Thursday, May 29, 2014

Mess Ups in Annual Physical Exams

While I was writing a continuing education course for healthcare professionals in mental health a few years ago, I became aware of an unsettling situation; all docs are not, really not created equal. I don’t mean by virtue of the schools they attended, where they grew up or anything like that. I’m talking about how their particular specialty doesn’t really keep them involved in truly being docs at all. The particular specialty, of course, in that instance, was psychiatry where little medicine seems to be practiced.

When I say “medicine” and I combine that with psychiatry, it gets a bit wiggy. Psychiatrists do have MDs, but that’s where it ends. They do almost nothing in terms of exams (even when patients are taking heavy duty meds) and their offices might as well be those of any psychotherapist or nurse who provides scripts for meds. I know, they do provide valuable services, but shouldn't they be a bit more "medical?"

But I shouldn’t be too harsh on them. They are pulled from the physical practice of medicine by their specialty that has become, more and more, a practice of prescribing and talking. Correct that. Most of them don’t even do much talking in order to get in as many med checks (15 minutes in length) as possible to bump up their production and their income. Some facilities come down hard on shrinks who don’t meet their quota of 15-minute sessions. Respect for the profession, in my opinion, appears to be eroding. Look at what has happened at the VA hospitals where they cooked the books on appointments. I've heard about the rather quick-and-dirty shrink visits where you'd need a knapsack to carry all the meds prescribed.

What about the other docs? You know, the ones you see each year for that all-important annual exam? Do we really need annual exams? I've been reading about medical associations that are now indicating these exams may not be all that necessary. But aren't we reading contradictory views about mammograms, prostate exams and even bone density testing? Seek and ye shall find all manner of thinking on any subject and medical thinking is similarly diverse.

Back to the simple annual exam. Just what tests is your doc supposed to do and are they all completed at every exam? Yes, I'm asking you if you know which things are supposed to be checked.  Not sure? Okay, our good friends over at WebMD have provided a breakout for you and I suggest you copy and paste it to your desktop and even print it out.

Right now I'll just assume you clicked through to the link, briefly reviewed it and you're back. Think hard. Did your doc do everything? I've heard of one doc, who just loves being a doc and wearing all those expensive suits, who sits typing on the computer with his back to the patient. When it comes time for the "physical" part of things he slips his stethoscope to his ears, listens to the patient's lungs and heart and that's all there is. No reflexes, stomach exam, thyroid palpitations, neuro, head and neck? Sure, the BP and respiration was taken by the tech and a nurse probably got your blood, but the doc? Not very much there. How many questions were asked and how much time did your doc spend with you? Were you encouraged to ask questions or was it a "fill out the questionnaire" and it's done time? Yes, give it all some thought.

Were you a smoker? When did you stop? Does your doc keep check of your lungs to see if that smoking (even years ago) started something of concern in your lungs? Ever get a chest x-ray recommended to keep tabs on it? New guidelines recommend that.

Does your doc look at your skin to check for any sun damage? Or is that left up to your dermatologist? Yes, we know. These days you have to have a specialist for each and every part of your body.

Informed consumers don't just buy cars or homes or life insurance. Informed consumers buy healthcare and you should make sure you're getting all you're paying for. After all, isn't your health more important than the car you drive?