Making the Most of Your Doctor Visit

When you go to your doctor or health care provider, you should be prepared.  This is one way you can be sure that your doctor visit focuses on your most important health issues. The following suggestions will help you get the most out of your doctor vist.

• Be on time.
• Make a list of things you want to talk to your doctor about. Update the list before each visit. This way you will be able to keep track of what has been discussed, and what needs to be discussed. Try to talk about the most important things first especially those that need immediate attention. Each time you go for your visit, you can refer to your list and take up where you left off. Be sure to express your immediate concerns first. We all know how short a doctor visit can be.
• Make a written or typed medical history* to take with you, especially if this is your first visit to a new doctor. Make a copy for you and your doctor. You both will be able to refer to it as needed. This will save valuable time, and give you and your doctor more time to talk instead of flipping through your medical record. It can be difficult trying to "remember" what test or procedure you had 10 years ago.
• Get copies of your medical records from all your doctors. "The medical record is the cornerstone of keeping track of everything pertaining to your health." You will be able to check the accuracy of your records, and bring any errors or absent information to your doctor's attention. Let your doctor know about anything you do not understand, or if there is something you are unable to read due to legibility. It is surprising to see how many doctors are often unable to read their own handwriting.
• Take advantage of the time your doctor takes looking through your medical chart during your visit by taking your own notes especially questions. As much as 1/3 of your visit time can be consumed by this alone.
• Allow each other to talk without interruption. 
• Bring a trustwothy companion.

Click on "Comments" below to add your tips or ask questions.


*medical history form http://www.mypatienthandbook.com/

Violent TV Movie Syndrome: Public Health Crisis in Vivo

Did you know that Violent TV Movie Syndrome (VTMS) is a major cause of many health and social problems? Single and repeated images of young children (or anyone) shot laying dead in pools of blood is horrific and unhealthy.  As a medical professional familiar with death first hand as part of my job, I can only hope and pray someone will be responsible and speak up.  This is child abuse. This is mental abuse. This is public health abuse.  Hollywood makes movies with less violence and bloodshed. Any educated person knows that repeated violence harms people in so many ways. It is so unnecessary to show these images to tell a news story or any other type of story. Images such as these depict what is seen in the coroner's office., and should be kept there.

Suicide, homicide, and post traumatic disorder are just a few medical maladies that occur from watching violence.  Surely you can choose to watch something else; however, the curious child with a TV remote may choose otherwise.  Protect yourself and your children.  This type of programming is hard to grasp and confuse with something else - real life! They become real life.  Doctors and health care providers have much more serious conditions to care for instead of illness and death induced by "Violent TV/Movie Syndrome" which can be prevented. For the doctors who take an oath to "do no harm", let us hope our media will do likewise.  Until then we can only counsel our patients to turn it off.

See this reference for more details http://www.parent.net/article/tv-kids-violence.shtml

Is the Doctor Really "In"?

Dear Patient,

It has indeed been a privilege and wonder to take care of you and your family.  Due to unforeseen circumstances, we must vacation indefinitely so we can find the best solutions for cost effective health care.  Our budgets are lean as well and get leaner as more patients drop out to do self care or go to emergency rooms, public health clinics, or stand in "lotto" lines to get get health care from traveling clinics.

We must campaign for your healthcare and our salary.  Routine sequential cuts for reimbursement by Medicare and Medicaid are taking its toll.  Insurance companies demand more time with less pay as well.  Now that the healthcare bill requiring each and every one of you to have insurance has been repealed.  Self pay is an option, but you must have food and shelter first.  Less money in, more money out.

Due to lack of campaign funds and time for raising necessary monies to do so, we are using and pooling our resources.  We wish to provide you with continuity of care, but we must also find ways to keep a roof over our heads and food on the table.  Many of my fellowess and fellow physicians are supplementing our income as well through other occupations.

Thank you for allowing me to care for you and the family.  We are true believers that great health is true wealth; however, you must have money to keep it.

Best health,
Dr. Feelgood

P. S. Check out Patient Handbook to Medical Care: Your Personal Health Guide via links in the right column.  Get a heads up and start checking yourself and your family.

Nootropic Neurological Nonsense - Limitless?

