There are about 175 k male and female high school athletes in the State of Georgia each summer during July or August that are required by their high school to get a “sports physical”. Without any professional guidance, parents are left to fulfil this obligation for their student athlete, usually at the last minute, with whatever resource they have available at the time.
The Georgia High School Association (GHSA) annually publishes a “Pre-Participation Physical Exam” form or ‘PPE” required by most schools to be submitted, signed and dated by a medical professional, by adolescent ‘s and their families for them to be eligible to play sports. Modified forms are used by some schools, however all require a physical exam and signature by a health professional.
Parents then must schedule an appointment with their general pediatrician or family medical clinic which they may not have visited since last year’s annual evaluation. Many parents choose to go to a ‘minute clinic’ at a local pharmacy, staffed by mid-level providers, who will gladly review your student athletes personal and family history, provide an examination, and if all is in order, will sign and complete the form. However, parents must beware the pitfalls discussed below.
The GHSA PPE form is a personal targeted medical history intended to identify “high risk” young athletes that may be at risk for unexplained Sudden Cardiac Death (SCD), non-cardiac death or serious injury from playing sports.
The GHSA form contains about 55 targeted questions centered around your athlete’s ‘General Health’, ‘Heart Health’ and ‘Bone and Joint Health’. It also asks about ‘Family Heart Health’. While the form is not guaranteed to identify and protect your student athlete from all potential hazards of sports participation, it is widely accepted as the best ‘evidence-based’ survey instrument available currently to screen your young athlete.
Many parents and their children hurriedly answer the medical history questions while sitting in their neighborhood pharmacy waiting for their turn to see the Nurse Practitioner in the minute clinic, after all the form is due this next weekend! While the providers in the Minute Clinics are licensed and well trained, they have most times never met you or your children and have no clinical history on which to base their clinical decisions.
Thus, there are many families who go to the Minute Clinic for expediency’s sake and answer one of the health questions in a positive manner, such as “Have you ever felt lightheaded or short of breath during exercise” or “Does anyone in your family have a heart problem”. These “Red Flags” are a dilemma for the Nurse Practitioner who must decide whether to sign off on your sports form or not.
As the minute clinic provider has no further information or documentation concerning these problems identified or their severity, despite the mother’s plea that is “was nothing” to worry about. The N.P. , after reviewing the record, taking vital signs and examining your student athlete, likely will not sign the form and recommends you go to your Primary Care Provider for evaluation.
Notwithstanding the cost and inconvenience of the first visit, you call you pediatrician’s office, and the next available “sports physical” is in two weeks. You plead asking them to fit your student athlete in the schedule so that he/she does not miss try outs. Having been a long- time patient of Dr. Happy’s practice they double book you the next day, late Friday afternoon.
By Friday’s appointment your adolescent athlete and you are stressed out, nervous and impatient. You are finally in the exam room late in the afternoon and Dr. Happy comes in and comments how long it has been and how much Sally has grown.
A cursory look into Sally’s medical record indeed reveals that she at four years of age saw the Pediatric Cardiologist for a “cardiac murmur” and that a small “Intra Atrial Communication” (a benign hole in the heart) was seen on echocardiogram. Also, Sally’s EKG identified some “Benign Premature Atrial Contractions” or PACs.
Dr. Happy’s face is not as cheerful as before when he informs you that Sally must see the Pediatric Cardiologist again to “make sure” the cardiac lesions and arrythmia identified 12 years ago will not interfere with her sports participation or place her at risk for SCD.
You cannot believe your ears and Sally is turning RED with anger. However, you smile, take the unsigned form that now has written on it twice “Not Cleared for sports until further assessment completed”, pay your Co Pay and you drive home in silence.
Luckily while driving, you remember the charming Pediatric Cardiologist, Dr. Eduardo Montaña, who told you and your then four-year-old sweet, beautiful girl “not to worry both conditions will resolve by themselves”. You took him at his word, and for that reason did not go for the recommended two-year follow up to document resolution of the issue.
Luckily, Dr. Montaña’s office fits you and Sally in as the last appointment on this busy Friday and you go straight to his office. His smiling staff is waiting for you and Sally and place you immediately in the exam room. Having been through this scenario many times over the years, Dr. Montaña comes in right after and explains that this “happens all the time” and he understands greatly inconveniences families. You both discuss that “there must be a better way to screen your Student Athlete” (stay tuned to Part II to find out what that is)
Within no time, Dr. Montaña’s excellent clinical staff has completed Sally’s vital signs and EKG and she in the Echocardiography room having her imaging study. As the echo is finishing Dr. Montaña returns and announces he has been viewing the echo and clinical data in his office and “everything is just fine!”
He hands you back the GHSA sports participation form, now signed, dated, and stamped by Children’s Cardiovascular Medicine as “Cleared for all Sports Participation Without Restrictions”.
You are again in your car, now with a smile on your face in awe that the pediatric cardiology visit took less time than the Minute Clinic. You ask yourself, maybe we should come back to Pediatric Cardiology annually for the “Sports Physical”, but then you wonder how your pediatrician would feel about that.
Sally meanwhile goes on the Children’s Cardiovascular Medicine’s Facebook page and views all the happy reviews and posts her own, “Dr. Montaña and his staff are cool and got the job done!” and mom tells her friends to think twice about the minute clinics for sports physical if their student athlete has a previous medical condition or history that will trigger another referral. Dr. Happy meanwhile is still at his general pediatric practice at 6:30 pm seeing other last-minute “Sports Physicals”” that just had to be seen today!