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Friday, April 16, 2010

Annual Physical Exam

Thanks for the graphic.
I do it every time this time of year - whether I think I need it or not.

Except, it's gotten a wee bit more complicated.

I have seen the same doctor, my "primary care doctor" - a osteopathic physician - for the last 14 years. After my exam, I had an EKG and the 'standard battery' of blood work and urinalysis.

He has sent me to the same nurse practitioner for the last 13 years who takes a pap smear every year and refers me out for my annual mammography.

I have seen the same endocrinologist for the past two years, referred to, of course, by my primary physician.

This year, since it's been eight years since the last testing, he also referred me for bone density study as well as a gastroenterologist for (say it ain't so, but oh no, it is) colonoscopy.

And, this year, I have acquired an orthopedic specialist, since I have either torn a rotator cuff in my left shoulder or have an acute case of tendonitis (let me tell you something: being 'in good shape' ain't all it's cracked up to be).

I'll have an MRI on the 28th when I see the specialist and we'll know how to proceed. Meanwhile, my chiropractor, whom I see every week for an adjustment on my lower back is treating my shoulder with electro-stim and hydroculator packs three times a week. I'm feeling slow improvement, but it still hurts like hell.

I'll have my last acupuncture treatment for allergies on Monday which has been highly successful - just a wee bit of sneezing, two episodes of slight wheezing, and one morning of itchy eyes, but other than that, all is well.

I know this is what I'm supposed to be doing in order to stay healthy - "an ounce of prevention is worth a pound of cure" and all that - but I gotta tell ya, it begins to feel just a tad narcissistic after about the second week of this.

And suddenly, it takes two to three weeks to get it all done, where it once took one day - an hour visit in the office - and that was that.

Now, it's "annual" this and "every five to ten years" that and "well, orthopedic surgeons now specialize in hips and knees and ankles vs. shoulders, elbows and wrists".

Are you kidding me? Really?

It sometimes feels as if it's all gotten a bit out of control - or, perhaps, specialization is an indication of better control.

Some days, I'm not sure.

Here's one incident that took me completely by surprise - to my delight.

So, my usual NP OB/GYN person was out on sick leave when I called to make my annual appointment. Turns out, she had a carpal tunnel thingy that got complicated in surgery and was not yet back to work. She was there on the day of my visit, but I saw her associate and afterward, she and I "visited" in her office for 10 minutes - just to catch up.

You know, 'girl talk' and all that. Hey, it's only once a year. Gimme a break.

But, when I was in with her colleague, who was really cracker-jack, she also did a very thorough history as well as physical.

"Do you drink alcoholic beverages?" "Yes."

"How often and how much." "Oh, depends on the time of year. Now that the Spring is here and into the summer, probably a glass of wine or two, maybe one or two times a week. During the winter? Maybe a glass of scotch on a Sunday night or once a month after a tough Vestry meeting. Or two scotches, if it's been particularly difficult and we've talked more about buildings and grounds than mission and ministry."

"Excuse me?" "Umm . . . church talk . . . never mind."

"Do you smoke?" "Well, it depends. If I'm stressed. If something wonderful has happened. If someone has a pack and makes an offer . . . . "

She frowned, looked over her glasses and said, "Do I have to make you write on the board 100 times, 'Smoking is bad for my health'?"

"Okay, okay, okay."

"Hmm . . . you have been in a relationship for 34 years, is that right?" "Yes."

"Are you monogamous?" "Yes."

"Is she?" "Far as I know."

And then this, right out of left field: "Has anyone said or done anything to you that has made you feel uncomfortable or threatened or hurt?"

"Why, no. No. I mean, you mean, like, well, domestic abuse or violence?"

"Yes. Physical or verbal. At home or at work or in your family or among your circle of friends?"

"No. . . But, wait . . . You know? . . . Thanks for asking."

"Of course. Thanks for not reacting badly. You would be amazed how many 'suburban housewives' I get in here who are really insulted and upset. Some have filed a written complaint. Makes me wonder why they are reacting so badly."

And then, I did. React badly. I started to get all verklempt, remembering the time, oh, way back when, when it really would have been important for someone - anyone - to have asked me questions like that."

"Are you okay?" she asked.

"Yes," I said. "I was just remembering when I wished - hoped, prayed - that someone had asked me those questions. . . You know?"

"Yes," she said, "Yes, in fact, I do. Which is why it's so important for me to ask the questions. You know? Because, 'way back then' even if we DID ask the questions, and we wanted to, we couldn't. Or, if we had, it wouldn't have made much difference because no one would have done anything about it anyway. You know?"

"Yes," I said, "I know only too well. Hey, thank you."

"You bet."

Maybe specialization is a good thing. Maybe we need to see different people for different things who'll ask different questions and not make assumptions.

Which reminds me - if you haven't read Ann Fontaine's brilliant piece on clergy misconduct in The Episcopal Church, please read it now. You can find it here.

