What should the doctor and staff be doing?
- Measure your pulse, blood pressure, weight, and height: Be sure the blood pressure is done right! (I can demonstrate: loose clothing, feet on floor, arm at level of heart and resting comfortably, at rest for 5 minutes), and be sure you know the results! Blood pressures should be below 130/80!
- Physical examination: years ago, the physical exam used to be the only way to detect many abnormalities, but today, imaging has replaced the exam for diagnosis in many areas. Nonetheless, a basic physical is useful and can help doctors decide about further tests. Specialists are probably the best at certain elements of the exam.
For instance, a dilated eye examination by an opthalmologist will be much more accurate than a general doctor checking, and can include a glaucoma check. And listening to the heart can recommend an echocardiogram, which visualizes the movement and structure of heart valves.
- Checking your skin, everywhere: Basal cell carcinomas and malignant melanomas are on the rise!
- Thyroid and neck exam: Most under and over active thyroids are easy to feel
- Stethescope exam of heart and lungs: Lung exams will reveal wheezes but aren't very useful in bronchitis or early pneumonias. Abnormal heart rates and sounds can lead to further testing.
- If female, breast check: Breast tissue starts at the collarbone and extends well into the underarm area. The doctor should teach you self-examination.
- Palpation of the abdomen, including liver and spleen edge.
- If female: Basic pelvic examination
- In both genders: Rectal examination. YES! 1/6 colon cancers is detectable on rectal
- In men: The prostate gland can be palpated (and testes should be examined too) and in women, early endometriosis shows in rectal
- Brief neurological examination, with check of reflexes
- In men: The prostate gland can be palpated (and testes should be examined too) and in women, early endometriosis shows in rectal
And we all understand that an exam can be overwhelming and complex, so do not hesistate to call us if any confusion remains after your visit!
What can you as the patient do to be sure your visit is productive?
- Arrive on time: Yes, doctors run late, usually because of unanticipated emergencies, and Bay Area traffic and parking are unpredictable. But if you are scheduled for a 15 minute visit and arrive 17 minutes late, your doctor will either need to reschedule you or borrow time from other patients to see you. The snowball effect on physicians' schedules of late patients is consequential!
- Bring a list of all medicine and supplements you are taking: More than 70% of patients are using supplements other than standard vitamins, and some interact with other medications. And even when the doctor is working from an electronic medical record, your updated list is important!
- Bring a list of any new medical problems or symptoms that you or any family member may have experienced since your last visit with the doctor: This might affect our advice on screening. And do not be embarrassed or omit concerns: 70% of women with urinary or bowel incontinence don't tell their doctors and yet there are many ways we can treat and cure these problems!
- Doctors care about the whole person, so your mental health is as important as your physical health: And while physical problems present with physical signs, psychological issues need to be communicated. Please share with us any issues or stresses in your life so we can help.
- Come with a list of questions: And a sense of what YOU want to accomplish from your visit.
She is an OB-GYN at the Pacific Women's OB/GYN Medical Group in San Francisco.
