For the past six years I have the privilege of doing physical exams on candidates for the military services. I am amazed to see young men and women who have never had a physical, some who have never seen a doctor, and many who have had only sports physicals.
Last week I saw an 18 year old man who said he had had lots of sports physicals. When he took off his shirt off his chest asymmetry was obvious. He also had marked scoliosis and it was readily apparent that his right leg was much longer than his left causing him to walk with a limp.
Didnt your doctor mention this when he did your sports physicals? I asked.
No, he responded. He never had me take my shirt off, so I guess he didnt see it. All he did was listen to my heart and run out of the room.
In the opinion of the American Academy of Pediatrics and the Academy of Family Physicians, such an exam is totally worthless and yields no valuable information to the doctor or the athlete.
Before we go on, I should say a word about The Health Insurance Portability and Accountability Act of 1996 (HIPPA). As strange as it seems, this legislation prohibits physicians, counselors, teachers, or other professionals from discussing with a childs parents any kids involvement in drugs, alcohol, sex, pregnancy, or any psychological problems.
Although we might both disagree with HIPPA, if a teen tells me something I know a parent should be aware of, I will make every effort to get permission from the kid to discuss it with them and the teen. I tell both the parent and the patient that if I think the teen has a fatal disease, is in danger of hurting himself (suicide), or others (homicide), my conscience will make me violate that law.
A physical, or more correctly, a health evaluation has four parts. First we try to find out if youve been healthy, then we exam you to determine if you are healthy, and finally we try to figure out if youre going to stay healthy, and if not, what can we do about it.
The evaluation begins with a review of the teens immunization record, his past illnesses, injuries, surgeries, and family illnesses. Other issues like school, work, exercise, and health habits are also discussed here and again later. Unless the teen is 18 or over, a parent should be present to help recall health events and fill in the blanks.
The second part of a health evaluation is a standard physical examination. For this part, teens should be seen alone or with a same sex chaperone. They will be examined, undressed (in a gown), from the top of their head to the bottoms of their feet. Unless a girl has had sex she does not need an internal pelvic exam, but the external genitals of both girls and boys should be examined. Boys should be taught how to do testicular self-examination. Teaching gives them valuable information about their own health maintenance, diminishes the embarrassment of the exam, and opens the door for questions. Girls over the age of 16 should be taught breast self-examination.
The third part of the evaluation is a discussion, without their parents present, about physical or emotional stressors teens may have. In this part we talk about STRESSED, an acronym for School, Teens (peers, siblings, family, parents), Religion (Values), Exercise, Safety (seat belts, bike helmets, gun safety), Sex, Emotions (anger, depression, anxiety, compassion, love) and Drugs (alcohol, tobacco). By the second or third time I see a teen, they are anxious to tell me if they are STRESSED and why.
The final part of the evaluation is a conference with the parent(s) and the teen. To discuss any issues the parent or child has, encourage the good health habits they have established, suggest changes they might need to make, and provide needed immunizations, lab or x-ray studies, and/or treatment.
Health evaluations are best accomplished by a doctor who knows the family, the teenager, and who shares a mutual respect. It cant be done effectively in a walk-in clinic or in 10 minutes. I reserve 30 minutes and usually need about 40.
I ask families to schedule the exam in the teens birth month, and if they need an exam for camp, school, sports, or any other reason in the next year, get the form to me and Ill complete it.
A sport physical cant substitute for a health evaluation but, a health evaluation is a sports exam and more.
For a more complete discussion of what a teen health evaluation should be, check out a copy of Messengers in Denim, at your local library. You will be especially interested in Appendix B, Review of Health Habits.