Since getting to the age when Medicare takes over, my annual physicals have been relabeled as Medicare Wellness Check Ups. I haven't changed hospitals. B/S&W.
Now I don't have to undress at all and put on a gown. They take vitals, look in my ears and mouth, listen to my heart and breath deeply. That is pretty much it. There appears to be more concern with my life at home like whether I have firearms laying around and whether I feel safe at home. No digital prostate exam, no lying on my back and punching on my abdomen. Pretty much takes less than 10 minutes with a doc.
Is that just the way Medicare is or are all physicals like that now?
I feel like the blood letting at the lab afterwards is the best I get out of it. Just wondering what others are experiencing.

Yes, when you go onto Medicare, they call them a Medicare Annual Wellness exam. I work in Family Practice and the only difference between a non-Medicare physical and a Medicare physical from my standpoint is the billing. It's a different charge I select when I sign my note to make sure it's coded correctly and so my Medicare patients don't get stuck with a bill.

As far as the actual exam, they are no different in how I approach them. Frankly, I think it's lazy medicine when you get an exam like that when you should be getting more.

On a side note, the digital rectal exam for prostate cancer screening is quite poor at actually detecting cancer. PSA level (blood test) is better, but not perfect.

Thanks to both of you for your replies.

Began Medicare two years ago and my physicals are just as thorough as they were before. I'm certain that
has more to do with my physician/patient relationship than Medicare. I know my doc is losing money on that exam. Agree with the comment above that the physical exam is a lost art.

Lavender Gooms said:

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As far as the actual exam, they are no different in how I approach them. Frankly, I think it's lazy medicine when you get an exam like that when you should be getting more.

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It's a check in the box to say you're doing something and make the patient think they're getting something out of it.

My mom gets an NP sent to her house to do vitals and run through a bunch of questions with her. I'm not sure if that's something just with her Medicare company, or if they do it in hopes they don't have to pay for an actual in person visit.

Medicine is going down the drain quite fast. Actually multiple drains, each one doing something different.

TRD-Ferguson said:

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Began Medicare two years ago and my physicals are just as thorough as they were before. I'm certain that
has more to do with my physician/patient relationship than Medicare. I know my doc is losing money on that exam. Agree with the comment above that the physical exam is a lost art.

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This hit me pretty hard a few years back when I went to the E.D. (formerly known as the E.R.) with pretty intense abdominal pain. I was positive that I was brewing appendicitis, so I decided to go in to the hospital where I practice. The E.D. doctor barely examined my abdomen at all, and she did it through my hospital gown before sending me off for a CT scan of the abdomen and a healthy dose of blood letting.

I did my Surgery training at Parkland in the 90s. If xxxxxx xxxx, M.D. "There's only two reasons NOT to do a rectal examination on a patient. No rectum. No finger", God rest his soul, would have seen the exam that physician did on a patient presenting with an "acute abdomen", he would have been horrified. He would have publicly shamed her for ordering labs, getting a CT, letting me leave my clothes on, the whole thing, on morning ER Rounds. I hated the way he did that publicly, but he did make us all better clinicians.

Imaging and lab work have come a long way in helping physicians make diagnoses. I am not saying they don't. I'm also not saying I am immune to all of this. I have a $15,000 "distal chip" scope in my office that delivers incredible pictures of the larynx. As a result, my ability to do a "mirror exam" of a patient in the office has significantly worsened. The key is availing oneself of all of the wonderful new technology and diagnostic modalities we now have while also not losing the incredibly important art of a good physical exam to go along with a patient history, and to accomplish it in the time needed to keep the lights on when reimbursements are flat but inflation has been killing medical practices in terms of their overhead.

Rant over. I feel better. Oh, and I didn't have appendicitis after all.

I may have been part of your resident orientation! Not a physician but spent 30 years working with you guys. Those "old school" docs were some mean SOB's to everyone.

I was in a meeting once with hospital staff. Their General Counsel was bragging about his "cute" Internal Medicine doc. One of the older physicians was a urologist and he said "Her fingers aren't big enough or long enough to give you a proper digital rectal exam. You may have cancer and not even know it"! He wasn't kidding either.

So, in defense of the ER doc, the surgeons don't care what your exam is like anymore. An appy is supposed to be a clinical diagnosis, but they won't see a patient until you get a CT. And if the CT is negative, they will argue with you about why they need to see a patient.

