctor  when sick. annual physicals are not a thing.  I am under the impression that they are only done in USA as part of medical insurance.  Not because of any medical need. 

We don't have all those other things done unless we need a medical report for something like work.   Australian life expectancy and medical outcomes are better in Australia than USA so I would venture to say that having universal health cover and being able to see a doctor when sick is better health wise than having annual physicals

[Kassia]

We've had this happen recently.  DH had a great family doctor who just retired and the new (highly recommended) family doctor was not nearly as thorough when DH saw him for his yearly physical.

I had a gynecologist that I loved.  She retired and her replacement is nice but...same issue.  Just not thorough.  

It's so tough getting good medical care.

[Pawz4me]

At my annual physical the following things are generally done/checked: weight, height, urinalysis, BP, temp, pulse ox, heart rate, listen to heart and lungs (front and back), eyes, ears, mouth, palpate thyroid and abdomen, skin check, blood work. She checked my reflexes once two or three years ago. She's the only provider who has ever done that.

[Katy]

Yeah, typically no one does physicals that old fashioned way anymore. Generally if something is wrong you likely would have noticed before your physical. But it’s much harder to tell something is wrong that shows up in lab work. 

[historically accurate]

4 minutes ago, Pawz4me said:

At my annual physical the following things are generally done/checked: weight, height, urinalysis, BP, temp, pulse ox, heart rate, listen to heart and lungs (front and back), eyes, ears, mouth, palpate thyroid and abdomen, skin check, blood work. She checked my reflexes once two or three years ago. She's the only provider who has ever done that.

Similar list except no skin check, occasionally ears, but I don't remember one at my last physical. 

[wathe]

You new doc is probably following evidence-based practice.  Have a look at the evidence-based periodic health exam literature.  Most of the value in the PHE is in screening (BP, paps, certain other tests, lots of talking and questions) and counselling (tooth brushing, diet, exercise, substance use, firearms in the home etc etc).  The physical exam is low value and mostly performative.

[wathe]

48 minutes ago, Melissa in Australia said:

In my country We go to the doctor  when sick. annual physicals are not a thing.  I am under the impression that they are only done in USA as part of medical insurance.  Not because of any medical need. 

We don't have all those other things done unless we need a medical report for something like work.   Australian life expectancy and medical outcomes are better in Australia than USA so I would venture to say that having universal health cover and being able to see a doctor when sick is better health wise than having annual physicals

Canada same.  https://www.cmaj.ca/content/186/16/1245

ETA:  we do have periodical health exams for preventive care, but they are not annual, and they are not physicals.

Edited August 19, 2022 by wathe

[TravelingChris]

1 hour ago, wathe said:

You new doc is probably following evidence-based practice.  Have a look at the evidence-based periodic health exam literature.  Most of the value in the PHE is in screening (BP, paps, certain other tests, lots of talking and questions) and counselling (tooth brushing, diet, exercise, substance use, firearms in the home etc etc).  The physical exam is low value and mostly performative.

That is not counselling-- that is lecturing and not at all helpful.    As part of our concierge plan, we get an annual exam.  Our doctor does a myriad of tests, and physical exam, too.  Like he measures bp in arms to check blood flow.  He does palpitate, does reflexes-- as does my neurologist too, and sometimes my rheumatologist also.  He does a EKG, visual, hearing every so often,  etc.  And he has us fill out questionnaires too- which highlight if we are doing less than we did the previous years, if we are depressed, etc.  

And one thing I really like about my doctor is that he does have some older techniques too- like shining light into your sinus cavities if you are complaining about sinus problems.  

[TechWife]

I think a general physical exam is of limited use for a healthy person. But - most physicians require a patient to be seen at least once a year in order for them to write routine prescriptions for things like high bp or cholesterol.

I recently had a visit to "establish care" with a new family physician. In addition to routine vitals, she did a complete exam as you describe. She also screened for a lot of different things and took a thorough medical history. I have a lot going on medically and am seeing several different specialists and we reviewed the areas of concern each were addressing. She wants me to come back in six months to assess where things are with that ongoing saga unless I need to come in earlier for her input, which I am welcome to do. She will monitor lab results and visit summaries from the specialists as they show up in my medical record.