Are you looking for mind bending treatment that will make you smarter as well as more mentally and physically efficient?  The neurochemical nootropics, the so-called "smart drugs", are finally getting the recognition they deserve. Though medical evidence is inconclusive, these drugs supposedly improve every aspect of mental cognition including memory, concentration, acuity allowing for smarter, quicker human function.  It sounds like a sure bet for anyone with Alzheimer's disease, ADD, and just pure laziness. They are commonly taken to keep one alert, increase energy, improve memory, and to decrease mental decline in aging.

So why is your doctor failing to offer you such a great "pick-me-up" medication?  Considered both a natruceutical dietary herbal supplement and recreational drug may make it difficult for your doctor to prescribe it for you.  But who needs a prescription? Premium prices for bulk amounts are available for the consumer patient to buy on line, and in specialty stores.  For instance $25 will buy you 120 of Piracetam's mega 800 mg capsules, or 60 tablets of BrainAlert with it's 24 "natural" ingredients (far too many for one pill, some toxic). Designer versions of nootropics are available also.  These are usually more recreationally formulated with less exact ingredients.

Side effects and adverse reactions including drug addiction may occur especially if the drug is withdrawn after long term use.  For this reason alone, doctors may be hesitant to prescribe it; however, it is easily available elsewhere.   The off-label recreational use of nootropics can be especially dangerous if addiction occurs.  You may be and feel "superpowered" until the drug wears off and withdrawal sets in if you lack more pills.

Upgrading your body and mind with smart pills can be productive or destructive. Can this nootropic neurological nonsense be "limitless"?

NOTE: For more context and perspective watch the brilliant film Limitless which shows how a writer achieves success and riches using nootropics.

Ovarian Cancer: Early Detection

September is teal time for Ovarian Cancer Awareness Month.  Ovarian cancer kills many women quickly and silently.  It is one of the cancers that is hard to detect.  The treatment is pure hell and the vague symptoms become unbearably painful.  Ladies, there is something we can do! The pelvic and transvaginal sonogram (also called ultrasound) is a simple test that every woman should have just because you are a woman. Like the mammogram, this medical test is inexpensive and non-invasive (unless vaginal insertion is considered so) as far as no IVs or contrast dye.  Consuming mass amounts of water until you have to urinate (but must hold) is the least discomfort you should experience.

Talk to your doctor about pelvic sonogram screening.  Most gynecologists have them in their office which is excellent standard of care and convenient for the patient.  It can be done and read the same day by your gynecologist, possibly by the time you sit down to talk after the exam.  The pelvic and/or transvaginal sonogram becomes part of your medical record for easy reference as needed thus providing consistency and, if necessary, for future comparison.  These tests are also becoming more readily available for direct consumer purchase without prescription at diagnostic centers and through health fairs.

The CA-125 blood test may be useful; however, it is nonspecific and may be seen with other conditions like endometriosis, pregnancy, fibroid tumors, diverticulitis, and liver cirrhosis.  It has been proven to be a reliable tumor marker once ovarian cancer is diagnosed. CA-125 tests, like the pelvic songram , is not recommended for women at average risk of ovarian cancer.  High risk patients like those with a family history of the disease, mutations in BRCA1 or BRCA2 genes, or suggestive symptoms are encouraged to get tested.

Early detection of ovarian cancer saves lives as well as fertility especially for women of childbearing age.  For these reasons alone sonograms should become part of every woman's prevention schedule on a routine basis like the mammogram.  The patient's quality of life can be saved in a cost effective manner.  The nonspecific symptoms of pelvic pain, low back pain, abdominal pain (bloating, fullness, distension), changes in bowel or bladder habits are surely worth looking into, but can lead your doctor into a quandry with many other diagnostic tests before ovarian cancer is suspected. The time this takes can definitely delay diagnosis. 

Speak up before the silence of ovarian cancer quiets your life.  Though unpreventable there are things you can do to lower your risk.  This includes oral contraceptives, genetic counseling, and removal of ovaries (oophorectomy).  Seek care and advice from experts in these areas via your gynecologist. The National Ovarian Cancer Helpline is very good for locating local resources. http://www.ovarian.org/local_chapters.php

Without a bonafide early detection test for ovarian cancer, we still must do all we can to detect early and prevent the rampage of this deadly disease.  The pelvic and transvaginal ultrasound along with a thorough pelvic exam can reduce the sounds of suffering that ovarian cancer shouts out in silence.

