For those doctors contracted to work at a county facility or community mental health center or indigent clinic or hospital, there is a local staff person in the room with you (often a nurse, and if not a nurse, then a nurse is available upon request). Amazingly, quite quickly you become adept at using other people's hands and ears and nose to provide you with the information that you need. You are also expected to work with the patient's local primary care physician to coordinate a physical exam to address whatever issue you feel needs to be addressed in such a way and to make sure that the patient has a general physical on a regular basis as clinically appropriate.