FWIW - this is a list of screenings the ACA policies cover at 100% - some of these are lab tests, some are Q & A screenings. I'm familiar with all of these being folded into a routine GYN visit or a routine family physician visit.

 

[kbutton]

Mine does the physical exam and is a young doc to boot.

 

[sheryl]

1 hour ago, Katy said:

Yeah, typically no one does physicals that old fashioned way anymore. Generally if something is wrong you likely would have noticed before your physical. But it’s much harder to tell something is wrong that shows up in lab work. 

I agree with you "to a point" but disagree inasmuch as sometimes the observant doctor can see something that someone might have missed.    Also, they are educated, trained and experienced to do so.  I sure hope it's not considered "old fashioned".  I think it's excellent common sense and thoroughness for a doctor to practice in this way.

[sheryl]

2 hours ago, Melissa in Australia said:

In my country We go to the doctor  when sick. annual physicals are not a thing.  I am under the impression that they are only done in USA as part of medical insurance.  Not because of any medical need. 

We don't have all those other things done unless we need a medical report for something like work.   Australian life expectancy and medical outcomes are better in Australia than USA so I would venture to say that having universal health cover and being able to see a doctor when sick is better health wise than having annual physicals

Thank you for sharing.  That is interesting.  I would venture to say life expectancy is due to so many factors though - genetics, activity, lifestyle, diet and the list goes on.   I still firmly believe that annual physicals are good.  It is annual - once a year.  It's a standard on which to compare from one year to the next.  Going in when sick does not sound very proactive or preventative.  And, yes, you go in when sick but one should not wait to have a heart attack to be seen.  That person should know from one of their annual physicals that they need to go on a med to prevent that.     

[sheryl]

32 minutes ago, TravelingChris said:

That is not counselling-- that is lecturing and not at all helpful.    As part of our concierge plan, we get an annual exam.  Our doctor does a myriad of tests, and physical exam, too.  Like he measures bp in arms to check blood flow.  He does palpitate, does reflexes-- as does my neurologist too, and sometimes my rheumatologist also.  He does a EKG, visual, hearing every so often,  etc.  And he has us fill out questionnaires too- which highlight if we are doing less than we did the previous years, if we are depressed, etc.  

And one thing I really like about my doctor is that he does have some older techniques too- like shining light into your sinus cavities if you are complaining about sinus problems.  

This sounds great.  Do you like the concierge plan?  K's colleague went on to start a concierge practice.  Maybe I should look in to that.  Does your insurance cover that and can you share details of cost - even if you pm me?

[sheryl]

25 minutes ago, TechWife said:

I think a general physical exam is of limited use for a healthy person. But - most physicians require a patient to be seen at least once a year in order for them to write routine prescriptions for things like high bp or cholesterol.

I recently had a visit to "establish care" with a new family physician. In addition to routine vitals, she did a complete exam as you describe. She also screened for a lot of different things and took a thorough medical history. I have a lot going on medically and am seeing several different specialists and we reviewed the areas of concern each were addressing. She wants me to come back in six months to assess where things are with that ongoing saga unless I need to come in earlier for her input, which I am welcome to do. She will monitor lab results and visit summaries from the specialists as they show up in my medical record.

FWIW - this is a list of screenings the ACA policies cover at 100% - some of these are lab tests, some are Q & A screenings. I'm familiar with all of these being folded into a routine GYN visit or a routine family physician visit.

 

OK, thanks for your input.  I just have to disagree with most of the replies as I think the annual is valuable information.  Oh well.....  I'll sail alone (with dh) on that one.

[sheryl]

21 minutes ago, kbutton said:

Mine does the physical exam and is a young doc to boot.

 

HOW does he/she perform the exam?  List above in my opening comment.

[ktgrok]

I. had my physical just a few weeks ago - checked eyes, nose, mouth, ears. Palpated my neck, guessing to check glands but maybe also artery? Listened to lungs front and back. Palpated abdomen, checked reflexes. 

From a vet med staindpoint a well visit should always include a "nose to tail" exam, in my opinion. Vets are even taught to do the exam in the same order every time so they don't forget something. 

[TravelingChris]

1 hour ago, sheryl said:

This sounds great.  Do you like the concierge plan?  K's colleague went on to start a concierge practice.  Maybe I should look in to that.  Does your insurance cover that and can you share details of cost - even if you pm me?

