Back in the early ‘80s when I ran a not-for-profit clinic on the west side of Chicago for older people before annual physicals were considered “nonspecific” or “inefficient” or “potentially harmful” [“Let’s (Not) Get Physicals” (Elisabeth Rosenthal, The New York Times, June 3, 2012)] I did a complete head to toe exam on each patient who registered, including vaginal exams on the women and rectal exams on the men.
I enjoyed the mechanization of the whole process. Take out your reflex hammer. Tap elbows, wrists, knees, and heels. Put it away. Take out your stethoscope. Listen to lungs, heart and bowel sounds. Put it away. Methodical and expedient. A whole hour was allotted to this first visit. Hard to believe in light of today’s harried health care system.
I remember telling myself to keep my facial expression bland. The slightest furrow on my brow shot a message to my patient—she found cancer or something equally horrible. As if the physical exam was an accurate barometer of health and well-being. As if I, the nurse practitioner, a.k.a health professional or primary care provider, had some secret connection to the Almighty and not only could find abnormalities but could predict life expectancy.
The physical seemed like a test or maybe a comparison of one older person to his/her peers. I can see Mr. Brown sitting at the edge of the exam table as I auscultated and percussed and said such things as “great lungs sounds” or “your heart beat is strong.” And after the exam I pronounced “you’re in great shape.” His smile radiating as he stepped down from the exam table probably thinking of himself in better shape than others his age. Then the common compliment: “That was the best exam I ever did get!”
Although I no longer practice as a nurse practitioner, I mourn the demise of the complete physical. Back thirty years ago when nurse practitioners were attempting to secure our identity as primary health care providers, the physical exam was a powerful tool signifying we could do what doctors did. And Medicare reimbursed this service. It was a vehicle to get us where we wanted to go—to become legitimate in the eyes of our clients and employers.
The physical, like my first car the gold Studebaker convertible my dad bought me that already was 12 years old, was serviceable but became too expensive and unreliable to keep forever.
But what a great ride.