Guest guest Posted August 5, 2008 Report Share Posted August 5, 2008 Sports exams are to “clear” one for sports as Presurgical exams are to “clear one for surgery. All you can do is find what you can and hope that kids are honest about symptoms and report them. Also educate them as to symptoms to watch for. Face it, most don’t want to drop dead on the playing field. What the public expects, as usual, is unreasonable and impossible so this is for our academies to do some education too. My statement usually says something like “no known contraindication to playing sports” like presurgical says “no active symptoms that would contraindicate surgery at this time and medically stable…” or something like that. In my viewpoint there is more to it than trying to screen out sudden death events as we can’t but hamstring tightness, female athlete triad, diet, calcium, protein, bad joints, etc we can do. We have to be realistic first before we can educate others about what we can do. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of nancy blake Sent: Tuesday, August 05, 2008 7:31 AM To: Subject: RE: Sports Physicals Both Jim and Joanne make valid points on 2 sides of an issue. I do agree that the physical to " clear " the kid is almost never going to yield useful information to save the kids from sudden death, and that is really what the outside world is expecting us to do with these exams. However, Joanne's point is absolutely right, that many of these kids will not get any medical care outside that 3 minute exam. If the only thing that comes out of the exam is identifying a kid in need, Hallelujah! So, I still have not committed to this, we'll see. Thanks for everyone's input. From: Jim.Kennedy@... Subject: RE: Sports Physicals To: Date: Monday, August 4, 2008, 11:34 PM Don't disagree, but as sports physcials to insure that they are safe to play, they have little utility. what you describe is not really the intent of sports exams. ____________ _________ _________ __ From: Practiceimprovement 1yahoogroups (DOT) com on behalf of joanne holland Sent: Mon 8/4/2008 9:31 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: RE: [Practiceimprovemen t1] Sports Physicals In Drain, I do sports physicals for the local team members at $15.00/child in my office only, and fit them in spaces I have between patients. I differ with the people who say these exams are useless at least in this setting. In my office I often am the first one to notice the child needs glasses, I have caught a couple of asthma patients whose parents were not paying attention and I found one color blind boy in the last three years. One of the teens was nearly clinically blind, but didn't tell his parents. The children here don't necessarily see a physician, if the parents don't have insurance, unless they are very sick and then they see an urgent care doc who may not do an eye chart. I also use the exam as a chance to direct the kids about how to use the public health clinic to get birth control if they need it, and to address how to avoid sports injuries if they have some physical variance such as hypermobility or very high arches. Also, with the exam cost as low as that, I make very good advertisment for my office. It brings people back to see me later. Joanne Holland MD/DVM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2008 Report Share Posted August 6, 2008 Your decision Myria. Think Spider man. I wouldn’t want my signature on a form saying he’s healthy after a cursory look over and have a spinal injury occur. Just because that is all “they require” doesn’t mean that is all that is prudent. But I am cautious. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Myria Sent: Tuesday, August 05, 2008 8:23 PM To: Subject: Re: Re: Sports Physicals It's for adult amateurs and this young man approached me and I would hate to back out now -- he would have to cancel his show that's in 3 days. Not even a full physical, check for spinal abnormalities and vitals is all it ask for on the sheet. From: brenthrabik Subject: Re: Sports Physicals To: Date: Tuesday, August 5, 2008, 12:27 PM concentrate on the things that make a difference like immunizations, seat belts etc. The rest of it is pretty much cover your butt for school systems. I do not like the idea of taking it out of the office because of not developing relationships. Brent > > From: nancy blake <nancycblake@ ...