Physical Exams

Buprenorphine Post
Posts: 104

Postby jmosby1469 » Wed Oct 07, 2015 5:57 am

No touch, what? I see that it pleases thee to jest.

Posts: 183

Postby MChaplin » Wed Oct 07, 2015 5:57 am

Ken- do you think you will do inductions without a documented physical?? I am thinking of doing the problem focused exam- we do have a table- my concern is I do not want to get involved with dressing/undressing or gowns- the exam as described in the guidleines is not unreasonable- and again I think I could do a better job than a doc in a box providing a "physical" for reimbursement- I don't have guidelines accessible but I will cut and paste them when I do- I do believe they include listening to the heart and lungs and****essing liver size and stiffness. I am pretty confident I can do that adequately without having pt underess. I don't think this is thoughtless - I think in fact they are made by real world docs from asam not nonclinical peeps. it is just going to be a hoop that my patients will have trouble jumping through- I ususalyy get them hooked up with a pcp for a physical but not when they first present because getting them stable has been my priority....

Posts: 1404

Postby drpasser » Wed Oct 07, 2015 5:57 am

Most Psychiatrists, like me, do not especially like to actually touch the pts. I do not have an exam table in my office. How can one do an adequate exam without a table? I do not plan to get one.


Posts: 84

Postby DrBallester » Wed Oct 07, 2015 5:57 am

A problem focused exam should suffice:

pupil size, jaundice?
needle tracks?
ankle edema?
diaphoresis, tremor?

If you have an exam table, hepatomegaly?

These items can be documented without any special diagnostic equipment.

Posts: 198

Postby NoDrugs4u » Wed Oct 07, 2015 5:57 am

I'm not a Psychiatrist, I am Family Practice and the definition of "Complete Physical" is very subjective depending on which authority you ask. I doubt a pelvic exam or digital rectal exam should be necessary to initiate buprenorphine treatment. I think the guidelines are another example of non-clinical people making guidelines for those of us in the real world. It would be nice if every patient could get a complete physical, but that is not always practical in the real world of addiction treatment. Sometimes we just have to use our clinical judgement (Gasp!).

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