Letter to the President: Code Blue! Get Crash Cart STAT!

Dear Mr. President,

Please be aware that the doctors of this great nation are finding it near impossible to care for our patients, your people.  Our patients are literally dying as the debt crisis looms in limbo for way too long.  We are trying to avoid our patients demise, but with almost 1/2 of our population, especially seniors and kids, on Medicare and Medicaid this is already a major problem.  Further cuts would be detrimental to us and our patients, your constituents. 

Quality of care and proper treatment is near impossible especially with the physician shortage.  Medicare and Medicaid should be increases to help us provide, instead of being cut again and again. Payment delays are unacceptable. This statement from the American Academy of Family Practice (Payment Delays Resulting From Debt Ceiling Impasse Are Possible, AAFP Warns http://ow.ly/1dZzY0 ) details the problems as does the letter sent to you and  in June by AAFP Board Chair Lori Heim, M.D., who said, "If any budget proposal is to restrain the growth in health care spending, it must also support programs that build the family physician and primary care workforce, pay for quality and outcomes of medical care, and ensure that everyone has access to that care."  http://bit.ly/pFjeE7  This is a code blue! Can you imagine not getting paid for your hard work? Or getting sued because you lacked?

The worriation of this debt disease is infecting our people in many obvious ways.  I see those on limited incomes with no less than five chronic conditions struggle to keep food on the table and a roof over their heads as their health expenses become obliviously unaffordable.  We all know what happens then.  Chronic medical care that could have been avoided incurs, and we all pay, especially the patient and doctor.

As we strive for a Healthy People 2020, it is looking bleak.  Though Congress has the purse strings, the buck stops with you.  Eliminate this unnecessary worriation that has gone too far and too long causing more anxiety, suicide, and worsening of overall health for many. 

As family physicians on the forefront of patient care, the burden rests with us to do our best. The most you and Congress can do is resolve the present debt crisis.  If this was was your doctor treating you and your family, such delay would be unacceptable most likely leading to adverse outcomes.  Everyone must do their job as if someone's life depended on it. Much too often it does, especially for patients and doctors.

Thank you, Mr. Obama. 

Best regards,
Dr. Richardson

Spill the Pills, Take a Knife Slice: Surgery vs. Conservative RX

Conservative treatment is the mainstay for many chronic diseases.  This means that your healthcare team will most likely encourage you to avoid surgery unless it is life threatening issue.  Why is the stigma of surgery avoidance associated with poor outcomes?  This day in time savvy surgery techniques and fewer post operative complications complications are more likely to restore your quality of life to a livable level.  In other words three years or more of taking pills with or without complimentary treatment can be more costly in the long run with a poor quality of life.

How will you know if surgery sooner rather than later is best for you?  Talk with your doctors and healthcare providers.  If you find there is disagreement, seek out more opinions until you find what is best for you.  Surgery is preventive and can improve one's quality of life in months especially if conservative treatment fails.  Conservative treatment may help, but after many years it is less likely and becomes more costly in every way primarily in worsening of symptoms.

Spare yourself countless years of needless suffering. Do your homework.  See what treatments work best for you.  Talk with your healthcare providers about new treatments, and look for doctors (specialists) who have experience in the area.  If you've been getting around with the same nagging symptoms and watching your years pass you by without improvement or feeling good on the same treatment year after year, get on with it! Consider surgery if it is an option.

Great health is true wealth!

Health News Anemic on Mainstream TV Media

Have you noticed that there is a media health news deficiency on your TV?  In 24 hours of TV observance, mostly redundant repetition, health news rarely got repeated or even mentioned.  In addition, health stories seemed to stem from some person's misfortune rather than their health challenge.  As many times as the story is repeated, rarely, if ever, is there a clue about what you could do if it happened to you.