It has been absolutely wonderful.  We aren't rushed through exams.  If we get sick in another state, we could see the local concierge doctor in the same nationwide program.  But the nationwide program allows the doctors to decide their own parameters.  For example, the doctor we chose still is covering dd2, since she is still 25.  Because he was so thorough, she got her gallbladder taken out this year, and very quickly too.  He also knew that she had had COVID, though both home tests and hospital/urgent care tests said no. He did the antibody test and she was super high.  The gallbladder issue less than six months later.  When my rheumatologist suddenly closed his practice and I was running out of Humera, he ordered it while I was researching and then getting my new rheumatologist.  My husband feels very comfortable with him too.  We both got voluntary calcium scan of our hearts and valves, etc for about 150 each and this was a voluntary test but one that first I wanted since I have chest pains frequently due to autoimmune causes-costochondritis, rib pain, heart burn, asthma, etc.  and my sister died of a 2nd heart attack at age 36 and my father died from another heart attack at age 62/  My husband's mother died from 2 heart attacks at age 64.  Well we both have no clogging of our hearts at all.  

It costs $412 a quarter.  He and a few of his partners in the clinic are with MDVIP,  But there are other concierge doctor services too.

[sheryl]

1 hour ago, ktgrok said:

I. had my physical just a few weeks ago - checked eyes, nose, mouth, ears. Palpated my neck, guessing to check glands but maybe also artery? Listened to lungs front and back. Palpated abdomen, checked reflexes. 

From a vet med staindpoint a well visit should always include a "nose to tail" exam, in my opinion. Vets are even taught to do the exam in the same order every time so they don't forget something. 

Great, thanks!  The exam you have is what dh and I used to be given from Dr. K.  This dr will do it upon request but we found that out after dh left the appt.  I guess after reading these replies I do NOT feel comfortable staying with him.  

[sheryl]

46 minutes ago, TravelingChris said:

It has been absolutely wonderful.  We aren't rushed through exams.  If we get sick in another state, we could see the local concierge doctor in the same nationwide program.  But the nationwide program allows the doctors to decide their own parameters.  For example, the doctor we chose still is covering dd2, since she is still 25.  Because he was so thorough, she got her gallbladder taken out this year, and very quickly too.  He also knew that she had had COVID, though both home tests and hospital/urgent care tests said no. He did the antibody test and she was super high.  The gallbladder issue less than six months later.  When my rheumatologist suddenly closed his practice and I was running out of Humera, he ordered it while I was researching and then getting my new rheumatologist.  My husband feels very comfortable with him too.  We both got voluntary calcium scan of our hearts and valves, etc for about 150 each and this was a voluntary test but one that first I wanted since I have chest pains frequently due to autoimmune causes-costochondritis, rib pain, heart burn, asthma, etc.  and my sister died of a 2nd heart attack at age 36 and my father died from another heart attack at age 62/  My husband's mother died from 2 heart attacks at age 64.  Well we both have no clogging of our hearts at all.  

It costs $412 a quarter.  He and a few of his partners in the clinic are with MDVIP,  But there are other concierge doctor services too.

Wow, sad and sorry to hear about the heart attacks claiming your loved ones! My Grandpa died of a heart attack but that was decades ago.  What number were you on your heart calc test?  And, was your dd's gallbladder issue a result of having covid?   DH and I just had covid beginning July 8/9 - I'm curious.  Glad your dr is so thorough!!!!

The $412, is that per person or family?  

[kbutton]

3 hours ago, sheryl said:

HOW does he/she perform the exam?  List above in my opening comment.

Like your doctor that retired. I don’t have it memorized—I’ve only seen him maybe three times, but it’s like what you describe.

[Ellie]

The doctor I had for the last, oh, 12 years didn't do annual physicals. I only saw her when I was sick, which, happily, isn't often. She retired. New doctor does annual physicals. I'm a little annoyed by that; I wanted something done, I have forgotten what, and he said that would be done at the physical, which was several months later. Interestingly, the previous doctor had her own private practice; the new one is part of a large group. I had the same insurance with both.

[Laura Corin]

6 hours ago, Melissa in Australia said:

In my country We go to the doctor  when sick. annual physicals are not a thing.  I am under the impression that they are only done in USA as part of medical insurance.  Not because of any medical need. 

