Hidden Conditions
I know some examiners that have high volume practices and don’t require commercial drivers to disrobe for a DOT physical.
Here’s an interstate driver who popped into a truck stop restaurant to wolf down a burger and fries.
Some would argue that this condition is not likely to be the immediate cause of an accident.
Until the development of an acute deep vein thrombosis or a pulmonary embolus.
But it might prompt an examiner to consider other cardiovascular conditions, and consider risk factors of obesity, possible diabetes, sleep apnea, etc.
How would you certify such a driver?
If multiple conditions are uncovered during the DOT physical “teetering on the edge” one might submit a “determination pending” to allow a complete work up with the primary doctor. Or you could go anywhere from a few months to a year to monitor progression and see if any other conditions rear up. I doubt I’d feel comfortable giving a full 2 year certificate at any rate.
Similarly, many a chest or abdominal surgical scar is missed by not making a simple observation. Joint swelling, bruising, petechiae and rashes can all be missed. I’ve even heard of an examiner not knowing a driver had a prosthetic leg because he never looked!
Make the driver disrobe for their DOT physical. Unfortunately, they’re not all going to be completely forthcoming regarding recent or past surgery and so many other conditions you can pick up with simple observation.
How would you handle the driver above? Let us know in the comments section below!
Download this Free Occmed Primer
I definitely believe the drivers should disrobe. I agree that undisclosed conditions may be identified. I like the advice to consider monitoring a condition like this in 3 to 6 months to be certain it is stable and then granting a one-year certification.
I have the male drivers remove their shoe, socks and shirts with a gown being offered if desired and female drivers socks and shoes and remove their blouses/shirts to the last outer upper garment (T-shirt, blouse, etc.). I can examine the legs of the male drivers when they lower their pants for the hernia exam. I have had non-disclosures (whether intentional or not). One driver put ‘no’ on all the answers to find by discovering scars that he had a hip replacement, part of a lung removed as well as one kidney. Another failed to report bypass surgery that was discovered when I asked about the scars on his lower legs (graft harvest sites) seen before even examining the chest – he asked if I could just make believe he was wearing socks and I didn’t see them. Some of my colleagues, however, disagree with needing to disrobe drivers at all.
Wow how could they not be convinced with sharing your experience?! Thanks Stuart.
I am incredulous that FMCSA MRB reccomendations do not REQUIRE drivers disrobe.
In this case due to diabetic neuropathy it is very likely the driver can’t feel his feet and ankles causing a grave concern in safe CMV operation.
Last an examiner might be saving the drivers life by spotting early signs of infection. Sepsis and resulting mortality in cases like this are common.
Being the driver that snapped this photo you as an examiner have a teachable moment during the exam. Seeing him at the counter I can do nothing.
Having just worked on a “last ride home” for a driver who passed due to sepsis and was in the sleeper for 3 days prior to discovery medical examiners who don’t even have drivers disrobe make my blood boil.
Thanks Bob, I want to reiterate your point that often the medical examiner is the only health care worker a driver may see. This provides the opportunity to not only keep the roads safe, but to refer the driver for needed medical care for his/her own benefit, with the “stick” of a “determination pending” or short term certification until needed care is assured.
Too often, though, I get comments from drivers that they can’t afford a sleep test or other needed services. I suppose many are independent and don’t carry the motor carrier’s insurance plan, but this remains a hurdle to getting adequate care.
For me, I never do a DOT exam unless the patient is undressed to their underware.
My reasoning (besides good medicine) is that if a driver that was cleared by me has an accident scrutiny will flow backwards in my direction. I would prefer to defend my self having examined the patient thoroughly. How many times have you heard from patient that examiners “didn’t even examine me” or “I didn’t even have to take my clothes off”?
