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“Cough again,” said the doctor.
Out came a weak and miserable “Aack, aack. Ecckk ecckk.”
Shivering, with nothing else on except my underwear, I slowly shuffled along with the other middle school boys in gym class as we moved towards the doctor at the head of the line. It didn’t help hearing the girls giggling on the other side of the gym curtain.
Open your mouth; say “Ahhh.” Take a deep breath. Now drop your shorts and cough.
That was pretty much our sports physical 30 years ago. Like everything else, boy, have things changed.
If we follow all the recommendations of numerous medical and advisory organizations on the school and sports physicals today, it seems that examining every kid would either take hours, or the kids would bolt after the first several questions:
Are you having sex?
Are you doing drugs?
Are you smoking?
Drinking?
Are you depressed?
How’s school?
Do you have any eating problems? Are you eating too much, or too little?
Are you under any stress?
How much time do you spend on the computer, the Internet, Facebook, texting?
Do you wear your seatbelt? Are you a safe driver? Do your friends drive carefully?
Uhhh, did we remember to ask if you’re doing drugs and having sex?
(Sounds like me on the ski-lift with my boys – a great place to ask those questions – no escape; highly recommended).
Even if the visit is technically a sports physical meant to determine whether someone can participate, most insurance will not cover another checkup. And we really do need to ask all those questions. Times have certainly changed, and it truly is more difficult and complicated today for our children.
“Back-to-school checkups are often the only visit most kids and teenagers have with their doctor every year,” says Paul Stricker, M.D., FAAP, and author of “Sports Success Rx! Your Child’s Prescription for the Best Experience.” According to him, “The annual physical gives the physician a chance to give the child a thorough physical exam. It’s also a good chance to address important questions, especially with teenagers, including adolescent issues of drinking, smoking, drugs, sexual activity, and depression.”
Over my career, here are some of the things my patient’s and I have discovered in the back-to-school or sports physicals:
- A number of congenital heart problems ranging from holes in the septum to valve deficiencies, some resulting in heart surgery.
- A few cases of Marfan’s and other genetic syndromes such as muscular dystrophy that was undetected up to that point.
- A 15 year-old who got a big surprise when she learned she was five-months pregnant; she thought she was just gaining weight and didn’t really look large, but the clue was that she hadn’t had a period for a while.
- Kids doing drugs, kids that had been abused, molested, depressed, suicidal or just engaging in risky behaviors.
- Undescended testicles, abnormal breast development, disabling menstrual problems, sexually transmitted diseases, scoliosis, skin cancer; by now you’re thinking: geez, we thought it was just about getting a form signed and getting some shots…..
Immunizations are one of the most important and one of the basic goals of the check-up. We review them, update any shots and then provide documentation to the schools – kind of hard to do if the parents don’t help provide the records, especially when seeing a different physician, so remember to bring them! Ultimately though, there will be an electronic medical record accessible to all with shot records, but that’s another article.
At the exam, doctors then address growth and development from measuring height, weight and body mass index to assessing maturity and behavior, with school performance also a proxy for those.
A careful physical exam is critical. I often think that it’s taken too lightly, almost as an afterthought and just another chore. But that is when we were able to pick up on cases dealing with heart issues, pregnancy and abuse.
With the limited time that everyone has today, it’s important to keep these goals in mind. We often get sidetracked with questions and worries related to the latest stories in the media or on the internet, but these are often not as relevant to the fundamental health of the kids. In summary, these physicals are important and often the only chance physicians have to get a good exam and visit with the kids. It’s not just to get a signature.
Of course, we could get back to the mass screenings, but I’m sure we’d get sued by the government, parents and probably the kids themselves if we ever went back to that long underwear line!