We don't have all those other things done unless we need a medical report for something like work.   Australian life expectancy and medical outcomes are better in Australia than USA so I would venture to say that having universal health cover and being able to see a doctor when sick is better health wise than having annual physicals

Same in the UK. There are various screenings at particular points in your life - Husband was just called in for his aortic aneurysm screening - but we don't do annual check ups.

As an example, last year I  started to feel dizzy when I stood up, so I had extensive blood tests. This year I haven't seen the doctor. 

[bookbard]

Australia here - I go get blood tests each year (for Vit D, cholesterol, iron and blood count) and the Dr will check my blood pressure, ask a few questions about any bodily changes since last time. I don't think I've ever had my reflexes checked though. She'd only check my ears if I had an earache; I see the optometrist each year who does a full on eye check, and I go to the skin Dr to get my skin checked. 

[TravelingChris]

3 hours ago, sheryl said:

 What number were you on your heart calc test?  It is a special form of CATSCAN and I can't locate our reports but I did know that we both had clear scans and at least, our arteries aren't blocked or anything And, was your dd's gallbladder issue a result of having covid?  We don't know.  She also has lots of masses in her breasts too that were seen on mammograms.  She was provisionally diagnosed w lupus a few years before college, but no treatmentl  She definitely has auto-immune issues but is having great trouble getting in to a good rheumatologist.  Mine wasn't accepting new patients as of this last winter. DH and I just had covid beginning July 8/9 - I'm curious.  Glad your dr is so thorough!!!!

The $412, is that per person or family?  Per person but we do have a FSA and it covers part of that too

 

[KungFuPanda]

11 hours ago, Melissa in Australia said:

In my country We go to the doctor  when sick. annual physicals are not a thing.  I am under the impression that they are only done in USA as part of medical insurance.  Not because of any medical need. 

We don't have all those other things done unless we need a medical report for something like work.   Australian life expectancy and medical outcomes are better in Australia than USA so I would venture to say that having universal health cover and being able to see a doctor when sick is better health wise than having annual physicals

I think a lot of the US’s health problems have very little to do with how often we have physicals and how they are performed. We have problems that skew our national averages in a big way. If you never smoked, aren’t obese or opioid addicted, and are unaffected by gang violence you are dodging a ton of risk factors. We also have more economic inequality than most, so being poor is another risk factor. So you’re right, universal healthcare WOULD improve our averages.  I’d love to see that and vote in that direction, but it sounds like the OP has access to regular care so her life expectancy is likely as high as it would be if she lived in Australia. 

[Melissa in Australia]

8 minutes ago, KungFuPanda said:

I think a lot of the US’s health problems have very little to do with how often we have physicals and how they are performed. We have problems that skew our national averages in a big way. If you never smoked, aren’t obese or opioid addicted, and are unaffected by gang violence you are dodging a ton of risk factors. We also have more economic inequality than most, so being poor is another risk factor. So you’re right, universal healthcare WOULD improve our averages.  I’d love to see that and vote in that direction, but it sounds like the OP has access to regular care so her life expectancy is likely as high as it would be if she lived in Australia. 

We have enough fat people, drug addicts , smokers and poor people here as well. those are not limited to USA

[LauraClark]

12 hours ago, sheryl said:

The nurse said patients need to be their own advocate and we can "ask" to have the dr. "check". 

I'm seeing this kind of thing a lot lately and it is maddening to me. I've never been to medical school, but I feel like I have to be an expert in order to advocate for myself to the actual experts.

My family has just been to several Drs/ER/etc (it's been a crazy couple weeks for our usually healthy family, but we're good now!) and I'm noticing that in general younger Drs are more likely to be overly professional, which comes across to me as uncompassionate. Also, our very rural area has 2/3 of very good drs-they are thorough: they really want to find the cause, they care about us, they are knowledgeable. But, in the more urban area next to us where our hospital is located, Drs seem much more likely to require you to advocate. I think it's a mix of age, rural/urban, selling into the corporate hospital system that sees patients as a number rather than an individual. 

[HomeAgain]

My two best doctors have been female.  The last one we seriously debated on moving to her new clinic with her, but the deciding factor was that our current one has urgent care on the way home from hockey practice.

