How important is the physical exam in medical oncology?

[futuredoc484]

The physical exam is obviously really important for surgical oncologists and radiation oncologists will routinely do DREs, pelvic exams, breast exams, flexible laryngoscopy, etc.

I am curious how important the physical exam is in medical oncology? Do medical oncologists tend to perform DREs, pelvic exams, laryngoscopy like rad oncs?

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[gutonc]

The physical exam is obviously really important for surgical oncologists and radiation oncologists will routinely do DREs, pelvic exams, breast exams, flexible laryngoscopy, etc.

I am curious how important the physical exam is in medical oncology? Do medical oncologists tend to perform DREs, pelvic exams, laryngoscopy like rad oncs?

Pelvics and laryngoscopy aren't part of the routine physical exam. Gyn Oncs usually see the Gyn patients and will do those exams. As an internist, I was never trained in laryngoscopy, nor did I do that during fellowship. And I don't bother with the DRE because I know that, for my anal and rectal cancer patients, their Rad Oncs and surgeons are sticking their fingers up there on the regular. One more finger won't change the treatment.

 

[DoubleBogey]

Pelvics and laryngoscopy aren't part of the routine physical exam. Gyn Oncs usually see the Gyn patients and will do those exams. As an internist, I was never trained in laryngoscopy, nor did I do that during fellowship. And I don't bother with the DRE because I know that, for my anal and rectal cancer patients, their Rad Oncs and surgeons are sticking their fingers up there on the regular. One more finger won't change the treatment.

Unless they’re having active symptoms...like bleeding

 

[HoldTheCoffee]

I'm not sure I would even in that circumstance if it were someone with a known rectal cancer ... not sure how a DRE in that case would drastically change management

 

[gutonc]

Unless they’re having active symptoms...like bleeding

Are you going to go full on "Little Dutch Boy" and just keep your finger in there until the bleeding stops?

As a medical oncologist, in the office, I have essentially no tools to manage anything like this other than some gauze and a few butterflies. If a patient comes to me with active bleeding, they're getting the f*** out of my office as fast as I can spirit them out the door. Hopefully before they even get past the front desk.

 

[HemeOncHopeful19]

I haven’t done a DRE in 6 years ever since I had interns that could do it.

Pelvic exams I couldn’t tell you but I hear Gyn Onc does them a lot (which actually drove me to pass on that elective)

Breast exams in fellowship we do with every breast patient but honestly I suspect if you did a study they wouldn’t make a measurable difference, unless MAYBE they are actively on neoadjuvant treatment and you can catch a treatment failure early (very rare). I have a relative who is in remission and she can’t remember the last time she had a breast exam on the private side.

This is the fellowship for people that want to keep their hands (and shoes) clean but aren’t afraid of some serious illness.

 

[gutonc]

Sorry to bump an old thread, but would someone kindly elaborate on what the typical heme/onc physical exam entails? One of the reasons it appeals to me is that it seems primarily cognitive/cerebral. How often does a medical oncologist get hands-on with DRE/pelvic/breast exams (I understand from the above exchange that it isn't routine, but still wondering about the frequency)? Was there a difference in your physical exams in fellowship vs practice?

Thanks for the info!

@gutonc

I do breast exams for patients on neoadjuvant therapy every 4-6 weeks just to confirm a clinical response. I have a few (weird) patients who demand one every visit but the data to support the sensitivity of a screening CBE is so poor that it's essentially performative (not unlike most of the rest of the clinical exam).

Pelvic exams are why Gyn Onc exists. We don't have the tools, or even the correct exam tables to be able to do them even if we wanted...which we don't.

As I tell all my rectal and anal cancer patients, "one more finger up your butt isn't going to change my treatment recommendation" so I don't do it.

 

[Mehena]

"The art of medicine consists of amusing the patient while nature cures the disease"
Either you're supposed to tell jokes or do unnecessary physical exams & manuvers. Also your Press Ganey review score could improve greatly as a result.

 

[gutonc]

"The art of medicine consists of amusing the patient while nature cures the disease"
Either you're supposed to tell jokes or do unnecessary physical exams & manuvers. Also your Press Ganey review score could improve greatly as a result.

Jokes go a lot farther in that realm than fingers up the butt.

 

[HemeOncHopeful19]

I do breast exams for patients on neoadjuvant therapy every 4-6 weeks just to confirm a clinical response. I have a few (weird) patients who demand one every visit

Both made me laugh because I always thought you exclusively see GI onc.

“How’s that FOLFOX going? That’s great to hear! Now time for the breast exam!”

 

[Mehena]

Jokes go a lot farther in that realm than fingers up the butt.

Legend 🙌

 

[gutonc]

Both made me laugh because I always thought you exclusively see GI onc.

“How’s that FOLFOX going? That’s great to hear! Now time for the breast exam!”

GI is my area of interest but I'm technically a generalist so see everything. Over the past decade, I've managed to shift my practice to be 70-75% GI on new patients, but the hospital where I practice sees roughly half of the breast cancer cases in the entire state (due to one of the surgeons there) so a lot of my patients have breast cancer. And those people never die, so you just keep accumulating them.