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The Sport Physical: Insanity and Magic

A father stands anxiously at the window to our reception desk, shifting his weight from side to side, clutching at a piece of paper.  “ My son can’t play football unless this form is signed, and practice starts this afternoon.  Can’t you help me?”  
“Unfortunately,” explains my receptionist, “We are booking out 6 to 8 weeks for a well check up.  Our same day appointments are set aside for patients with serious, acute illnesses, and besides, sport physicals are not covered by insurances.”  
“What am I supposed to do?”  asks the distraught parent.  The receptionist gives him a sympathetic look and hurries to answer the persistently ringing phone.  Some desperate families actually go to the emergency room to get their sport physical forms filled out.  Thus the insanity of the sport physical season plays out.
Typically, the required paperwork is handed out to families in late July, and the school system expects physician offices to to see all student athletes in a two week time period during the first half of August.  Sorry, but that is  logistically impossible. We do actually have sick people to take care of. The school system’s insurance won’t allow the coaches to allow the athletes to play unless the sports physical form is signed.  
I’ve spent years wondering why this was required, and I think I have finally figured it out:  The sports physical form is magic.  With this miraculous piece of paper, no student athlete will ever get sick. Nor will they suffer any type of cardiac arrhythmia during play, nor will they be harmed in any way by their chosen sport, and if by some chance they are hurt in course of play, they will never, ever sue the school.  Amazing.
A teenage boy was undergoing his well child check up with me, and I asked if it would be okay if I did a hernia exam.  He told me that he already had that done last month.  I checked the chart and saw no record of a visit in our office, so I asked if he was sure, and he said the school had done it at the gymnasium.  Some “old lady” he didn’t know “poked around down there and said I was okay”.  Wow.  And this type of activity is supposed to decrease a school’s liability?  I’m not a lawyer, but it seems to me that allowing an athlete to run around on a football field while he awaits an appointment for his annual physical would incur less liability than allowing a volunteer to undress boys in a school gymnasium and examine their genitalia.  But what do I know?  I’m just a doctor.
At Eureka Pediatrics our medical records are confidential, but even so, for personal topics we have a “counseling section” where we can further restrict access to the information.  Conversely, the most commonly used school sport physical form blatantly violates the student’s confidentiality.  The form has about 6 questions at the top asking students to check “yes” or “no” boxes indicating ...whether they are depressed, suicidal, abusing drugs and alcohol and if they have emotional problems.  The form is in triplicate, and is clearly designed to have copies go to various departments within the school.  What part of “MEDICAL INFORMATION IS CONFIDENTIAL”  do the school lawyers fail to comprehend?  The form blatantly violates HIPPA laws.  This is supposed to reduce liability?  I just don’t get it.  Can you imagine having your patients fill out a personal, medical questionnaire in triplicate and then distributing it in an indiscriminate fashion?  Your malpractice carrier would be on the phone with you so fast it would make your head spin.  

Schools put out pleas for doctors to volunteer to line up a bunch of athletes in a gym and pass a stethoscope across their chests and pronounce them “fit to play”.  I am all for volunteerism, but I think if a physician donates his or her free time it ought to be for the purpose of helping poor, sick people, not relieving the school system of an unreasonable obligation that it has placed upon itself.  It is unfortunate that the school’s liability insurance requires this, but the sport physical does not make sense medically.  Children should have an annual well child exam (in any month of the calendar year--not just August) in their medical home with primary care provider, and that should suffice to clear them for sports.


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