Yearly physical

[StarTrekDoc]

I tried to get my PCP to not do a PSA every year, and that was ok for a while. Back then I had to sign a form that stated that I understood the risks and benefits of my choice not to repeat it annually. I think they got tired of the time sink that those discussions took up. Now they just do PSA every year. I just go with the flow.

And they do urinalysis annually as well. I went in for my annual labs in a fasting state after a rigorous mountain biking workout early one morning. I had a few red cells in my urine and got sent to the urologist for further work up. The evaluation came out fine and the urine was normal when performed in a well hydrated state.

She also does a traditional physical exam. My doc is very careful to follow up on everything. Although I have no risk factors, she insisted I take 10 mg per day of atorvastatin based on the 10 year risk of an MI. It’s based on plugging every patient into the risk calculator and once you are a male that gets older, basically every male needs to be on a statin based on age. It sometimes feels a bit like overkill, but she’s very detail oriented. I resisted the statin decision knowing that the number needed to treat to prevent one non fatal MI is something over 100, but 10 mg per day of atorvastatin is my only med so I go with it. I frame it as a “supplement” since I don’t like the idea of taking medicine because I have an “illness” when I do not.

Wondering how long your PCP takes with you on your annual?

If the only risk factor in Primary prevention is the age and my index of suspicion for CAD is low - no Fhx, great exercise, BMI normal, and no other RFs aside age --- I offer Calcium scoring as the tie-breaker (@WBD I would have brought up Ca Scoring in your case). You'll be surprised how many have focal disease that promptly gets folk on a statin.

Though a near majority do have low to zero scores -- by the time age 70s the NNT really drops into the 20-30s and that's darn good for a single pill.

[White.Beard.Doc]

I just realized I backed into an unintentional joke…. Being accepting of annual PSA testing is “going with the flow”. Hah!

I would have really “backed into it” if we were talking about the annual prostate exam!

[White.Beard.Doc]

Wondering how long your PCP takes with you on your annual?

I would estimate she takes 20 minutes for the annual physical. The MA gets everything all set up and entered in the EHR. The RN gives any needed vaccinations. The front desk does all the labs and any other testing. They have a very efficient set up.

[TheDangerZone]

Early to mid 30s. My pcp gets blood and urine every year. When I check the emr for results I have a TSH and free T4 and a dx chronic fatigue.. I have never complained of fatigue but figured it was a way to get reimbursed for an annual test he finds useful. The blood work otherwise consists of a CMP and lipid panel. The UA always checks out fine. I like the guy overall so I don’t really bring it up the fatigue thing.

What are PCPs typically doing testing wise on a healthy male in their mid 30s? My BMI is right at 25.

[Fitz]

The Well Exam is tough. The patient often has 2 or 3 problems to address and the physician has an agenda for health promotion. It is always a compromise. It has been estimated if a doctor was to perform all the recommended services at a well exam it would take about hours. So in the real world I think most PCPs try to hit the high impact topics for a given individual. Very little of this is lab or exam. I think most of us use this as a guidehttps://www.uspreventiveservicestaskforce.org/uspstf/topic_search_results?topic_status=P

[Hatton]

My FP only examines me if I have a complaint. He always asks me what I need. I get blood work from my rheumatologist.

[Lordosis]

Early to mid 30s. My pcp gets blood and urine every year. When I check the emr for results I have a TSH and free T4 and a dx chronic fatigue.. I have never complained of fatigue but figured it was a way to get reimbursed for an annual test he finds useful. The blood work otherwise consists of a CMP and lipid panel. The UA always checks out fine. I like the guy overall so I don’t really bring it up the fatigue thing.

What are PCPs typically doing testing wise on a healthy male in their mid 30s? My BMI is right at 25.

Sounds like fraud to me. I would be somewhat upset to be given a bull crap diagnosis as an excuse to order testing that I did not need. I would not complain but I would definitely find a different physician.

With a borderline BMI it would be reasonable to check cholesterol and sugar every year but if there is nothing else out of line I might even do that every other. But with young people with absolutely nothing wrong I generally do cholesterol and sugar every 5 years starting at age 30.

Again I don't know how much of this is cover your butt versus patient expectation versus what we always have been doing?

[Lordosis]

Early to mid 30s. My pcp gets blood and urine every year. When I check the emr for results I have a TSH and free T4 and a dx chronic fatigue.. I have never complained of fatigue but figured it was a way to get reimbursed for an annual test he finds useful. The blood work otherwise consists of a CMP and lipid panel. The UA always checks out fine. I like the guy overall so I don’t really bring it up the fatigue thing.

What are PCPs typically doing testing wise on a healthy male in their mid 30s? My BMI is right at 25.

Oh and I hope you already have disability insurance. I've heard stories of people who've had erroneous diagnosis screwing that up in the past.

[TheDangerZone]

Sounds like fraud to me. I would be somewhat upset to be given a bull crap diagnosis as an excuse to order testing that I did not need. I would not complain but I would definitely find a different physician.

With a borderline BMI it would be reasonable to check cholesterol and sugar every year but if there is nothing else out of line I might even do that every other. But with young people with absolutely nothing wrong I generally do cholesterol and sugar every 5 years starting at age 30.

Again I don't know how much of this is cover your butt versus patient expectation versus what we always have been doing?

Thanks, that’s the insight I was looking to hear. I’ve had disability since residency (thanks WCI) so this hasn’t come up or been an issue.

