Adolescents represent the most underserved group in healthcare

-A A +A

The Preparticipation Physical Exam, or PPE, commonly known as a sports physical is performed over six million times in the U.S. annually and may be the only contact an adolescent or teen ever has with a physician.
In fact, adolescents represent the most underserved population in healthcare. Traditionally, parents have viewed the PPE as a yearly, comprehensive medical evaluation, whereas physicians have held that it is more of a cursory exam in which possible limitations to sports participation may be identified.
As pediatricians, I think we do a pretty good job of facing the reality that the PPE, and also the camp physical, has often times become our one chance at providing healthcare to these young athletes and identifying secondary issues that might affect their health and well being.
The primary goals of the PPE are to detect conditions that might predispose to injury, detect conditions that might be life threatening or disabling, and to meet legal and insurance requirements, although it feels a bit annoying to write that last one.
Secondary goals include picking up on issues such as delinquent immunizations, high risk behavior involving smoking, drug abuse, sexual behavior, performance enhancing supplements and also mental health concerns, such as depression or anxiety.
As with any form of healthcare it is difficult to accomplish these goals without first making that connection to the athlete.
This is the “care” part of healthcare and is one reason why it is important to set aside more time to do a PPE. As with every visit, we are charged with the task of meeting that patient’s needs, whatever these might be.
My experience tells me that we must be able to listen with an empathetic ear and be quietly astute in our observations.
So while we are asking you to turn your head and cough we should also be able and willing to read the signs that tell us about social withdrawal or strained parental relationships, for example.
The PPE has been found to disqualify less than 2 percent of athletes from participating in sports. Of these, the vast majority are because of cardiovascular and musculoskeletal concerns.
Guided questioning about any history of fainting or chest pain with exercise or family history of sudden death under age 50 may help in identifying such things as hypertrophic cardiomyopathy or prolonged QT syndrome, for example; but these can be difficult to pick up on and most (97 percent in one retrospective study) instances of sudden death, thankfully very rare, would not have been discovered on routine history and physical.
Not surprisingly, 92 percent of orthopedic injuries are detected by history alone.
In the early 1990s, a six author society task force published a monograph on the PPE and provided updates every 3-5 years, most recently in 2010. This serves as our template for practicing nationally standardized guidelines in the performance of the PPE and ensures consistent, high quality exams.
This task force found that among other things, guided questioning about family history is crucial and that routine blood and urine screening tests are neither warranted nor cost effective in asymptomatic young athletes. A copy of the Los Alamos Public School PPE form is posted at www.drtomchildhealth.com.
I believe that the health of our children is everyone’s destiny.
Dr. Thomas Csanadi
Los Alamos

Editor’s note: Thomas Csanadi, MD, is a local pediatrician who recently opened Dr. Tom, Child and Adolescent Medicine. He will be a regular contributor of  columns that focus on health related issues.