Going for a routine physical exam? New guidelines suggest less is more.

January 4th, 2019

By Natan Schleider, M.D.

Early Electrocardiogram called a String Galvinometer Circa 1911

My primary care physician is a very bright internist in his early 70s who I saw recently for a routine physical exam. He examined my head, neck, chest, and abdomen and then, putting on gloves and grabbing some KY jelly, told me to bend over for a prostate exam.

‘Prostate exam!’ I said, ‘Why? I have no prostate or urinary issues, no personal or family history of prostate cancer, and don’t see the need.’

‘Just being thorough,’ he replied.

While I like my doctor, there is thorough and then there is ‘too thorough.’ Moreover, I reminded him, routine prostate exams are no longer indicated [Source: US Preventive Task Force].

‘We’ll skip the prostate exam.’ I said. He shrugged as if to say he wasn’t doing his job properly. He then checked my legs and the exam was over.

While some of you may like the comprehensive check every nook and cranny exam, I personally don’t nor do I recommend or perform them. I stick to what the data supports. Why some patients seem disappointed that I haven’t probed every orifice is beyond me but to each their own.

Next time you’re in for an adult physical, here are tests which are no longer considered routine or necessary unless, of course, the doctor feels they are needed based on your medical history, symptoms, or other risk factors.

  • Digital Rectal Exam (meaning sticking a finger into your anus and rectum)
  • Pelvic Exams in Women
  • Testicular exams are up in the air but consensus is that male patients, especially those age 20-35 (when testicular cancer is most common) can perform their own monthly self-examination and/or have the doctor do the exam. The US Preventive Task Force recommends against testicular exams during a normal physical [Source: https://www.ncbi.nlm.nih.gov/books/NBK82767/table/vaphysical.t1/?report=objectonly]
  • Thyroid exam for thyroid cancer
  • Abdominal exam for pancreatic cancer, liver enlargement, or spleen enlargement
  • Lymph node palpation
  • Back exam for determining mobility
  • Checking reflexes in arms and legs
  • Breast exams need not be done if more sophisticated tests like mammograms are available

Some testing on routine physical exam are still being reviewed but as I peruse the medical literature, it seems that, to my old school doctor’s chagrin, much of the physical exam in adults is probably not helpful and may even lead to false positives.

Certainly some patients will swear that their doctor caught a disease by poking around or hammering on the knees with a reflex hammer and all I can say is: God bless those doctors. I’m interested in the facts here, just the facts.

Thx for reading,

Natan Schleider, M.D.

Source: https://www.ncbi.nlm.nih.gov/books/NBK82767/

Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult

Hanna E Bloomfield, MD, MPH and Timothy J Wilt, MD, MPH.

Created: October 2011