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Annual Exams

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In my clinical rotations I've seen about a 100 different ways to conduct an annual well-person exam. Some good, some bad, mostly somewhere in between. Are there any tips or tricks or special things that you do during an annual exam to make the patient feel like they are really getting a good visit? Any simple things (generally applicable advice, certain physical exam features, etc.) that you've picked up over the years that patients really appreciate?

 

If you have a standard well exam that you've honed over the years I would love to hear the structure of it and see what elements I may be missing or simple things I could add to make it more valuable for the patient. Thanks!

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For starters, actually review pt. forms in their presence that they've brought with them, or at least acknowledge that you've looked at them (and for goodness sakes, understand the meaning of the question asked and what the differential list is).  AAFP website has had both male/female annual exam forms in the past for download.  As far as PE, I used to use the same exam that I would use for a DOT driver's exam and would add age/risk appropriate modifications (listen to carotids/femoral arteries, DRE), as well as on school athletic/camp physicals.  If you actually give a hoot as far as what you seen on a fundiscopic exam I would recommend giving consideration to splurging on a panoptic head (to me it made a world of difference).  My own internist never does the same exam twice which is a shame since she's been out of school about the same time that I have been.  Make sure that they're current on all applicable immunizations (Who qualifies for an early PPV as an adult?  Who currently is the one patient that gets more than one Tdap booster in their lifetime?).  You should already know a basic exam from training.

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No real advice from me except - think about what you, as a patient, would want.  It's a good starting point.

 

I really like the above advice especially reading the forms in front of them or indicating that you HAVE read them - you can get a lot of info from those forms and as a patient it's nice to know it wasn't just something to entertain myself in the waiting room that no one ever looks at.

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I like the idea of going through the forms with the patient so they don't feel like they were completed in vain. I'll certainly download the AAFP documents as well to see if they have anything I'm missing. The basic exam is no problem. I just want to make sure the patients feel like they're getting the most possible out of their yearly exams.

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Group Health was a really good place to start doing exams, especially well child/teen exams, because everything was loaded into EPIC for you--just bring up the template and run it.

 

One of the things I think people skip over in sports physicals is anticipatory guidance.  About 50% of my time, maybe a bit more, is spent in counseling *after* the history review and physical exam.

 

One thing that I offer each teen patient is that if they're ever in a car with a driver who is texting and driving, and the driver won't put away the phone or pull over when asked to do so, is that they are to grab the phone and throw it out the window.  I promise them I will pay the replacement cost of the phone if they show up with a receipt and a story. Haven't had to yet, but I make them repeat back "the one thing I want you to remember" at the end of the visit, which is "throw it out the window".   As far as I know I didn't crib this off of any other medical provider, but rather adapta-stole it from my initial SCUBA instructor who promised to pay for a replacement weight belt (at the time, I think they ran $50-100) if any student ever needed to ditch one in an emergency.

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