The key with both: they LISTENED.  They asked questions.  They allotted an hour with each patient in their schedule with just them, not split between nurse/pre & after care.  They had great memories and took meticulous notes.

I have a Nurse Practitioner now who was Dr. 2's right hand man and she's pretty decent.  Not quite the same, but good.  She's pushy but in a way I knows she cares about my health.

 

I've also had totally terrible doctors who dismissed me, belittled me, and assumed things.  It got so bad at one point that I needed dh in the exam rooms with me because they would talk over me and tell me what I was feeling, but would listen to dh describe the exact same thing about me and get taken seriously.

[Laura Corin]

2 hours ago, KungFuPanda said:

I think a lot of the US’s health problems have very little to do with how often we have physicals and how they are performed. We have problems that skew our national averages in a big way. If you never smoked, aren’t obese or opioid addicted, and are unaffected by gang violence you are dodging a ton of risk factors. We also have more economic inequality than most, so being poor is another risk factor. So you’re right, universal healthcare WOULD improve our averages.  I’d love to see that and vote in that direction, but it sounds like the OP has access to regular care so her life expectancy is likely as high as it would be if she lived in Australia. 

I guess the question then is whether - for someone with good access to healthcare in the US - an annual check up produces benefit to the OP as an individual, taking into account that extra testing/treatment can have a negative as well as positive effect.

[ktgrok]

I will point out that in most (alll?) states, a doctor legally cannot treat someone, including prescribing meds or tests, if they have not seen them in the past year. How does that work in the UK, or australia? If someone is on a prescription medication do they go in for annual visits and just call it something else, or can they continue to get prescription without a visit annually, or?

4 hours ago, bookbard said:

Australia here - I go get blood tests each year (for Vit D, cholesterol, iron and blood count) and the Dr will check my blood pressure, ask a few questions about any bodily changes since last time. I don't think I've ever had my reflexes checked though. She'd only check my ears if I had an earache; I see the optometrist each year who does a full on eye check, and I go to the skin Dr to get my skin checked. 

I will say, in Florida so many people have allergy/sinus/ear issues that checking ears seems maybe more needed than elsewhere. Although plenty of people have stories to tell of not knowing htey had a bad build up of wax in the ear, to the point of effecting hearing, until they got ears checked by a doctor, so still probably worth it if you are already there. Only takes a few seconds. 

2 hours ago, Melissa in Australia said:

We have enough fat people, drug addicts , smokers and poor people here as well. those are not limited to USA

Yes, but your poor people have access to medical care if they need it. Here, poor = no medical care for many. 

[Jean in Newcastle]

My doctor checks those things which make sense to check FOR ME. So my reflexes are checked on occasion- not as a rote exercise but because I report issues with things that require my reflexes to be checked. He knows that my mouth is checked twice a year by my dentist so he doesn’t check my mouth unless I report a problem with my mouth. He knows that my eyes are checked annually by my eye doctor so he only checks them if it’s indicated.  Same for pretty much everything on that list. He might have done more when I saw him the first time (I can’t remember) but since he knew  my previous doctor and had my chart in front of him, maybe not. 
 

My lab work is tailored to my health needs as well and while I am sure many people have similar labs, they are not mindless. I prefer a doctor who doctors this way. 

Edited August 20, 2022 by Jean in Newcastle
Typo

[sheryl]

4 hours ago, TravelingChris said:

 

I'm replying to this but I don't see your reply now so I'm going on memory.   🙂  Thanks for that!  I think mine is a 12 and this dr wants to put me on cholesterol med.  Apparently the perfect number is 0.  I would like a 2nd opinion is 12 is worthy to start a med or not.  

Your dd has had some challenges for such a young age.  Hope she sees improvement!!  

So roughly $1600/yr per person.   Thanks for sharing.  I just researched K's former colleague and dh and I would "each" pay 1200/yr.  Something to think about. 

[sheryl]

3 hours ago, KungFuPanda said:

I think a lot of the US’s health problems have very little to do with how often we have physicals and how they are performed. We have problems that skew our national averages in a big way. If you never smoked, aren’t obese or opioid addicted, and are unaffected by gang violence you are dodging a ton of risk factors. We also have more economic inequality than most, so being poor is another risk factor. So you’re right, universal healthcare WOULD improve our averages.  I’d love to see that and vote in that direction, but it sounds like the OP has access to regular care so her life expectancy is likely as high as it would be if she lived in Australia. 