2nd year, I had just returned from a fleet tour as a flight doc. So I was very rusty on managing ED patients and talking to disgruntled resident consults. Had an 18 y/o with classic periumbilical pain to the RLQ, anorexia, mild fever, McBurney's tenderness on point, positive Rovsing, you name it. Textbook. Got labs and CT to ice the cake, and WBC was 20k, but CT showed air in the tip of appendix, no appy! Ended up looking for something else. Did swabs, did an US, pelvic. No evidence of torsion, PID, or anything else to explain symptoms.

Called upper level (4th year) surgery resident taking consults. And she argued with me for 5 minutes saying it's not her problem, CT was negative, find something surgical if I want her to see the patient, etc. Luckily surgical residents can't decline consults, and she sent an intern to see the patient. They ended up admitting the patient around 6pm. 2am they took her to the OR. Path report showed gangrenous appendicitis.

Also, I've asked my gen surg colleagues this before. Haven't got a firm answer. If you have no fingers, is a toe an acceptable alternative?

Thanks for the response. I'm kind of sad to hear that's the response you would get from a general surgeon. My general surgery training finished in 1992. I think Parkland, and ERT (the physician I referred to but specifically did not name) might have already been a bit of an anachronism back then. He didn't even want you to get a CBC. Talk to the patient, lay your hands on their belly and in any orifice available, make the call. As "Pit Boss", you would consult General Surgery. If they declined to take the patient to the O.R., that liability was on them.

I certainly didn't go into the E.D. that day hoping for a rectal exam from a colleague. And I haven't looked at sensitivity and specificity data on CT scans in diagnosing appendicitis. But I was certainly struck by the cursory examination I received that day, and I can't imagine that the average patient would get anything more, considering that I was a staff physician at the hospital I went to.

All the best.

I don't know. It sounds like you really wanted to take your relationship with your colleague to the next level by the sound of your first post.

I'm in my 40's and physicals for me at BSW have always only consisted of...
Talk to assistant about any prescriptions I'm taking
Doctor comes in
Looks in eyes, ears, and mouth
Knee reflex thing (?)
Stethoscope
Press on stomach
Prescription refill
Done.

Two big things have destroyed medicine in this country - the corporatization of medicine, and insurance companies. Lots of things stemming from those two, but they're the root, in my opinion.

Is the medical profession headed toward a socialist type of medical care? Any Doctors seeing this? I noticed when my father went in for a heart Valve replacement and didnt survive the surgery. HE actually passed before he went into surgery. I was not there and got there too late. My sister said they came in and gave him meds to prep him for surgery and my Sister said he was not doing good and he passed PRE surgery. I truly believe they were not going to do the surgery becasue of his age didnt wan to spend the money. HE was 89 and in decent health.

Well if you DON'T have firearms laying around at home how could anyone possibly feel safe? They're just trying to help you.

Sorry for your loss.

To answer your question, no I do not think we're headed towards socialized medicine. There is a push in medical training, and has been for some time, to focus on quality of life instead of just length of life. So instead of telling someone to go through a cancer treatment that'll extend their life maybe a year, but make that year miserable for them, trying to instead just manage symptoms and make them as comfortable as possible in the time they have left. But it's still up to the patient to choose.

The closest thing to socialized medicine, where people might be denied care ( outside of inability to pay), would probably insurance preauthorizations. Essentially, if you aren't familiar with it, in an attempt to save money insurance forces doctors to fill out paperwork stating that they think a medicine/procedure would benefit the patient. In my opinion it's a way to make life difficult for the doctor so that they choose some cheaper alternative. Because the doctors aren't getting paid like lawyers, charging by the minute to fill out paperwork, spend time on the phone arguing with insurance companies on why the patient needs something etc.

I'll leave you with some comedic, but sad, videos about the state of things currently. They're short.

Counterpoint said:

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I'm in my 40's and physicals for me at BSW have always only consisted of...
Talk to assistant about any prescriptions I'm taking
Doctor comes in
Looks in eyes, ears, and mouth
Knee reflex thing (?)
Stethoscope
Press on stomach
Prescription refill
Done.

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I came close to getting that exam. But this time no reflex test or stomach gouging. I found out yesterday when I called about my PSA results from the blood letting, it wasn't ordered since now they only do it every other year at B/SW. So no digital or PSA this year. Possibly the new literature indicates it is not necessary every year. However, the literature a few years back indicated that a combination of those 2 was the best screening route.