Within a 24 hour period health commercials comprised more health information than actual broadcasts.  Most of these are via big pharma, heavily sedated with drug enticement for profit.  If you wanted to know about the daily health news like the current blood shortage or the new measles outbreak, you can read about it on line before it becomes old news on TV, if at all.

Of course there are newsworthy things going on in health medicine - everyday.  Drug recalls, disease outbreaks, new disease research, and public health hazards infect our communities daily.  Local news may mention it, and is more likely to carry health news you can actually use as well as local resources to help you out.

Medical information on TV is limited and stagnating. Sixty seconds on the news. Two minutes on the talk show after commercials on prescription medication. Outdated show on this channel, and outdated repeat on that channel in between the new show. Watch some on this channel then click and click to different channels to connect your medical news for today. Channel surfing can become quite cumbersome with a low yield within 24 hours. Excluding taped health shows the daily intermittent health news infusion averages less than one hour.

Solution: health channel. The TV box is probably the most used medium by which folks get their news and information. It is certainly a way to get information to people. The most used information source is one of the least used by the cutting edge medical field.

Health and medical coverage on TV is surely lacking in this consumer driven health conscious society. We can watch as much sports, cartoons, movies, news as we want, but we still have to piece together our medical information and supplement it with the written word, or health care providers’ spoken word.  

Great health is true wealth. Dedicated health channels and more daily health news would make us even healthier and richer. Transfuse, please.

Your Physical Exam: Below the Waist

After the physical exam above the waist is completed, the rest of the exam follows. For females, the pelvic exam and rectal exam are done next. The pelvic exam can also be done by a gynecologist, a doctor who specializes in female medicine. This depends on your preference and/or if your primary care doctor chooses to refer you. It is an examination of the female external(outer) genitalia (parts) and internal (inside)reproductive sexual parts. The first female exam should be done at any age if there are any symptoms. Routinely, the first pelvic exam is done once the female is sexually active (having sex) or 18 years of age. It is recommended that a third person or chaperone who is an authorized health professional should be in the room for this exam. Every health care setting should have chaperone policies in place for gynecology exams. This should always be presented as an option, if there is no policy or law. Furthermore, it should be offered to a patient for the full physical examination, especially if the physician is the opposite sex of the patient.

The assistant will help you get in position. Your legs will be placed in stirrups (foot holders) that are at the end of the table. You will then slide your hips down until the buttocks touch the edge of the table. Your legs will then be able to relax
apart. (Some doctors have more comfortable exam chairs.) For those who might not be able to do this, there is the frog-leg position. The heels are brought together while the legs are bent: the heels are, thus, brought as close as possible to the
buttocks, like frog legs. For persons not able to assume either of these positions, referral to a gynecologist is necessary. Please note also that you should not be put in this position until the doctor is ready to examine you. That’s just good manners on the doctor’s part. Once the exam begins, the doctor will instruct you when to lie down. You should also be informed when and where you will be touched during each part of the exam. The doctor will be wearing latex gloves to do this part of the exam. You may also request that a mirror be placed so that you can watch the exam.

There are five basic parts of the pelvic exam. The first part is the exam of the external genital area where the doctor inspects and palpates for any abnormalities. The second part of the exam is done using a tool called a speculum. This is for looking into the vagina and at the cervix. It resembles a fancy pair of tongs (or a pelican beak) and is either plastic or metal. Most doctors
will and should warm the speculum with water before use. This allows for easier passage of the speculum. In the closed position the speculum is then placed gently in the vagina and opened to keep the vagina walls apart. When this is done,the doctor is able to see the cervix. The third part of the exam involves doing a Pap smear, which is a screening test for cancer of the cervix. A thin wooden stick about the size of a popsicle stick(called a spatula) and a stick with a tiny (about quarter-inch) brush on the end are used to do the test. When gently rubbed against the cervix, they are able to pick up cells. The cell samples are then placed on a glass side or in a test tube, which is then sent to the lab. The speculum is then removed.
Part four is the bimanual exam, which includes palpation of the internal female organs. One or two fingers that have been lubricated are placed in the vagina, while the other hand presses
over the pelvic (lower abdomen) area. The uterus(womb) and ovaries (eggs)can be felt for any tenderness or masses. The last part of the exam is the rectovaginal exam. Using a clean lubricated glove, one finger is inserted into the vagina and a
second finger into the rectum. This is an important part of the exam for two reasons: to check the rectum for bleeding and masses, and to further palpate the female organs. A complete
pelvic exam includes a rectal exam. The stool is checked for blood by placing a sample of stool from the gloved finger in the rectum onto a special card (commonly called guaiac or Hemoccult cards). If there is no stool for the specimen, your doctor will give you cards with instructions on how to collect samples at home. Once completed, the cards are returned to the doctor to be checked for blood. This is a very important test. Small amounts of blood in the stool cannot be seen with the naked eye but can
be detected with this test.

