21 Reasons

Why I don't do outpatient comprehensive care.  Welcome PookieMD to the world of blogging.

I'm going to extrapolate on your  #4.

• Not having the diabetic patient's shoes and socks off (when you come in to examine).

One thing that really hits a nerve with me is the patients attire during exam.  I am a hospitalist.  I admit sick people (most of the time).  Pick just about any adult disease state and I'll bet there is a hospitalist that could be called to either admit or consult on that patient at some point during the hospital stay.  My job as a physician is to be thorough.  Some docs are more thorough than others.  There are some docs that can spend two hours admitting a patient.  There are some docs that can do the same work in 1/2 an hour.  My hospitalist group of 18 docs has both types.  Same training track.  Same board certification.  Completely different efficiency ratios (that's another post for another day).

But the training remains.  We are programmed to be thorough.  And being thorough means doing a complete physical exam.  That means examining everything.  From your head to your toes. If you are sick enough to be admitted,  you are sick enough to get the full walk through evaluation.

But it really irks me when I show up in the ED to admit  Mr Smith for fever, tachycardia, and and altered mental status.  It irks me when I have to unbutton his heavy flannel shirt just to listen to his lungs through his tank top hidden underneath.  It irks me when I have to pull off his over sized XXL sweatshirt with a hoody to listen to his heart.  It irks me when I have to tell him to undo his 6 inch belt buckle with a picture of Dolly Parton so I can feel his femoral pulses under his Wranglers.  It irks me when I have to rip his Keds off of his swollen kankles only to get blown out by the stench of his smelly socks.  It irks me because the guy deserves a full exam.  And I can't do that, nor can any doctor, without a patient that has been stripped down to their bare necessities.  Every doctor doing and billing for a comprehensive physical exam should have a fully stripped down patient to examine. 

That is basic first grade medical protocol.  For trauma patients,  you get your cloths cut off.  For medical patients, we at least give you the option to remove them yourself.  There are exceptions to the rule.  If you are young and have no medical problems and your source of disease of clearly external to your layers of clothing,  your fine.  Everyone else, not OK.

Reasons when it's really really not OK to have any cloths on.

• Fever (lots of places it can come from)
• Diabetes (things are always more complicated)
• Obesity (things are always more complicated)
• Smelly (Bad things can hide)
• Old (things are always more complicated)
• Immobile (bad things happen when you don't move)
• Unconscious or altered (all I have to go off of is your body)
• When the source of your complaint is smack dab under your clothing site
• Abnormal vital signs of any kind (I need to look everywhere)
• Smokers (because bad blood vessels are every where in their body)
• Prisoners (Because I don't want to get shanked)
• Out of control patients. (Who knows what they are hiding)
• Abnormal Labs.  Any of them. (you could be hiding disease anywhere)

Please.  Get Naked.  Help your patient get naked.  Do it for Happy.