Are physical exams degrading?

[ShazD]

I have just heard back from an independent gynae oncology expert as I investigated my care under my original gynae oncologist and questioned why I did not even have my abdomen checked when complaining of bloating. I also asked why I did not have a physical exam when there was a dispute between 2 scans and my confirmed past history of endo was unclear as well as endometriomas disappearing. He says that with the introduction of scanning physical exams have been done away with since 50 years ago. He also said they were uncomfortable, embarrassing and degrading for women. So why when I saw 2 female gynae oncs did they both perform physical exams as well as checking my abdo?!

[Seasun36-uk]

Hi Shaz. I think he is WRONG!! Physical examination has always been part of a Medical Practitioner’s set of skills - no technology can replace that! It gives the complete picture and is good practice! I (as a nurse/midwife) - have chaperoned many an Obstetrician, GP & various other medical staff.

I just can’t believe they missed it in A&E and I hope your newspaper article went far & wide. Having had Gallstones two years prior to OC, I can say that the pain/signs&symptoms are NOT similar! Keep going Shaz!

[ShazD in reply to Seasun36-uk]

I know! I could not believe he said that despite me clearly stating that in section 2.2 of the NICE guidelines pathway for detecting ovarian cancer it says ‘ physical examination is an integral part of the clinical assessment’. He could not cover for the gynae onc not performing a ca125 marker so I know I am onto something. They think I am difficult but I am like a dog with a bone. I think they think they can sweep things under the carpet. I asked my private oncologistfor a private referral to another gynae onc (female this time)and had to ask 4 times for the referral to be done. When I contacted the insurance they wanted to know why I was changing consultants so I told them I believed my diagnosis should have been picked up earlier. They are now looking into it. This must be why the oncologist did not refer me. My husband and I could not understand why he was not happy to refer earlier . Oncologist was probably hoping to avoid insurers looking into things with regards to the gynae oncologist. They have a referral network going between each other. ..... say no more.

I saw my new gynae oncologist today and I cannot believe the difference in the standard of care. She actually wrote everything down in an actual file and collected all my notes and had phoned my oncologist before seeing me. She actually looked at my abdomen and did a physical exam and talked about diet and family history. A change from the first one! I didn’t even take my coat off at the first one.

If I had a patient see me complaining of a sore leg and a Doppler reading suggesting arterial insufficiency with a history of leg issues and I ordered a duplex scan of their leg which negated the initial Doppler and did not record any leg measurements, presence or absence of leg pulses, Claudication etc, did not record any history taking regarding lifestyle and did not even check their skin only to have them present later with a massive infected leg ulcer. Then they said well we saw the nurse specialist and told her our leg was sore but she didn’t examine it and wrote us a one line letter telling us everything was fine and the first scan was wrong and not to come back and told our GP this. I would probably lose my registration or be put under close supervision.

[Seasun36-uk in reply to ShazD]

Absolutely Shaz!! Keep strong, with your husband by your side, with that bone you won’t let go of. Too much of this goes on, albeit thankfully not TOO often. But one is too many & your future health & prognosis has probably (certainly) been affected by your (lack of) treatment.

Although I haven’t had this happen to me personally, I have seen it happen to patients/relatives.

My husband’s cousin pressed for a PSA test (with symptoms) and when the reading came back high, his GP said, ‘Now look what you’ve gone & done’. His cousin went on to have removal of the prostate for cancer & changed his GP....I could go on.

Believe me I have utmost respect for most medical staff, but not in your case Shaz (or others who’ve been misdiagnosed).

Your new Consultant sounds great!! 🙂

[CJR99]

Shaz,

This chap sounds completely archaic!I’ve just had a physical check and it was very helpful in ascertaining the exact point of pelvic pain and a chance for me to display my very bloated tum....again!

This has triggered various scans including a second mri...I think a physical check is essential, if they’re not going to scan you there and then!

You have my full support...wishing ypu better times ahead...loved your news article by the way...best wishes,Clare x

[ShazD in reply to CJR99]

A top gynae onc consultant which is why I am so angry.

[Maus123]

Hm that's not been my experience, Shaz.

At the Royal Marsden, I received regular physical exams along with ultrasound (abdomen, pelvic area, vagina) and CT/MRI scans, plus ca125 blood checks. Same here in Germany, in the University hospital in Munich.

The physical exams include vagina, rectum, abdomen/pelvis and breasts.

I'm glad those are performed, because it is such an easy way to pick up some of the possible recurrence symptoms like ascites or liquid in other organs etc.

In addition, all results are written down and shared with my GP.

So I'd say: Poke away!

Would recommend that you keep looking for another gyn onc (just saw that you found a competent one now, thank god).