The male genital exam is the equivalent of the female pelvic. The doctor inspects first. With gloved hands, the penis glans (tip) and shaft are checked. If the male is not circumcised, the
foreskin (extra skin) should be pulled back. Then each scrotal sac is palpated to check the testicles for any abnormal lumps or bumps. This is a good time for the doctor to show you how to do your own monthly scrotal exam. Next the famous “cough” test is done in standing position. This is to check for hernias and is done with the insertion of the examining finger into the scrotal
and inguinal (groin) area while the patient coughs. It is done on the right and left side. The rectal exam follows and is usually done with the doctor’s lubricated gloved index finger inserted into the rectum. In addition to checking the stool
for blood, the prostate gland (which makes male fluids) is also checked for size, tenderness, and masses. This is an important cancer screening test for men and should be done routinely after age 40.

Examination of the musculoskeletal system(arms, legs, back), nervous system (including mental health), and skin mark the end of the complete physical. The extremities (arms and legs)are checked for symmetry (the same on both sides, and were being checked as you got on and off the exam table, to see if you required assistance or were using an assistive device such as a wheelchair,walker, or cane. Following instructions and answering the doctor’s questions during the exam allows for an indirect check of the nervous system. The skin can be inspected as each of the previous parts of the physical is done. Be sure to
have the doctor show you how to do your own self skin exam.

The inspection of the extremities continues as the doctor looks for scars, skin color change,edema (swelling), and effusions (joint swelling). The joints of the arms and legs are then tested for range of motion (actual movement) actively (movements done by patient) and passively (extremities are moved by the doctor). They are also checked for any tenderness, swelling, and
warmth or coolness. The strength, reflexes, and sensation(feeling)in the extremities are usually tested at this time or can be included in the neurologic(nervous system) exam. Strength is tested by resisting the doctor’s strength. Pushing the hand against the doctor’s hand, kicking the leg out, and gripping a finger with your hand are all relative tests of strength. The reflexes are checked with a reflex hammer at several places on
the arm (front and back of the elbow, above the wrist) and leg (below front of knee, back of ankle on Achilles’ tendon). Sensation can be checked using different items but is usually checked by light touch on the same parts of the arm or leg at
the same time. A sterile pin touched lightly on the area to be checked can also be used. Different areas of the body are touched while the patient’s eyes are closed and the doctor asks whether the touch feels the same on both sides or if a sharp or
dull feeling is experienced with the pin. Position sense is checked by being able to tell if your finger or toe is being held up or down with eyes closed. Vibration sense is tested on a finger or toe joint with a tool called a tuning fork (a six-inch
or so steel piece that vibrates when tapped lightly). Your job is to tell the doctor if it’s vibrating and when it stops. Finally, the extremities are checked for the pulses(circulation) in the arm and leg and for any vein abnormalities.

The rest of the neurological exam involves checking the way you walk, talk, and answer a few questions designed to check the mental state(such as where you are, the date, ability to identify a simple object). The cranial nerves(nerves involving the face and neck area) can also be checked now, if they were not included in the head and neck exam. During the back exam the doctor first looks at your posture. The shoulders and hips are checked for symmetry and deformities. The muscles of the neck, posterior thorax (chest), and lower back are palpated to check for any tenderness or spasm. Likewise, the bones of the spinal column are also checked. Movement of the neck and lower back is
done actively and passively in all directions of movement.