> > Subject: [Practiceimprovemen t1] Sports Physicals > To: " IMP Group " <practiceimprovement 1yahoogroups (DOT) com> > Date: Monday, August 4, 2008, 8:55 AM > > Anyone doing these? I have been asked by a local group of Pop Warner football to do their sports physicals. Easy money. The concern is the legalities. Of course, any abnormal findings the kid gets referred back to their PCP. I don't want to rack up lawyer fees to have my lawyer look into it, negates the money I would make. Any ideas, suggestions, comments, thoughts, warnings? > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2008 Report Share Posted August 7, 2008 Actually its long QT, asymmetric septal hypertrophy and anomalous coronary artery. ________________________________ From: on behalf of Sent: Wed 8/6/2008 7:48 AM To: Subject: Re: Sports Physicals Graham- yes Joanne- virtual hug. On Tue, Aug 5, 2008 at 10:29 PM, Graham Chiu <compkarori@... > wrote: Don't sports guys who have sudden death die more from unsuspected cardiomyopathies and short qt syndromes? On Wed, Aug 6, 2008 at 2:21 PM, nancy blake <nancycblake@... <mailto:nancycblake%40yahoo.com> > wrote: > Good idea, but if I don't par with their insurance, or it's an HMO that > requires you to see only your declared PCP, then the insurance thing is out > unless they are your patient for good. > > > > > In Drain, > > I do sports physicals for the local team members at $15.00/child in > my office only, and fit them in spaces I have between patients. I differ > with the people who say these exams are useless at least in this setting. > In my office I often am the first one to notice the child needs glasses, I > have caught a couple of asthma patients whose parents were not paying > attention and I found one color blind boy in the last three years. One of > the teens was nearly clinically blind, but didn't tell his parents. The > children here don't necessarily see a physician, if the parents don't have > insurance, unless they are very sick and then they see an urgent care doc > who may not do an eye chart. > I also use the exam as a chance to direct the kids about how to > use the public health clinic to get birth control if they need it, and to > address how to avoid sports injuries if they have some physical variance > such as hypermobility or very high arches. > Also, with the exam cost as low as that, I make very good advertisment for > my office. It brings people back to see me later. > > Joanne Holland MD/DVM > > > > -- Graham Chiu http://www.synapsedirect.com <http://www.synapsedirect.com/> Synapse - the use from anywhere EMR. -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2008 Report Share Posted August 7, 2008 I'm behind in emails, so perhaps others have answered.But, as I understant it, absolutely, that's the most dangerous thing to miss.The real debate is whether an EKG is called for.But, if doing a sports physical, be sure to at least check for changes of heart sounds and murmurs with squatting/sitting/standing as that can uncover outlet obstruction perhaps.Otherwise, I always ask about past joint injuries (badly rehabed joint increases risk for new injuries) and head trauma or concussions. Also double check if any recent mono (big spleen left over from a couple months ago is not a good way to start football season!).... etc.Being a good doc takes more than 5-10 minutes as best I can tell no matter what I'm seeing the patient for.Tim > > > > Don't sports guys who have sudden death die more from unsuspected> cardiomyopathies and short qt syndromes?> > > > Good idea, but if I don't par with their insurance, or it's an HMO that> > requires you to see only your declared PCP, then the insurance thing is out> > unless they are your patient for good.> >> > > >> >> > In Drain,> >> > I do sports physicals for the local team members at $15.00/child in> > my office only, and fit them in spaces I have between patients. I differ> > with the people who say these exams are useless at least in this setting.> > In my office I often am the first one to notice the child needs glasses, I> > have caught a couple of asthma patients whose parents were not paying> > attention and I found one color blind boy in the last three years. One of> > the teens was nearly clinically blind, but didn't tell his parents. The> > children here don't necessarily see a physician, if the parents don't have> > insurance, unless they are very sick and then they see an urgent care doc> > who may not do an eye chart.> > I also use the exam as a chance to direct the kids about how to> > use the public health clinic to get birth control if they need it, and to> > address how to avoid sports injuries if they have some physical variance> > such as hypermobility or very high arches.> > Also, with the exam cost as low as that, I make very good advertisment for> > my office. It brings people back to see me later.> >> > Joanne Holland MD/DVM> >> >> >> >> > > > --> Graham Chiu> http://www.synapsedirect.com> Synapse - the use from anywhere EMR.> > ------------------------------------> > Yahoo! Groups Links> > To visit your group on the web, go to:> http://groups.yahoo.com/group//> > Your email settings:> Individual Email | Traditional> > To change settings online go to:> http://groups.yahoo.com/group//join> (Yahoo! ID required)> > To change settings via email:> mailto:-digest > mailto:-fullfeatured > > To unsubscribe from this group, send an email to:> -unsubscribe > > Your use of Yahoo! Groups is subject to:> http://docs.yahoo.com/info/terms/> > > > ---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.