Is my doctor avoiding certain tests, during my annual physical exam, to spare my modesty?

Question

Hi Everyone:

My question concerns the tests that I should expect during my annual physical exam.  I am a man, and my general practitioner is a woman.  She has been my doctor for a long while, and I have a good relationship with her.

When she first became my doctor, she conducted a very thorough (and somewhat embarrassing) exam, including tests of my testicles, a test for a hernia, and the like.  I did find this embarrassing, but expected.  I tend to blush a lot when embarrassed, and I'm sure she noticed.

For these past 20 or so years, I have gone to her for a yearly physical.  However, since that first examination, she has never again performed the hernia check or testicular examination.  She did teach me how to self-examine my testicles on the first visit, so perhaps she assumes that I will tell her if anything changes.

Now that I am well passed 40 years old, she has started ordering PSAs.  However, she has never performed a digital rectal exam.  This seems strange to me, since my brother's doctor has performed this exam on him since he turned 40, and the same is true for those friends of mine who go to the doctor (which is definitely not ALL of them!).

Finally, except when I have had specific, minor issues with my skin, she never asks that I remove any clothing.  Except to loosen my shirt, so that she can push on my liver, listen to my heart, etc.

As I mentioned, I find a lot of the aforementioned tests to be embarassing, so I have actually been somewhat relieved that she has avoided them.  However, I will deal with the  embarrassment, if that will help to keep me healthy.

What I need to know is, are these tests simply not appropriate in my case? Or, if they are, could she be avoiding them because she wants to spare me the embarrassment?  Is it even possible that she is uncomfortable in doing these sorts of tests?  I have never seen any other men in her waiting room, so I might be her only male patient.

I have considered asking her about this, but I don't want to risk insulting her by questioning her judgment.  I also don't want her to feel that she should perform these tests, simply to make me feel like I'm not being neglected.

Any thoughts?

Londres70 · Accepted Answer

Doctors, nurses or anyone in the medical field are not taught to "avoid" any particular part of an examination to keep a patient from being embarrassed.  If you are over forty, you should be getting this particular examination once a year with an annual physical.  It makes no sense that she is not doing this and that you should go to another physician to have this done, i.e Urologist.  This is NOT any intricate exam, but very basic and one that all PCPs should be able to perform.  Why pay another physician to perform an exam she should be able to do?  

I would bring it to her attention; just mention you have some concerns about your prostate health, etc. since you are over the age of 40 and will she exam/check this for you.  I don't think she will think you are trying to question her judgement.  In my opinion sometimes these situations happened because doctors are too rushed, become less thorough over time or may have possibly forgot.  

Patients are very focused on embarrassment, which is understandable, but I can tell you after being a nurse for 14 years and seeing so much of "this and that," there is really no embarrassment on my part.  I think the first week in my nursing program, the instructors told us to dump being embarrassed when assessing a patient.

LeanMean · Answer

I posted a similar question to this at: http://www.medhelp.org/posts/General-Health/Physical-Exam---Good-Doctor-/show/1818202#post_8380664 

Would love to hear your thoughts. 

I have become concerned over the past few years with doctors being overly modest. I am genuinely concerned that it is compromising my health. 

I suffered with a hernia for three years before I finally saw a doctor who thoroughly examined my genitals and lower abdomen. This really frustrated me. 

I am planning to go a physical (with the Dr. who found my hernia last year), and I want to explain this but fear it will be taken the wrong way. What do you guys think?

StayingFit · Answer

I just wanted to let you all know that I have to wait a few months before I can see my doctor for my annual examination, due to insurance rules.  So, I will not have an update until July, most likely.  I promise to update this post at that time.

Thanks again to all of you for taking the time to respond!

Londres70 · Answer

Merci!!!!   I am glad I could help you out.  

Keep us posted on the outcome with your physician and "stay fit"  :))))

StayingFit · Answer

I really appreciate your advice, thanks!  I am trying to mark your answer as the best that I received, but the option seems to have disappeared.  In case I can't do that, I did want you to know that your responses were the most helpful.

Londres70 · Answer

Yes, just mention you are over the age of forty and would like your prostate checked, simple as that. If she goes into some "song and dance" why she can't, in which I know she should be able to, then that should be a "red flag."

StayingFit · Answer

Londres70, thanks very much for your insight.  While the cost, in dollars, of seeing a urologist would not be great, I agree with you that it should not be necessary. 

I like your idea of mentioning that I have concerns. Not symptoms since, thankfully, I don't, and I would not want to mislead her.  But raising a concern and asking for the examination should suffice.

As sez28 mentioned, finding a doctor that you like is not easy!  So, I'll give her a chance, and find another if I don't like the outcome.

StayingFit · Answer

Firstly, I would like to thank you all for your responses.  I just joined this site today, and I posted this question, in the hope that I might hear from someone eventually.  I am pleasantly surprised at how quickly you responded, and the thoughtfulness of your advice.

If I were to summarize what you all have said, it would be that I should discuss this with my doctor.  I may find that she has not conducted these tests, since they are not deemed necessary.  In addition, an appointment with another doctor may be warranted.  

I think that this makes a lot of sense.  I probably should start to form a realtionship with a urologist, anyway, and this is an opportunity to do so.  If I were to request the name of a good one from my current doctor, this could provide a nice seque into the larger discussion.

BTW, thanks caregiver222, for your insight as to whether these tests truly are called for in my case.  This was one of the questions that I had hoped to have answered, so I would welcome the opinion of others on that, as well.  I also don't blame you for not wanting your girlfriend to act as you doctor, in that particular area!  Better to make a clear distinction between doctor and GF, in that particular case.

caregiver222 · Answer

I have a nice female doctor - actually a cutie pie (married unfortunately) - my previous male physician passed on, and my girlfriend physician (another cutie pie) was interested in touching me for other reasons - who suggested to me I might need such examinations and I informed her on no uncertain terms her practice of medicine was limited to everything above my beltline.

My two cents worth is that you can (and should) have the proctoscopic exams performed by another doctor and, if you respect her medical judgement,  still retain her as your physician.

There is a difference of opinion as to the frequency with which a digital examination is required, and many people (including myself) feel it is unnecessary to have done every year.

simeon78 · Answer

As your Primary Care it is here duty to perform test only as might be necessary regarding your health.(Remember the oath:first do no harm.) As this should always be the case, it is possible she has spared you both the embarrassment of the test because you have not voiced any concern regarding them. Putting the shame and embarrassment aside, if you feel these test are important and necessary in regards to your family history I would be mature about it. Her discomfort and your embarrassment are not the issue, your health and concern should be the only subject for discussion. If she brings up that she is uncomfortable and you still value her as a PCP she could always refer you to another doctor for your physical. Take Care.

AnnaMariaQQss · Answer

I CAN NOT STRESS THIS ENOUGH...as I do many times over and over, when in doubt, find a new dr or get a 2nd opinion. And ask A LOT of ?'s.

U only get 1 body and 1 chance to live a healthy productive life. Don't take chances and be through! Good luck

sez28 · Answer

Hi StayingFit, my only thought is be honest with your dr, it is her job to look after your health and if you feel that, that is being comprimised in anyway I feel you need to let her know. Im not sure but I guess because she has taught you how to do your self examination she would assume that if you had any worries or findings that you would tell her. Personally if you have a good relationship with your dr she wont be offended coz its really hard to find a dr in this world that you like! I would just ask her why there maybe a reason, like they dont usually do it every year or the like. At least if you ask you will know! Hope this helps!