Please be reminded that the way the physical exam is done may vary from doctor to doctor. This is unimportant as long as a complete physical exam is done. Please note that the above
description of the CPE is quite generalized and does not include every specific detail. Book references for more detail include: "Bates Pocket Guide to Physical Examination and History Taking" by Barbara Bates, M.D., et al. (also available on CDROM
and VHS tape), and "Bedside Diagnostic Examination" by Drs. Elmer and Richard DeGowan. Many medical school curricula use
these references.

Once the physical exam is complete, the doctor and assistant will leave the room so you can get dressed. If an EKG (electrocardiogram — heart tracing) and X-ray are going to be done, you may be asked to get partially dressed (bottoms only) and keep the gown on. If blood has not been taken, that can be done at this time, too. Following these tests you will be able to get fully dressed. The doctor will then sit down with you in the office or exam room and discuss your symptoms,the physical findings (normal vs. abnormal), diagnosis, and whether any further tests or treatments are needed.

This is also the time for obtaining any prescriptions and to be told about any further tests or specialists whose expertise will be required. The doctor may also counsel you with information about your diagnosis and treatment, as well as any number of preventive healthcare topics. You may also be given handouts and booklets. Doctors may refer you to pertinent medical and patient education websites such as www.webmd.com. Email is becoming another way to talk with your doctor, in addition to phone calls, regular mail, and faxes. Prescriptions for medication are usually given to the patient at the end of the visit. Prescriptions are written orders for medicine that the doctor
has chosen for you. The patient should take these to the drugstore as soon as possible to stay well or to hasten recovery. Prescription medication must be dispensed by a licensed pharmacist. Some doctors fax or call the prescription in to your drugstore. Asking the doctor to do this for you will ensure you receive your medication promptly and will save you a trip to the drugstore. Some doctors are now using e-prescriptions
over the computer to send in patient prescriptions. By giving your doctor the number for the druggist you use, you will be able
to get a prescription filled in less time. You may also get prescriptions for medicine that can be bought over the counter—that is, without a pharmacist. Your pharmacist is the best person to help you with obtaining your medicine, discussing side effects and interactions, what the medicine is for, and so on. Be sure to discuss this with your doctor, too.

Best health!



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Your Physical Exam: Above the Waist

After your doctor has taken a thorough medical history, a complete physical exam (CPE) is performed. The doctor started your physical exam from the time you were greeted just by looking at you. Are you able to get up and shake hands? Are you able to sit back down? Is there a cane or walker lying beside you? Are you speaking clearly? Are you tearful? This and many other observations can tell the doctor a lot. So the physical has begun before the doctor puts a healing hand on you.

The head, eyes, ears, nose, and throat (HEENT) are usually inspected first. The doctor looks at the scalp for any hair loss or other abnormalities. Your head is palpated (touched and felt) to check for any lumps, swelling, or sore spots. The eyes are next. You will be asked to follow the doctor’s finger with your eyes up, down, left, right. This tests your eye muscles. Pulling down the lower eyelid and pulling up on the upper eyelid allows for inspection of the white of the eye and the eyelids. The eye reflex is checked by shining a light on the colored part of the eye and is done with the lights dimmed (or light off and door cracked). The doctor uses the ophthalmoscope (an instrument) to look inside the eye. The blood vessels and nerve to the eye can be seen. Certain abnormal findings in the eye indicate diabetes, high blood pressure, and other maladies. For any findings that are abnormal with the eye, you will be sent (“referred” is the
up-to-date term) to an ophthalmologist (eye specialist). Routine eye exams by the ophthalmologist may also detect some diseases that are known to progress toward blindness or other complications. Looking at and reading from an eye chart tests the vision.

Can you hear a whisper? How about a watch ticking? Faint noises close to the ears allow a doctor to check to see how well you can hear. Formal hearing tests (like audiometry) are done by an otolaryngology doctor, also known as the ENT (short for ear, nose, and throat) doctor. Hearing tests may also be done by hearing aid centers. The doctor uses the otoscope (the same instrument used for the eyes with an attachment made for looking in the ears) to look in the ear canal and at the eardrum. Using the same tool, each nostril and the mouth are inspected. A stick called a tongue blade is used to hold the tongue down when the doctor asks you to say “aaaaahhhhh.” This is done so that the throat and the rest of the mouth can be checked. This procedure also tests the nerve for the gagging reflex (part of the nervous system exam). A gloved finger may be used to palpate (touch) the inside of the mouth. Any problems here will earn you a referral to the ENT doctor or dentist. Now may be a good time to ask any questions about the exam thus far. Please wait for the doctor to remove the gloved hand first.