---------------------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2008 Report Share Posted August 26, 2008 I'm way behind in emails, so I apologize for bringing up an old thread, but I strongly believe in sports physicals - free, discount or full price. I'm the rare case, but I once did a sports physical on a young man whose brother had died suddenly after a basketball game. No one had told him or his mother that he should be checked for similar problems. The echo, at that time was normal. He may never develop subaortic stenosis, but somebody should at least check and monitor him for the potential if he wants to continue as an athlete. Concussions are also a major concern. Their certainly appears to be a post concussive syndrome and a multiple concussion syndrome being seen in athletes; and I think a lot of the players and parents are unaware that a "few" sports concussions may affect a player's mental abilities and have consequences far down the line. Some trainers and coaches don't seem to consider concussions too serious. Teenage men may also have scrotal masses or hernias they don't anyone about. StrazI'm behind in emails, so perhaps others have answered.But, as I understant it, absolutely, that's the most dangerous thing to miss.The real debate is whether an EKG is called for.But, if doing a sports physical, be sure to at least check for changes of heart sounds and murmurs with squatting/sitting/standing as that can uncover outlet obstruction perhaps.Otherwise, I always ask about past joint injuries (badly rehabed joint increases risk for new injuries) and head trauma or concussions. Also double check if any recent mono (big spleen left over from a couple months ago is not a good way to start football season!).... etc.Being a good doc takes more than 5-10 minutes as best I can tell no matter what I'm seeing the patient for.Tim> > > > Don't sports guys who have sudden death die more from unsuspected> cardiomyopathies and short qt syndromes?> > > > Good idea, but if I don't par with their insurance, or it's an HMO that> > requires you to see only your declared PCP, then the insurance thing is out> > unless they are your patient for good.> >> > > >> >> > In Drain,> >> > I do sports physicals for the local team members at $15.00/child in> > my office only, and fit them in spaces I have between patients. I differ> > with the people who say these exams are useless at least in this setting.> > In my office I often am the first one to notice the child needs glasses, I> > have caught a couple of asthma patients whose parents were not paying> > attention and I found one color blind boy in the last three years. One of> > the teens was nearly clinically blind, but didn't tell his parents. The> > children here don't necessarily see a physician, if the parents don't have> > insurance, unless they are very sick and then they see an urgent care doc> > who may not do an eye chart.> > I also use the exam as a chance to direct the kids about how to> > use the public health clinic to get birth control if they need it, and to> > address how to avoid sports injuries if they have some physical variance> > such as hypermobility or very high arches.> > Also, with the exam cost as low as that, I make very good advertisment for> > my office. It brings people back to see me later.> >> > Joanne Holland MD/DVM> >> >> >> >> > > > --> Graham Chiu> http://www.synapsedirect.com> Synapse - the use from anywhere EMR.> > ------------------------------------> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2008 Report Share Posted October 17, 2008 I saw this abstract criticizing our method of doing sports physicals Support for Exercise ECG During Preparticipation Screening of Athletes Using exercise electrocardiography to screen athletes identifies significant cardiac abnormalities that may otherwise go undetected, according to an observational study published online in BMJ. The study included some 30,000 Italian athletes (mean age, 30) who were referred for screening — including resting and exercise ECG — before participating in competitive sports. (Preparticipation ECG is standard in Europe.) Exercise ECG detected abnormalities in some 1230 participants in whom resting ECG patterns had been normal. Ultimately, some 160 athletes (0.5% overall) were disqualified from competing because of cardiac anomalies; of these, 80% had normal resting ECGs, and 96% had normal personal histories and physical examinations. In an accompanying review article, British researchers call the American model of preparticipation screening, which relies on medical history and physical examination alone, " cheap but relatively ineffective. " They note that 80% of athletes who die from sudden cardiac death have no symptoms, and " physical examination identifies few implicated disorders. " -- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2008 