The art of the sports physical
Sunday, July 21, 2013 10:00 PM
The new school year is rapidly approaching. Most of the youth in Montgomery County participate in some type of organized school sport. The IHSAA requires high school athletes to have a yearly PPE or "Pre-Participation sports Examination." Many junior highs or middle schools and even grade schools are now requiring them before allowing athletes on the field.
Dr. John Roberts is a Crawfordsville physician and one of the owners of The Paper. In addition to his weekly column, he writes a daily health tip that can be found on page A1.
Unfortunately, some athletes and families see the PPE as an unnecessary hurdle they have to jump and want to get it over with as quickly as possible. This mind set has resulted in schools or other organizations setting up mass screenings for athletes. These involve setting up multiple "stations" to complete the PPE. For example, one station might review the athlete's medical history, another might do the blood pressure, another the heart and lung exam, etc.
While these screening events are convenient, and often less expensive than seeing one's private physician, I am here to make the case against using them if possible. First of all, if an athlete has a family doctor or pediatrician, they have likely followed the athlete for a number of years. They therefore have a unique relationship with the athlete that improves the depth and quality of the PPE. If something is discovered during the PPE it's also much easier to have it taken care of then and there.
Let me first address the health history. This is without question the most important part of the PPE form - athletes and parents should fill it out completely. Doctors focus their exam of organ systems based on the answers and explanations given in the history. These histories are often incomplete. This can be due to the athlete or parents not feeling it is important, or more commonly because they have simply forgotten the information.
These omissions are more likely to be discovered by the athlete's private doctor since he or she has access to the health history in the patient's chart. They may not be discovered in a mass screening environment.
The actual physical exam portion of the PPE is also very important, especially the heart and lung exam. While this is possible in a noisy gym, I would much rather have my athlete's exam done in a quiet exam room in the doctor's office where subtle heart murmurs may be heard.
Lastly, one of most important reasons for doing the PPE at your doctor's office is that it allows the doctor to address age-appropriate topics in a private environment. Family physicians and pediatricians often don't see pediatric patients after their kindergarten physical unless they have an illness or injury. The adolescent years, when the bulk of these PPE's are performed, are a critical time of psychosocial development.
It is very difficult, in a room crowded with other athletes, to discuss anxiety, depression, sexual development and risky behaviors such as sex, tobacco, alcohol and drug abuse. It's also a good time to review immunization status and discuss newer vaccines for young women.
I try to make it a point to ask what the athlete's aspirations and future plans might be. It's really a great time to gain or re-gain trust and rapport between an adolescent and a health professional that they can come to if they have problems during their teen years.
I hope that you can see that, while convenient, mass health screenings are not necessarily the best place to address an athlete's health.