The Value of the Physical Exam

Free image - Pexels

The other day I went to the salon to have my hair cut. My stylist, who I love, got a new puppy and was realizing just how expensive it is to go through all of the puppy exams, dewormings and vaccines. She hasn't even gotten to the neuter surgery yet. She said, "Ugh! It's so dang expensive! It's an exam fee every time! Sometimes I think they just say things need to be done to charge more."

I've known her for a little while now, so I said in response, "Hey! That is not true! You take that back!"

She said, "Alright alright, I'm sorry, well not you! Its just so much money."

Now, my exam fee at my practice is $58 for a nose to tail exam. (It's about $65 for an exotic, $85 for an emergency). The cost for my haircut:  $70. The cost for a cut, balayage color treatment and style: $300. Plus tip.

My $58 exams include the following: consultation that includes answering every question the owners have and some questions they didn't even know they had, nutrition counseling, behavioral counseling, training tips and resources, complete history taking for the current problem(s), physical exam which includes examining the following body systems:

1. Cardiovascular (listening to the heart and checking pulse quality and consistency) - When your doctor listens to your heart, s/he is not just taking your pulse. I am listening to the rhythm of the beats, listening for irregularities in rhythm or strength, listening to the clarity of the sounds, listening for extra sounds such as clicks and murmurs, checking that the pulse rate matches the heart rate, and of course measuring the pulse and whether it matches the situation at hand. I check the mucus membrane color in the mouth for color and moisture.

2. Respiratory (listening to the lungs) - I am listening to the breath quality, the rate of breaths per minute, the effort of breathing, the actual sounds themselves: are they harsh? too loud? too quiet? crackly? wheezy? too fast? too slow? too shallow? too deep?

3. Musculoskeletal (body condition )- I'm checking how close the patient is to their ideal weight. Is there too much fat? too little? I'm checking the muscling. I'm checking for normal stance, ambulation, and carriage.

4. Integument (skin) - I see a lot of skin cases, so I'm looking at the surface of the skin to check for external parasites like fleas, ticks, lice, mites. I'm looking at the skin itself to look for normal, or is t too dry, too moist, too red, too scaly? Is there evidence of infection? Is there evidence the pet is scratching, chewing or licking? Is the hair coat shiny, clean, and healthy or is brittle and broken or is there hair missing? I'm checking the skin in the ears, in between the toes, and all over the body.

5. Gastrointestinal (mouth, abdomen, anus) - I check the teeth for health, gingivitis/periodontitis, look for masses in the mouth, smell for odor. I palpate the abdomen to feel for the stomach, liver, spleen, intestines and colon. I check underneath the tail to make sure everything looks normal. I rectal to look for masses in the area (*disclaimer - I don't rectal everything).

6. Urinary (kidneys, bladder, external genitalia) - I palpate the abdomen to check the size of the kidneys and urinary bladder and evaluate the external genitalia for any abnormalities.

7. Eyes - I look at the external eyes and eyelids for brightness, discharge, swelling, crusts, masses. I look at the eyeball and the inside the eye to evaluate for abnormalities.

8. I'm looking for external clues that might tell me if there is a problem with the endocrine or lymphatic systems.

9. Nervous (nerves) - I'm checking for abnormalities with the nervous system while I'm looking at the face and other areas. Depending on the complaint or what I find above, I may do an extended physical that includes a full orthopedic exam or a full neurologic exam.


Once the exam is finished I inform the owners of the findings, discuss the current working diagnosis, formulate a differential list, and then make a plan for tests that will help us get to a definitive diagnosis. I do it all in a methodical and streamlined fashion so I am able to complete my exam and consultation in 10 to 30 minutes depending on the case difficulty, with additional follow through in many non-routine exams.  I do all of this for the bargain price of $58.

Additional recommended tests, medications, vaccines, are compiled onto an estimate which is presented to the owner. I can't do bloodwork, xrays, surgeries etc for free. Just like the stylist can't spend 2 hours doing a balayage treatment for free. People must charge appropriately for their time.

My stylist told me I should get my hair done more often. I told her I would, if it wasn't so expensive.


___________
**I love my stylist and this post is not meant to pick on her, obviously I happily pay her for taking care of my hair. It is just meant to illustrate the differences in the way people feel regarding vet care vs other types of care, and to explain what actually happens during those physical exams.

***Don't even get me started on what people pay dog groomers.