G'won. Read it. Whether you need to or not.


Ann said...

Glad you are taking care of yourself even if it takes longer. And I weep at the wonderfulness of a practitioner who asks about abuse. wow!

Gretchen said...

Oh, right on. Wish someone would have asked me in, say, 1985-86. Thanks for sharing the good news that doctors are doing this.

Gretchen Chateau
Atlanta GA

Kirkepiscatoid said...

Other screening questions on "annual physicals" I was taught to ask back in my days on the floors:

"Do you wear seat belts?"

"Do you have guns in the house?" If the answer is "yes," "are they kept in a way children cannot get to them?"

(THAT is the question you will get "complained about" in rural Mo.)

"In the past year, have you had episodes where you felt blah, tearful, blue, overly nervous or upset, that lasted more than a few days?"

And the flip side to the question I was taught to ask as the converse of "Do you feel safe in your home?" (the MU version of the "domestic violence" question you got--I was always taught to ask the slightly more "indirect" version of the domestic violence question b/c rural people tend to be more stoic, and the question also might elicit physical home safety questions in the elderly, as well.)

"Do you ever worry that you might get angry or upset enough that someone in your home could be harmed?"

The other thing I was always taught to ask the more elderly or infirm ones is "Do you have a rail in your bathroom to help you get in or out of the shower or tub?" HUGE numbers of elderly falls occur in the bathroom. Simply suggesting getting a rail installed can be a lifesaver.

The other thing I learned was the tidbit that "less than ten percent of people will change a behavior when you suggest it, but out of those who do change a lifestyle behavior, about 2/3 of them will say, "because my doctor told me to," when they are asked why they made the change, and most of them will say they were told this by their doctor more than once."

Elizabeth Kaeton said...

Yes, Ann. These were things nurses used to be taught to ask. It's good to see the tradition continues.

Elizabeth Kaeton said...

Thanks, Gretchen. I'm sure there are many who "complain" who have no idea that women like you and me have the histories we do. If they did, they wouldn't complain.

Elizabeth Kaeton said...

Hey Doc - really? Oh, I'm sure docs are taught to ask those questions, but I've never - EVER - known a Doc who asked those questions.

I know nurses and NP's are, but I'm delighted to know that they actually carry through and ASK them. Yes, she did ask me about seat belts.

And, you are absolutely right about behavior change coming about by physician suggestion. It's very powerful.

Ann said...

A friend of mine whose husband was hitting her was asked by one of our ENT docs - who hit you? - do you need help getting to a safe place - call me any time. A good guy!

Elizabeth Kaeton said...

I wish that were more the norm than the exception, Ann. Good guy none the less.

Mary-Cauliflower said...

I still think of a college friend whose attitude toward me seemed to cool once she moved in with a wealthy and successful man after we graduated. As he gained more and more control over her social life, he felt more and more free to tell her what to do. The physical force escalated over time as well - because at that point there was no one left for her to tell.

Elizabeth Kaeton said...

That's how it works, MC - which is why its so important for health care professionals to ask the question.

it's margaret said...

So --did you pass.... all the tests, I mean... are you healthy or do you get to wait WEEKS to receive the good news...

I just got my "NORMAL" letter back for stuff... including cancer screen. So, good to go. Hope you are too. Normal, that is...

Kirkepiscatoid said...

What usually happens in the private practice office setting is the "screening" gets turfed to the nurses. In the Big University Teaching Hospital, however, you have plenty of medical students, interns, and residents to do your screening also.

The best FP docs I know, those questions get asked twice--once by the nurse and reviewed by the doc. You'd be amazed how many people will tell one but not the other, and it's about 50-50 which one gets told.

I was taught back in my days on the floors and clinics, if the nurse screens the patient first, ask the same questions but in a slightly different way. You be surprised how many things can be elicited by asking the same question twice but in a different way. Patients who tell one "my legs gave out from under me" might in a different line of questioning, spill that they are really having fainting spells. (Rural Missourians don't faint, you know. We're too tough for that.) Abuse gets picked up b/c they don't always tell the same story for the same injury. LOTS of ways the "two person questioning" brings stuff forward!

Elizabeth Kaeton said...

Hey there, Margaret: Well, I won't know the results of any of my tests for a few weeks but the doctor will email and call me if there is anything that needs immediate attention. And, I can email any one of my docs with a question or concern. Cool, right?

Except for my paps smear results. They have this call in service with a date and time to call and a number to enter and you get your results then. Or, the doc will include that report in the "final report" I'll get in a few weeks.

I forgot to mention that I had my annual eye exam a few weeks ago and will go for my hearing test in two weeks.

Head to toe and good to go for another year.

Elizabeth Kaeton said...

Kirke - we used a similar technique in the ER. The paramedic, the nurse, the doc, the lab tech. If we had any suspicion , we'd caucus outside to figure out another way to ask the question and who to send in next.

eileen said...

Points so very well taken Elizabeth. Brings tears to my eyes.