Right, all I'm saying is it's nice to have a reference from the annual visit.  So, my sister didn't know until her annual that she is now classified as type 2.  DH and I don't go in often at all.  But, I know Dr. K would refer back to my previous annual to review notes.  

[sheryl]

2 hours ago, LauraClark said:

I'm seeing this kind of thing a lot lately and it is maddening to me. I've never been to medical school, but I feel like I have to be an expert in order to advocate for myself to the actual experts.    Exactly!   I feel like I/we need to know quite a bit.  I "DO" believe people need to be advocates for themselves but for the annual.  IMO, the annual checks "standard" areas as I mentioned above.  I think the dr should perform those without us asking.  Now, if someone has gained a bit of weight in a short amount of time or sees a rash, etc then yes, be an advocate and call in to be seen.   Glad y'all are doing better!!!  We live in the Piedmont region!! 

My family has just been to several Drs/ER/etc (it's been a crazy couple weeks for our usually healthy family, but we're good now!) and I'm noticing that in general younger Drs are more likely to be overly professional, which comes across to me as uncompassionate. Also, our very rural area has 2/3 of very good drs-they are thorough: they really want to find the cause, they care about us, they are knowledgeable. But, in the more urban area next to us where our hospital is located, Drs seem much more likely to require you to advocate. I think it's a mix of age, rural/urban, selling into the corporate hospital system that sees patients as a number rather than an individual. 

 

[sheryl]

1 hour ago, HomeAgain said:

My two best doctors have been female.  The last one we seriously debated on moving to her new clinic with her, but the deciding factor was that our current one has urgent care on the way home from hockey practice.

The key with both: they LISTENED.  They asked questions.  They allotted an hour with each patient in their schedule with just them, not split between nurse/pre & after care.  They had great memories and took meticulous notes.

I have a Nurse Practitioner now who was Dr. 2's right hand man and she's pretty decent.  Not quite the same, but good.  She's pushy but in a way I knows she cares about my health.

 

I've also had totally terrible doctors who dismissed me, belittled me, and assumed things.  It got so bad at one point that I needed dh in the exam rooms with me because they would talk over me and tell me what I was feeling, but would listen to dh describe the exact same thing about me and get taken seriously.

That's incredible - an hour!  Very good!  

[HomeAgain]

7 minutes ago, sheryl said:

That's incredible - an hour!  Very good!  

I know!  I nearly cried the first time I left because I felt listened to.  It was such a different experience from previous doctors.  Dh was like, "what?  Isn't this the way it always is?"  Then he went with me after I slipped on the ice and wrenched my knee.  I saw my usual doctor at that practice and he blew me off, said it was fine without looking at it, and that I just needed some motrin.  DH was perplexed.  "Aren't you even going to do an x-ray?  It's purple."  He's hearing stories now from his female coworker whose doctor told her that her IUD couldn't possibly have been the cause for a full-body hormonal imbalance because it's "localized".  She had it removed after several years and several other issues are now gone, too, like her constant apathy.

It was a really difficult decision not to move practices with Dr. 2.  I miss her.  Our other good doc retired.

[Laura Corin]

1 hour ago, ktgrok said:

I will point out that in most (alll?) states, a doctor legally cannot treat someone, including prescribing meds or tests, if they have not seen them in the past year. How does that work in the UK, or australia? If someone is on a prescription medication do they go in for annual visits and just call it something else, or can they continue to get prescription without a visit annually, or?

Repeat prescriptions have a time limit,  so you might need to see the doctor for that monthly, 6-monthly, yearly or less often, based on the science on that particular medication.  Regular screening  - mammogram etc. is organised by public health usually, not the GP. If I call the GP with an issue, then the doctor will order tests based on potential diagnoses.

[shawthorne44]

I think there is a value in those checks.   

For example, as a kid my parents took me in for a physical every year.   A recent check was needed before going to summer camp, so it was even done about the same time every year.  One year at school the school nurses did a scoliosis check on everyone.  I had it!   The doctor had never checked for that!   Since then finding a primary care doc that includes checks that don't cost extra has been a priority.  Because of the scoliosis check in school I was able to get a surgery that mostly corrected it.   If it had been found earlier, it would likely have been completely corrected.  I hadn't been aware that it was a problem.  

