“I want to be tested for everything.”
“Can you book me for one of those total body scan things?”
The complete physical begins with a series of health-related questions called the review of systems. The goal of these questions is to ferret out occult disease. In my experience, patients’ responses tend to be influenced by two main things – their personality type and the reason for the physical.
On the one hand are healthy people who are seeing me solely because they need to have their mandatory job-related physical examination forms filled out. On the rare occasion that they actually do have an active medical problem, they go to great lengths to hide it from me. It’s not too difficult to figure out why – their livelihood depends on my giving them a clean bill of health. In these patients, the system reviews are shockingly brief:
“Have you been having any chest pain?”
“No.”
“Shortness of breath?”
“No.”
“Weight loss?”
“No.”
“Wait a minute – according to our scale, you’ve lost 40 pounds over the past three months.”
“Really? I hadn’t noticed. Probably just that stomach flu I had last week. Hey, how about those Winnipeg Jets!”
Neurotics who are in for “a good physical” represent the other side of the equation:
“Have you been having any chest pain?”
Mr. Somatoform gets that far-away look in his eyes. He strokes his chin thoughtfully as he contemplates the question.
“Now that you mention it, I did have an episode of chest pain not that long ago.”
“When?”
“Last Christmas.”
“Nine months ago?”
“Yes.”
“What sort of pain was it?”
“It felt like a bolt of lightning.”
“Where did you feel it?”
“It shot from my right armpit to the centre of my chin.”
“How long did it last?”
“About three-quarters of a second.”
“Has it ever come back?”
“No, it hasn’t. What do you think it was, doc? Could it have been a heart attack? Should I be seeing a cardiologist?”
“I don’t know what it was, but I’m pretty sure it wasn’t anything too serious. Let’s move on. Have you had any shortness of breath?”
“Funny you should mention that… .”
Ramblers are a breed unto themselves:
“Have you been having any chest pain?”
“Chest pain, chest pain… . I’m not quite sure how to answer that, doctor. I haven’t had any chest pain lately, but back in the winter of ‘64 old doc Tilley had to admit me to the hospital for two days on account of the fact I was getting a mighty peculiar discomfort – I can’t really say it was a pain, mind you, because it was more of an ache than an actual pain, sort of like a nagging toothache, if you know what I mean – right above this here rib. At first they thought it might be pleurisy because plenty of folks in our neck of the woods had been coming down with it right around the same time I took sick, but in the end doc Tilley figured it was just…uh…doctor?”
“ Zzzzzzz… .”
And let’s not forget the Chronically Vague:
“Have you been having any chest pain?”
“Uh-huh.”
“How long have you been getting it?”
“Huh?”
“How long have you been getting the chest pain?”
Mr. Isidore gazes at me with the eyes of a chicken. After half a minute of deep thought he responds, “Quite a while.”
“How long is ‘quite a while’?”
“Oh, I dunno. A long time.”
“Weeks? Months? Years, perhaps?”
“I dunno. Been quite a while, though.”
After I’ve completed the review of systems I usually leave the room while my patient changes into a gown. If I return to find they’ve put the gown on with the gap facing the front instead of the back, I automatically deduct two points. The same applies to people who still have their T-shirt on underneath the gown.
I start every physical by asking my patient to turn their wrist over so I can palpate their radial pulse. Due to the location of the artery, it’s easier for me to check the right wrist than the left. Inexplicably, 98 percent of patients offer me their left wrist. Why is that? I’m sure there’s a research paper for some starving university student in there somewhere. Similarly, when I examine patients’ necks I usually ask them to tilt their heads downward slightly to make it easier for me to feel the glands. Most people immediately hyperextend their neck, which results in them staring up at the ceiling. Go figure.
Some people have more earwax than Shrek. Every so often I come across an unexpected surprise, like the time I discovered a bunch of uncooked spaghetti noodles wedged into a young man’s ear canal. As it turned out, earlier that week he had used them in an unsuccessful attempt to curette out some earwax. Epic fail! Once I had to flush a fly out of someone’s ear canal. How the frak do you get a fly in your ear?
When the ear exam is finished, I’m ready to inspect the throat. I stand in front of my patient, aim a flashlight at their mouth and ask them to open wide. Three-quarters of people open their eyes widely instead of their mouth. Research paper!
Occasionally a detailed eye exam is required. Some people are unbelievably calm when it comes to having their eyes checked – irritating drops and dazzling lights shone directly into their pupils don’t faze them in the slightest. Others are eye wimps – the instant the ophthalmology tray is brought out they reflexively scrunch their eyelids shut so tightly a crowbar couldn’t pry them open. It usually takes a fair bit of cajoling before these folks will allow me to proceed. Years of examining eyes have taught me that there are four cardinal directions: up, down, left and the other left. “Okay, Ms. Knowles, please look to your left. No, the other left.”
Next comes the throat. When I push down on someone’s tongue with ye olde glorified Popsicle stick and ask them to say “ah,” it’s not because that’s how I get my jollies. Saying “ah” makes the soft palate rise, which makes it easier for me to visualize the back of the throat. Half the time I ask patients to say “ah,” they either straight-up don’t do it or else they try to fake it. What? Do they think I won’t notice? Hel-lo, McFly, I’m right here! I notice! Say “ah!”
I just love it when someone a foot and a half away from me spontaneously ejects their dentures to show me a lesion in their mouth. Isn’t there some sort of unwritten rule of social conduct that stipulates prior to popping out one’s false teeth, a person is supposed to give innocent bystanders fair warning? I’m still waiting for the day somebody asks me to hold their drippy dentures for them.
Chest auscultation is always interesting. When asked to take deep breaths, many people take one deep breath and hold it. How is that supposed to help me? Sometimes I’m tempted to sit back and wait to see how long they’d last. And then there are the times when patients seem to forget how to breathe and I end up having to remind them to exhale after each inspiration. “Deep breath…exhale! Deep breath…exhale!” When I get tired of repeating myself I say, “That’s good! Just keep doing that, okay?” Seems to work.
While I’m on the topic, what mysterious force compels people to start talking to me while I’m auscultating to their chest with my stethoscope? At least once a day I’ll be straining to decipher a subtle heart sound when suddenly “My great-grandmother died of a heart attack when she was 98!” explodes into my eardrums. Now that’s annoying. Minus 10 points.
The umbilicus is the centre of the abdomen. Heck, it’s practically the centre of the entire body. You’d think people would make an attempt to keep it clean, right? Maybe even treat it to a little soap and water once in a while? Don’t count on it. I’m here to tell you that the hygienically-challenged walk among us. Some belly buttons are so full of dirt, you could plant an oak tree in them. Others contain enough lint to fill a Beanie Baby. Wash your belly buttons, people! This has been a public service announcement… .