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Ask Dr. Gott 1/1
What makes for a good exam?
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    DEAR DR. GOTT: Please indicate what a good physical exam should consist of and what tests and procedures should be ordered.
    My former doctor never used a stethoscope and didn't do much of anything, but he would charge around $300 for a physical examination.
    DEAR READER: The answer to your question depends on a person's age, sex, health status and many other criteria.
    A physician who keeps his stethoscope draped around his neck is practicing bad medicine. Avoid him like the plague, especially if he charges inappropriately and pretends that his incomplete exam is standard procedure.
    A stethoscope, when used properly, is a basic requirement for good medical practice. I cannot conceive of a primary care physician who disdains its routine use.
    Generally, a doctor should begin with questions regarding conditions that may have occurred since your last visit. Medications should be reviewed for efficacy, as dosages might require modification, or your medication might be eliminated completely. Your general wellness should be reviewed, and any issues should be addressed. A physical exam can include a check of neck pulses, arms, heart, lungs, abdomen, legs, feet for circulation and more based on symptoms. Women, depending on age, might have timely Pap and bone-density tests. Men should have rectal exams.
    Once the examination is completed, testing should be coordinated. Laboratory work might include a complete blood count, a comprehensive metabolic profile, a lipid panel for cholesterol levels, a PSA for men, a CA-120 for women, a PLAC to determine the risk for stroke, thyroid studies if appropriate and more. Both men and women should have a colonoscopy and at least a baseline EKG, and follow-up if appropriate. A chest X-ray, especially if there is a history of smoking or smoke exposure, should be coordinated.
    While each person is different, it is helpful for a physician to have baseline studies to determine whether a person is healthy. Many conditions go undetected because of vague symptoms attributed to advancing age or other causes. The way for a physician to combat this is to order appropriate testing and report back to a patient. This can be done via a repeat office visit or a simple telephone call. Just make sure all your questions are answered, and you are good to go for another year.

    DEAR DR. GOTT: I have a dry cough that sometimes produces phlegm. Then I sneeze and my nose runs. I've seen my doctor several times for the condition. First he said it was a sinus infection, then maybe an allergy. The last time, he said I had a virus. Well, I've had the condition for several months and it's getting old. Some days I go hours without coughing, and some days I spend hours coughing. Can you offer any sage advice?
    DEAR READER: Your doctor has more work to do to diagnose your cough, which could be secondary to a low-grade lung infection, bronchitis, allergies (that you haven't been tested for yet), asthma, heart failure or a peculiar reaction to certain drugs, notably ACE inhibitors. Return to your doctor for additional testing. If he defers, ask for a referral to a pulmonary specialist.
    To give you related information, I am sending you a copy of my Health Report "Pulmonary Disease."
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