Yes! Reminds me also of the power of “touch” in medicine, more so in the healing process, but the “laying on of hands” reveals much not only from palpation but from the patient response – apprehension/withdrawal vs. relaxation/acceptance. A touch that respects that response learns and adapts further evaluation appropriately – understanding of discomfort felt, guidance for further recovery, reassurance for next diagnostic steps, etc.
In the case above, feeling the warmth of impending phlebitis or demonstrating pitting edema or loss of sensation could be enough to prompt genuine concern impressed upon the driver to take needed actions. “The Carrot”
And if all else fails, issue a determination pending or short term certification. “The Stick”
Or probably both.
Drivers claiming they can not afford medical care are not being entirely truthful.
There is a charity The Christopher Truckers Development and Relief Fund which will provide assistance with needed medical care, assistance with bills if time off work required and in cooperation with the American Sleep Apnea Association will do an HST and provide Cpap for qualifying true charity driver patients for $100. Many osa vendors will do weekly or monthly payments for drivers without insurance or with high deductible plans.
It’s education for both drivers and medical professionals on how to handle these challenges.
Bob, this is great information. I did not know about this and I get often get questions from truckers not able to afford needed tests. Now I have a resource to refer them to, thanks so much.
The truck driver should be treated as any other person that comes in for an examination. Much information can be missed for not performing a detailed inspection. And inspection is part of the examination process. The driver may not remember all of his medical history or something may seems insignificant to the driver may in fact be very significant when determining whether or not to issue a medical approval to operate an CMV. The driver does not have to be naked. He/she can left with an exam gown , cape and/or shorts for their modesty.
It’s interesting to learn that when multiple conditions had been seen in a DOT physical exam it could result in a few months to a year monitoring before being allowed to drive for an employer. That’s reassuring since knowing that my driver will be healthy is very important. A driver with a potential of having an attack or seizure while on a trip can cause more dangers, stress, and panic than convenience. I sure hope more drivers will undergo the DOT exam and completely get checked for the safety of everyone. Thanks!
I’ve been driving truck for 40 years and never had to disrobe for a dot physical,had many hernia checks by dropping my parents, but my last physical I had to disrobe (get nude) and put on Short’s they gave me that didn’t fit sit there for a hour while nurses would walk in on me and the a lady doctor I never seen before and a nurse came in had me lay down pulled my shirts down one on each side of me to check for hernia, I’ve never been so uncomfortable, embarras in my life this was totally uncalled for.i got a family doctor to do that, the D.O.T Doctors need to do what’s required by fmcsa not what they think should be done, I mean hell, hip replacement,lung removed, broken bones, having diabetes
And other things I see these doctors talk about dose not disqualified you from driving. I guess I just don’t understand why some of the doctors a trying to take a man lively Hood away from him so he can lose everything he worked for.unreal I’m done
Thanks for your comments, Stan. Most examiners would have you keep your underwear on but still don a gown. Unfortunately it’s difficult to check for surgical scars and even limb prostheses without having a driver disrobe. But it should be done in a modest and respectful manner.
I liked what you said about having a patient disrobe for a DOT physical to help diagnose conditions that were not visible immediately. My uncle is beginning to work as a trucker and mentioned to me that he needed to get his DOT shortly, so I am curious about what is looked for. Thank you for the information about how being able to see things more clearly might prompt an examiner to consider conditions and risk factors like obesity, diabetes, and sleep apnea.
My last. Physical was April of 2018, had me get semi-naked with throwaway shorts and gown. When the MD, which was a woman came in had me take the gown off and lower my shorts to my mid thigh. With less judgement of words and not to get to graphic I was covering just the tip, and then she instructed me to lower them further and I was kind of like okay you want to see mr. Johnson, I don’t know what they were looking for but then that was it it was over I passed.
As a “fitness for duty” exam, not a general internal medicine physical, the examiner is just looking for conditions which may interfere with safe commercial driving. Checking for a hernia is part of the DOT exam, perhaps groin pulses for vascular disease, but not usually checking for cancers, such as a rectal or testicular exam.