[jhwkr542]

There's very little evidence to support any of these tests outside of cholesterol. Screening an asymptomatic population, especially younger pts, is almost never "positive" and PPV plummets when the disease prevalence is extremely low. Just one of my big complaints being in the lab utilization world. I've tried to convince surgeons and anesthesiologists that pre-op coag tests are unnecessary in patients with no bleeding history...you can guess how that went.

[jfoxcpacfp]

We were recently told about a slew of complaints from patients that they are disappointed in several providers physical exams. Specifically with the lack of certain testings including psa, ekg, urine screening, and a few others. The advice handed down was these items should be addressed and explained why they are not necessary. "it will only take a minute"

My personal opinion is if someone brings up PSA screening and would like to continue doing it even without good reason I will go along with it. But I do not open that door unless they open it first. And I'm talking pure screening. Of course if there's symptoms or concerns that the whole other matter.

Am I crazy? Should I just be doing these things routinely to avoid medical legal issues and to prevent complaints? What do you other pcps do?

I generally use the physical exam as a chance to catch up on routine health maintenance and put in a plug for a healthy lifestyle changes. The examination part I feel is actually a minor role of the visit. I've talked with lots of other physicians who mention doing a for show exam but I try to keep it to just the useful and practical evaluations.

Again these were general complaints across the board so I don't have anybody specific in mind to bring up but I would bet the person complaining that somebody didn't look in their ears also came to their physical exam with nine unrelated complaints.

You get to decide how to run your practice, within rules and regs, of course. It seems to me (as a non-doc, of course) that patients can easily have unrealistic expectations, especially with webMD and all of the other medical sites in easy reach - or maybe don’t know what to expect and ask friends what happens at their physicals in addition to googling for an answer. My PCP died unexpectedly last month. I think he went to extremes with tests and bloodwork, but he was what I consider old school, did not use an EMR system, for example. I strongly doubt whoever I use next will be anywhere near as “thorough”, but I’m not sure exactly what to expect.

Using this example to say that what a physical means to you may be very different from what it means to different patients and to other doctors and from state to state. Do you think setting expectations ahead of time with a friendly explanation of how you do things in your practice, what will and won’t happen, that there is no standard from practice to practice, and why they may need to schedule an appt for other tests would help?

[ObgynMD]

I didn’t realize pcp’s get paid to run tests? How does ordering a TSH get the pcp more money?

I also thought pcp’s did ekgs’s routinely on older folks 😑 oops.

I tell folks I’m not a real pcp and they would benefit from seeing an internist or FM in addition to me.

[Savedfpdoc]

for commercial insurance a free physical visit gets you basic labs and a discussion on preventative health/vaccines.
physical exam is basic.
if you have a mole or knee pain etc your worries about then too bad…your insurance company says that if I discuss those then I have to bill you a separate visit .

Commercial insurance usually pays for the following if applicable under a physical:
cbc cmp lipid ua psa
pap-although these are long and frequently involve extra complaints so recommend to do esperare visit amd can still be free
mmg
Vaccines
sometimes vitd, testosterone


medicaid: doesn’t pay for labs during a physical, vaccines yes

medicare: doesn’t pay for labs under a physical. Vaccines sometimes yes depending on whether they have a supplement plan vs advantage plan and even then it may not be 100% covered

ecgs-not covered under a physical under any coverage…did it at a Medicare wellness and patient upset he got billed $7

if your getting more than what I put above during a physical and not getting charged then you probably met your deductible or your pcp is doing free work and not billing for it

[jhwkr542]

for commercial insurance a free physical visit gets you basic labs and a discussion on preventative health/vaccines.
physical exam is basic.
if you have a mole or knee pain etc your worries about then too bad…your insurance company says that if I discuss those then I have to bill you a separate visit .

Commercial insurance usually pays for the following if applicable under a physical:
cbc cmp lipid ua psa
pap-although these are long and frequently involve extra complaints so recommend to do esperare visit amd can still be free
mmg
Vaccines
sometimes vitd, testosterone


medicaid: doesn’t pay for labs during a physical, vaccines yes

medicare: doesn’t pay for labs under a physical. Vaccines sometimes yes depending on whether they have a supplement plan vs advantage plan and even then it may not be 100% covered

ecgs-not covered under a physical under any coverage…did it at a Medicare wellness and patient upset he got billed $7

if your getting more than what I put above during a physical and not getting charged then you probably met your deductible or your pcp is doing free work and not billing for it

Covered is not the same as medically indicated. My PCP does a UA on me that I don't pay for. There's no reason a 36 yo asymptomatic male needs a UA. Like fishing in a pond with no fish. Even if you get something on the hook, it's probably not a fish.

[AR]

for commercial insurance a free physical visit gets you basic labs and a discussion on preventative health/vaccines.
physical exam is basic.
if you have a mole or knee pain etc your worries about then too bad…your insurance company says that if I discuss those then I have to bill you a separate visit .

Commercial insurance usually pays for the following if applicable under a physical:
cbc cmp lipid ua psa
pap-although these are long and frequently involve extra complaints so recommend to do esperare visit amd can still be free
mmg
Vaccines
sometimes vitd, testosterone


medicaid: doesn’t pay for labs during a physical, vaccines yes

medicare: doesn’t pay for labs under a physical. Vaccines sometimes yes depending on whether they have a supplement plan vs advantage plan and even then it may not be 100% covered

ecgs-not covered under a physical under any coverage…did it at a Medicare wellness and patient upset he got billed $7

if your getting more than what I put above during a physical and not getting charged then you probably met your deductible or your pcp is doing free work and not billing for it

I've never really understood bolded. You are supposed to do a physical exam, but if you find a funny looking mole on your exam, then there is a separate charge?