 

[wathe]

2 hours ago, Laura Corin said:

I guess the question then is whether - for someone with good access to healthcare in the US - an annual check up produces benefit to the OP as an individual, taking into account that extra testing/treatment can have a negative as well as positive effect.

Exactly.  The evidence suggests that it doesn't.

[shawthorne44]

2 hours ago, HomeAgain said:

My two best doctors have been female. 

I strongly prefer female doctors.   I had horrible periods as a teen.  As in bled myself very anemic and I've prayed for death. Mom and I kept looking for a doctor to help.   They all dismissed my problems as "in my head."   Finally we stumbled on a female doc.  She was the first one to actually believe me!    She was able to help.  Since then I've been pleased with every female doc I've had.  

 

 

[Pawz4me]

2 hours ago, Laura Corin said:

I guess the question then is whether - for someone with good access to healthcare in the US - an annual check up produces benefit to the OP as an individual, taking into account that extra testing/treatment can have a negative as well as positive effect.

The only people I know who have regular annual physicals are people who are on medication and/or have some already diagnosed health issue. Like my PCP handles my thyroid checks and medication, so I have to get blood work twice a year to keep tabs on that. One visit is a very quick "are you feeling okay/think anything's off with your thyroid" chat and then a blood draw, and the other visit is the annual physical, which takes just a little bit longer and covers more territory. Younger people, men particularly, often don't get annual physicals. Neither of my sons has had one since their pre-college visit to make sure they had all the required vaccines. That's been six and nine years ago. Females usually go once a year in order to continue to get BCP prescriptions. 

Edited August 20, 2022 by Pawz4me

[wathe]

2 hours ago, ktgrok said:

I will point out that in most (alll?) states, a doctor legally cannot treat someone, including prescribing meds or tests, if they have not seen them in the past year. How does that work in the UK, or australia? If someone is on a prescription medication do they go in for annual visits and just call it something else, or can they continue to get prescription without a visit annually, or?

I

Management of chronic medical conditions (hypertension, diabetes, most things that need scripts) are distinct from preventive care, though both might be addressed during the same visit for convenience.   Visit schedule for these chronic disease management will depend on the condition and how stable the condition is.  Someone with new hypertension might have management visits every 3 months until stable, then annually, etc.  Content of the visit is different - PHE mostly screening and preventive care.   Canada has an extensive body of literature and sets of guidelines for PHE - US likely does too.

PHE (well-visits) is more frequent and requires more hands-on exam for pediatrics, screening for physical developments - see Rourke Baby Record tool, less frequent for teens (see Greig Adolescent Record tool, which recommends visits very one to two years)

I don't think we have a one-year or other time rule like you describe.  Instead must meet standards of care, which are may be different depending on the medical condition and its stabilty.

 

Edited August 20, 2022 by wathe

[wathe]

3 hours ago, LauraClark said:

I'm seeing this kind of thing a lot lately and it is maddening to me. I've never been to medical school, but I feel like I have to be an expert in order to advocate for myself to the actual experts.

My family has just been to several Drs/ER/etc (it's been a crazy couple weeks for our usually healthy family, but we're good now!) and I'm noticing that in general younger Drs are more likely to be overly professional, which comes across to me as uncompassionate. Also, our very rural area has 2/3 of very good drs-they are thorough: they really want to find the cause, they care about us, they are knowledgeable. But, in the more urban area next to us where our hospital is located, Drs seem much more likely to require you to advocate. I think it's a mix of age, rural/urban, selling into the corporate hospital system that sees patients as a number rather than an individual. 

Some insight from personal experience here:  This is a necessary defence.  Young looking doctors are at a big disadvantage, especially young-appearing female doctors. Both patients and staff tend to dismiss them, not take them seriously, mistake them for a nurse or low-level provider, make inappropriate  speech at them (getting honey'd and sweetie'd and dearie'd with alarming frequency, being told that they look much to young to be the doctor, etc.). It's exhausting.  "Overly professional" is a conditioned response all this garbage.  This is actually an enormous issue that's beyond the scope of this thread.

[wathe]

12 hours ago, ktgrok said:

 

From a vet med staindpoint a well visit should always include a "nose to tail" exam, in my opinion. Vets are even taught to do the exam in the same order every time so they don't forget something. 

