The Changed Face of Doctoring in America

Nancy and I have lived in the Cleveland, Ohio area for 2½ years in a retirement community. Over that time period, we have made 5 visits to doctors; and we have seen 4 different doctors. One visit was to an emergency room for a sore throat. The other visits were to primary care doctors to whom we went for general check-ups.

At each of those “general check-up” visits, we requested physical exams; but we were refused that service each time. The doctors only talked briefly to each of us about our present health situation and ordered lab tests. None of them ever laid a hand on us. One of the doctors charged Medicare $250 for each of us. All the other visits cost us $30 for each co-pay.

My, how things have changed!! When I was in the practice of primary care, a patient who came to me requesting a general check-up got a full physical exam including a check of vital signs (blood pressure, pulse, height, weight) a mirror exam of the larynx, an exam of the retina after dilatation of the pupils, and careful examination of the neck, chest, breasts, heart, abdomen, groin (pelvic and rectal), extremities, all lymph bearing areas, limbs and joints, and a brief neurologic exam.

A routine medical history included an interview of the present problem and review of the past history, including previous surgery, medications, illnesses, occupation, travel, recreational activities, family problems, and habits.

I am aware of the fact that laboratory tests are much better these days than they were when I was in practice (up until 7 years ago). It is possible to find a lot more disease by laboratory tests today than it was then, also. But…I still think that present day doctors miss some important things when they do not exercise their ability to find health problems by using classic tools of history and physical exam.