Posted by: notdeaddinosaur | March 26, 2015

Note to Patients: When it’s Not A “Physical” You Need

We interrupt our regular blogging for a PSA (that would be a Public Service Announcement, not the controversial prostate cancer screening test) directed to our patients.

Dear Patients,

First of all, thank you for calling for an appointment. Seriously. Ever since I’ve gone open access, if the phone doesn’t ring I’m toast. And thank you for your interest in preventive care. The fact that it’s now free (well, no cost to you at time of service; trust me, it’s not “free”) has probably motivated more of you to call. That’s okay. But sometimes it seems that your idea of a “Physical” and mine are worlds apart.

A General Physical examination, often shortened to “a physical,”  is the term used by most people (and most insurance companies, including the ACA/ObamaCare) to refer to a periodic encounter for preventive care. Other synonyms include a “well visit”, or just a “checkup.” Preventive services are, by definition, things done for healthy people. Got that? HEALTHY. As in not sick, no symptoms, feeling well.

There’s actually a lot we need to accomplish at a preventive care visit. In addition to reviewing your medical history (no, I may not have known you had your knee scoped last month), updating your medication and allergy list, addressing your immunization status, and doing a basic examination, this is when we go over your diet, talk about your exercise regimen, and review what kinds of routine screening tests are appropriate for your age, gender, and medical conditions. That takes time; time I’m happy to spend, because preventive care is important (even though it doesn’t save money), but it is a visit with an agenda.

Many of you want “a good physical” when you’ve got multiple vague complaints that might be pretty mild. You may not even be convinced you need to see a doctor, so you figure you’ll just “come for a physical” and I’ll be able to figure out what’s wrong with you (or if there is anything wrong) without you having to answer too many questions like “How long have you been tired?” and “What do you mean by ‘dizzy’?” or “What do you mean by ‘not quite right?'”

It doesn’t work that way!!

If you’re having multiple vague complaints that make you think there may be something wrong, then you need a “new problem” visit so we can sit down together and get it figured out. Maybe there’s nothing really wrong and you are just a worrywart. Or maybe you do have cancer or diabetes or something else that terrifies you to even think about but as long as you don’t say it out loud, it’s not that. Whatever it is, I can help. From putting your mind at ease to getting you started on the road to diagnosis, treatment, and (hopefully) a cure, that’s my job.

But I can’t do it if all you do is schedule a “physical”. And no, we can’t “call it a physical” to save you the co-pay. Doing that fails to fairly compensate me for what’s often a complex visit (vague symptoms are usually much harder to figure out than more defined issues), it cheats you of your actual preventive care visit, and technically it’s insurance fraud.

Thank you for your attention.

-Dr. Dino



  1. It’s interesting the difference between the Canadian system and yours. I often run into this problem but just change the appointment type myself to an intermediate assessment and bill that to the government. I can’t imagine how complex it would be with different entities paying for different types of visits!

  2. So what do you do: tell the patient to schedule another visit for their other complaints (which pisses them off) or charge them an office visit in addition their physical (which get applied to their deductible and pisses them off)?

  3. This happens all the time. Wellness visit is not where you go through every vague complaint for the last whatever. I don’t know where you go for that visit. But as Robert says there’s no good solution, either way somebody gets pissed off. Maybe education (which Dino is trying to do here) is the answer.

  4. Thank you for clearing that up. I didn’t know and I’m sure there are a lot of people who are just like me. If a patient goes in for a physical and the doctor finds something wrong, say a whooshing sound in the carotid arteries, does it become a new problem visit?

  5. Lisa: If the Preventive Care visit reveals something abnormal (like a carotid bruit/whooshing sound, or the fact that you’ve stopped going upstairs because every time you do it feels like an elephant sitting on your chest) then I have several options. If it’s something minor that can be addressed quickly and easily, I just do it and don’t worry about extra billing. If it’s more serious, I’ll explain it to the patient and either schedule another visit, or address it then and charge for a visit on top of the physical (including applicable co-pays and deductibles.)

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