The neck exam is next. At this time the thyroid gland is palpated. This is best done while the doctor stands behind the patient and places the right hand around the right side of the neck and the left hand on the left side of the neck. If any swelling or lumps are noted, further blood tests and a thyroid and/or neck scan may be ordered by the doctor. The lymph node glands can also be checked at this time. They are located in the front, back, and sides of the neck. They are also in the armpit and groin and are checked with those parts of the body. The lymph nodes should not normally be enlarged. More blood tests and Xrays may be ordered if they are enlarged.

Inspection, palpation, and percussion (lightly tapping) as well as listening to the chest give the doctor a chance to check the lungs. The doctor listens with a tool called a stethoscope, which makes the sounds louder. It is placed on the bare skin (beware of the doctor who tries to listen on top of your clothes) starting at the top of your upper back moving from the left to right, or right to left, from the top to the bottom of the chest
while you take deep breaths. The same will be done on the chest.

Then the stethoscope will be placed over the heart on the left and right sides of the breastbone. These areas are where the heart valve sounds are heard best. You may also be
asked to do certain things like holding your breath or bearing down (as when having a bowel movement). This makes some murmurs easier to hear. Certain positions may also be better for hearing some heart sounds. Your doctor has been trained to listen for certain things. If any abnormal sounds are heard, more tests may be ordered. These may include an X-ray of the chest(CXR, for short) and heart tracing(electrocardiogram—EKG, for short). Usually these can be done in the office after completion of the exam. Depending on your complaints, symptoms, and the results of the CXR and EKG, you could require more tests that are not done in the primary care physician office.

The breast exam is also done at this time. The doctor will let you know exactly what is to be done. For female patients, it is recommended that a third person or chaperone be present when this exam is done. After the gown is lowered to the waist, the doctor looks at the breasts with the patient sitting up on the exam table. The breasts should look the same size (sometimes one can normally be a tad larger or smaller than the other) and shape with the nipple positioned centrally. The breast is also checked to make sure there is no abnormal swelling, lumps, skin discoloration, or skin changes. Next you will be asked to put your hands on your hips and then raise your arms above your head much like doing your own breast inspection in front of the mirror. The doctor will again look and examine for any abnormal places. While you lie down on the exam table, the doctor will palpate each breast up and down vertically from right to left or vice versa. Palpation in a circle from out to in is another technique used. Breast tissue under the arm is also checked. The nipples are then squeezed gently to check for any discharge. Deeper palpation of the axilla (armpit) is then performed to check the lymph node glands. These steps are then repeated on the opposite breast. Any abnormalities may warrant a
mammogram and/or sonogram and possibly a surgeon’s evaluation. Men should also receive a breast exam. This is a good time for the doctor to teach to do your own self breast exam (SBE).

Now it’s time to look, listen, tap, and feel the abdomen, the area many people refer to as the stomach. This is where the liver, spleen, kidneys, bowels, and female reproductive organs are located. With this lineup of important organs the doctor has a lot to check. This part of the exam is done in the supine (lying on your back) position. Looking at the abdomen for scars tells about anysurgery you may have had. Listening with the stethoscope for overactive or underactive bowel sounds and/or bruits (sounds made by abnormal blood flow through arteries when there is blockage) is next. By tapping and feeling, a doctor is able to check for enlargement of the vital organs listed and to make sure that there are no abnormal internal masses or swelling. At this time the groin is also checked for any enlarged lymph nodes. If there are any abnormalities, further tests will be ordered by the doctor.



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Free Health Advice - Would You Dare?

In these days of rising costs on everything, health care may be seen as "optional" unless free or discounted. Many healthcare providers are often asked (especially at parties!) for free advice on and off the Internet. 


Would you use free health advice from a doctor, nurse, or other medical provider? http://twtpoll.com/r/s16vcz