
To the question at hand: I follow USPSTF for screenings, judicious additional labs, spend time on habits & prevention, etc. I do exposed skin, heart, lungs, belly. rarely a thyroid.(particularly the look in ears, check the throat song and dance is silly). A crusty peds NP made snippy comments repeatedly about how I didn't look in her ears on physicals so I put it on my stickynote. Dumb, but it takes a worthless second and her complaints took longer. With the skin exam of exposed skin, if I see AK's I'll freeze them, or consider derm referral if bluelight approrpiate. Time permitting, and derm referral NOT gonna happen, I'll do a TBSE particularly for someone with RF or AK's. I am typically discussing other preventive stuff as I do that portion of the exam. I also ask the ROS as I examine the particular body part, unless there is reason to be specifically concerned otherwise (hx CHF - I'll ask the CHF stuff in a chunk, etc).
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