I am old enough to remember standing shirtless on a chilly afternoon in the school gym lined up with my fellow teammates while a volunteer doctor went down the row clearing us for school athletics in a medical assembly line. This scene has been a familiar rite of passage for generations of student-athletes. However in this day of modern preventative medicine, is the sports physical the best we can do to assure a child’s well-being?
Most major medical organizations now recommend that school-aged children obtain an annual comprehensive physical in their medical home performed by their own doctor. These visits include much more than just a medical exam. A child’s developmental and school progress is addressed as well as screening for serious problems such as depression, vision or hearing impairment, and sexually transmitted diseases. Blood testing is often performed and immunizations are provided. Clearance for sports participation is also done at this time, and appropriate paperwork is then filled out.
But the much briefer sports physical is still present in the marketplace as an option to families. These days, this type of physical is not likely to be performed in the school gym. Often, it is performed on a cash-only basis by retail pharmacies looking to make a quick profit. The patient’s medical record usually is not available. Immunizations are not routinely administered, and any medical, psychological and developmental concerns are often not addressed. Although parents are usually asked to follow-up for a comprehensive physical in their medical home, few parents actually come in for a second physical. In many respects, it is a missed medical opportunity whose sole purpose is to fill out a school form.
I worry that sports physicals are doing more harm than good. It is being substituted for a comprehensive physical exam in many cases. A child’s health is jeopardized when immunizations are not kept current, and various psychosocial needs are not addressed. Sports physicals performed by anyone other than the child’s physician also violate the important medical home concept. The counter argument that I sometimes hear is that physicals offered by retail-based chains are quick, cheap, and easy to obtain, and that is why they may be preferred by some families. I do not disagree. However, we should not settle for cutting corners when it comes to children’s health.
On a systemic level, if schools wish to mandate a physical exam, they should insist on a comprehensive physical performed within the student’s medical home. This should be required for athletes and non-athletes alike. In this way, we can assure that all children are receiving the best preventative health care possible.
Hugo Scornik is a pediatrician.
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