Big difference being that dogs/cats can't give a first-person (first-animal?) history.  Observation (owner's and vets) is our only history tool. There is overlap with pediatrics (babies) and vet med here, I think,  and evidence-based well-visits/PHE do involve more hand-on exam for peds than for adults.

(I have exactly zero knowledge about preventive vet care or the state of the evidence on that!)

Edited August 20, 2022 by wathe

[TravelingChris]

2 hours ago, Laura Corin said:

I guess the question then is whether - for someone with good access to healthcare in the US - an annual check up produces benefit to the OP as an individual, taking into account that extra testing/treatment can have a negative as well as positive effect.

Why would extra testing have a negative effect?  I mean, yes, if radiation is used, but for blood tests, ekgs, palpitations, hearing exams, eye exams, Pap smears, ultrasounds, -what negative effect?  When the CDC decided that Pap Smears should only have to be done every 3 years, and I skipped a year before coming back for one, he said, that if they catch the cancer in year one, it is an office procedure.  If in year 2, it is a procedure that would have to be done at a surgery center or hospital, but not too bad; If you wait, and it is discovered in year 3, you are talking about surgery, and cancer drugs, or radiation too.

[Laura Corin]

5 minutes ago, TravelingChris said:

Why would extra testing have a negative effect?  I mean, yes, if radiation is used, but for blood tests, ekgs, palpitations, hearing exams, eye exams, Pap smears, ultrasounds, -what negative effect?  When the CDC decided that Pap Smears should only have to be done every 3 years, and I skipped a year before coming back for one, he said, that if they catch the cancer in year one, it is an office procedure.  If in year 2, it is a procedure that would have to be done at a surgery center or hospital, but not too bad; If you wait, and it is discovered in year 3, you are talking about surgery, and cancer drugs, or radiation too.

Sometimes things are detected that would not have developed within the person's lifetime and that lead to damaging treatment.  Eta prostate cancer is the classic example. 

Edited August 20, 2022 by Laura Corin

[wathe]

It's also interesting to note how insurance influences this.   Universal healthcare insurance here knows that annual physicals aren't based on evidence and are unlikely to provide benefit, so they fund them accordingly.  NO WAY  could docs spend an hour on a PHE here.  They would go bankrupt.  Wouldn't be possible to pay even office overhead.  Fee here for PHE age 18-64 is $54 in 2022.  Doc has to pay staff and office overhead out of that.

In a private pay system, I guess doc charges whatever they want (I think I saw hundreds of $ upthread?).  And provides patient satisfaction with non-evidence based, performative care that does not actually benefit the patient (and may cause harms linked to over-diagnosis and over testing).  Consumer satisfaction model, I guess.

[wathe]

9 minutes ago, TravelingChris said:

Why would extra testing have a negative effect?  I mean, yes, if radiation is used, but for blood tests, ekgs, palpitations, hearing exams, eye exams, Pap smears, ultrasounds, -what negative effect?  When the CDC decided that Pap Smears should only have to be done every 3 years, and I skipped a year before coming back for one, he said, that if they catch the cancer in year one, it is an office procedure.  If in year 2, it is a procedure that would have to be done at a surgery center or hospital, but not too bad; If you wait, and it is discovered in year 3, you are talking about surgery, and cancer drugs, or radiation too.

Because every test has a false positive rate.  The more tests you do, the more false positives.  With enough tests, you are certain to have a false positive.  Which then prompts further testing, often more invasive.  The tests themselves can have physical complications (radiation, infection, tissue trauma).  And use resources that might be better spent elsewhere - healthcare capacity is finite and under tremendous strain.

A good clinician will balance the pre-test probability (odds that this particular patient has whatever condition the test is testing for) with the sensitivity and specificity of the test in question.  The best clinicians test less.

[heartlikealion]

I don't even remember. I've gone back a couple times for follow ups but my last wellness exam I decided to have at my OB/GYN because she combined it with my pap (which is like every 3 years now). And I don't think they look at eyes, mouth, reflexes there. I've had several over the years at the OB/GYN (for convenience) and they do BP and labs for whatever the standard things are. The one I had at my current general practitioner... I don't think he did all of the things you're looking for. He may have done some. It's been 2 years since that wellness exam.