I changed mine too, not long after my return to Germany. Because he insisted on prescribing me (despite having low grade serous OC) hormone replacement therapy to counter menopause side effects... which I said don't really bother me. I never looked back.

Glad you followed your guts. Hugs, Maus.

[Anitaalmond]

I had physical exams 6 years ago on diagnosis but not had one since. My Oncologist uses the scans and CA125 blood tests to treat me and assess my needs. He would not gain anything by putting me through a physical exam. He has checked my tummy on two occasions but that is all. I am glad he chooses not to as I have known him 6 years and our relationship whould not be as good if I was embarrassed and feeling awkward.

[citrine]

That sounds strange!

When I went to my GP with a bloated stomach in 2011, the first thing she did, after asking questions was to check my tummy. The gynaeoncologist did the same as well as an internal examination. I would have been astonished if he hadn’t. I’m now on yearly follow ups and whoever I see, they examine my tummy as a matter of course, although they do ask me if I’d mind. ( I have the CA 125 test too.)

Wishing you the best of luck.

[bamboo89]

My original male gynaecologist did a fairly rigorous physical examination, but to absolutely no avail - he reassured me everything was fine, nothing 'sinister' was going on, and it was okay to wait 4 weeks for scans and I might need a general surgeon later to check out the lymph node in my groin. Actually, I had Stage 4b serous epithelial ovarian which had differentiated into non small cell neuroendocrine cancer in the swollen inguinal lymph node, all picked up by US and CT, followed by a biopsy. So much for internal and external examination...

[ellseybellsey]

When I was on three monthly follow up appointments my gyae onc done physical exams every time, that’s how he felt the lesions in vaginal vault.

Ellsey xx

[ShazD]

That is what concerns me that I went in complaining of symptoms and he sat on the other side of a very large desk and made a clinical judgement without even visualising my abdo. I don’t think it is accepatable practice and don’t want any one else to have to be treated the same. He also teaches gynae medical students so god knows what their clinical assessment skills will be like. When I questioned him I was told I was a very sick woman and it would not help me to discuss events leading up to my diagnosis.

[ZenaJ]

Well if they have been done away with I'd like to know what all those examinations I've had were then. He's talking out of his ..... xx

[bluepeterella]

I had a physical examination carried out by a male gynaecologist when I was first told there was a problem with my CA125 and I possibly had cancer. I was in floods of tears at the time, and he was rolling his eyes at the nurse and saying he couldn't perform the exam because I would not relax. He kept saying to me, 'You have to relax!' I am still angry that I was put through this.

I was also examined internally at my surgical appointment when my scan and biopsy were discussed, and I heard that my cancer had spread to my peritoneum, and was therefore a later stage than I had thought. Once again I was in tears and panicking at the thought of not being alive long enough to see my daughter into secondary school. Again it seemed the examination didn't give much information as I could not relax. I actually don't understand what information the surgeon hoped to gain from the examination as the tumours presumably were clear on my scan.

I found both experiences degrading, distressing and above all unnecessary.

[bluepeterella in reply to bluepeterella]

Oh dear I am always doing this i.e. not reading the original post properly!

When I first went to the GP with bloating he carried out a very thorough physical examination of my abdomen and I'm very grateful of that. As a result he was concerned enough to test my CA125 and put me onto the cancer pathway.

My response is of course about internal exams which is a different story ....

[Coldethyl]

I had internal from own female GP which revealed bulky uterus ( also had stage 1 womb cancer) and triggered scans which showed ovarian lesion - I had thorough pelvic exam by the gynae onc registrar prior to surgery - since I have had two external abdominal exams by oncologist and one internal by her registrar so clearly they haven’t had memo that examinations old hat x

[Hidden]

Positively bizarre as a response.

I understand the scanning technology continues to be refined. I find it very hard to believe anyone thought 50 years ago "oh yippee, no need to use those skills I was carefully trained in" .

My experience is of an interaction between the real patient interaction with the doctor and the virtual one that the radiology people do.

I'd never have been referred down the OC pathway if my GP hadn't done a physical exam of my abdomen. And thank heavens she did.

Since then, I've had sporadic ones, but I've also been tending to have quite a lot of scans, so not worried about it not being a regular feature.

[Harrygirl]

ShazD,

I am sorry your initial consultant was so patronizing; I agree, very scary that he is teaching(?!)medical students assessment skills, since his are not up to par. Thank goodness you are a strong advocate for yourself and have good Gynae oncs now, but the fact your concerns were initially dismissed is beyond maddening. I had a combination of internal exams as well as ultrasounds and to be honest the scan results showed initial abnormalities, but there’s nothing like a physical assessment to help establish a baseline. Keep advocating for yourself and making sure you are heard. That consultant should be struck off. I wish you all the best, Christine