Report Share Posted October 17, 2008 real practical in the real world Brent > > I saw this abstract criticizing our method of doing sports physicals > > *Support for Exercise ECG During Preparticipation Screening of Athletes * > > Using exercise electrocardiography to screen athletes identifies significant > cardiac abnormalities that may otherwise go undetected, according to > an observational > study published online in *BMJ. > > *The study included some 30,000 Italian athletes (mean age, 30) who were > referred for screening — including resting and exercise ECG — before > participating in competitive sports. (Preparticipation ECG is standard in > Europe.) > > Exercise ECG detected abnormalities in some 1230 participants in whom > resting ECG patterns had been normal. Ultimately, some 160 athletes (0.5% > overall) were disqualified from competing because of cardiac anomalies; of > these, 80% had normal resting ECGs, and 96% had normal personal histories > and physical examinations. > > In an accompanying review article, British researchers call the American > model of preparticipation screening, which relies on medical history > and physical > examination alone, " cheap but relatively ineffective. " They note that 80% of > athletes who die from sudden cardiac death have no symptoms, and " physical > examination identifies few implicated disorders. " > > -- > M.D. > www.elainemd.com > Office: > Go in the directions of your dreams and live the life you've imagined. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2008 Report Share Posted October 17, 2008 Never happen here where parents would never pay for this. The Academy of Sports Medicine also has done the cost benefit and feels that this is not cost effective in this country. Is it just my part of Colorado, or is everyone's volume down the last 2-3 weeks due to the economy? ________________________________ From: on behalf of Sent: Fri 10/17/2008 7:17 AM To: practiceimprovement1 Subject: Sports physicals I saw this abstract criticizing our method of doing sports physicals Support for Exercise ECG During Preparticipation Screening of Athletes Using exercise electrocardiography to screen athletes identifies significant cardiac abnormalities that may otherwise go undetected, according to an observational study published online in BMJ. The study included some 30,000 Italian athletes (mean age, 30) who were referred for screening - including resting and exercise ECG - before participating in competitive sports. (Preparticipation ECG is standard in Europe.) Exercise ECG detected abnormalities in some 1230 participants in whom resting ECG patterns had been normal. Ultimately, some 160 athletes (0.5% overall) were disqualified from competing because of cardiac anomalies; of these, 80% had normal resting ECGs, and 96% had normal personal histories and physical examinations. In an accompanying review article, British researchers call the American model of preparticipation screening, which relies on medical history and physical examination alone, " cheap but relatively ineffective. " They note that 80% of athletes who die from sudden cardiac death have no symptoms, and " physical examination identifies few implicated disorders. " -- M.D. www.elainemd.com <http://www.elainemd.com/> Office: Go in the directions of your dreams and live the life you've imagined. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2008 Report Share Posted October 17, 2008 I know I am in a lull. We are trying to revamp my scheduling system to see more patients and no one is calling except my chronic care patients. Need to see more easy, short visit acutes and there just aren’t any. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Malia, MD Sent: Friday, October 17, 2008 11:56 AM To: Jim.Kennedy@...; practiceimprovement1 Subject: RE: Sports physicals My volume was way, way down the end of Sept and early October. Since late last week it's quite busy and booked well into November. It's mostly my chronic followups for dm/htn, etc, who I pre-scheduled a few months ago so they could get flu shot at regular appt. So I may have caused this fluctuation myself. But everything was creeepily slow for a few weeks there. I'm not sure if it's the economy though. My former office manager (at large local hmo) who I saw recently said they always anticipated a lull in early fall. So perhaps the timing is coincidental with the economy, or perhaps they are working together and amplifying the issue. Tim > On Fri, October 17, 2008 11:42 am EDT, Jim.Kennedy@... wrote: > > > Never happen here where parents would never pay for this. The Academy of Sports > Medicine also has done the cost benefit and feels that this is not cost effective in > this country. > > Is it just my part of Colorado, or is everyone's volume down the last 2-3 weeks due > to the economy? > > ________________________________ > > From: on behalf of > Sent: Fri 10/17/2008 7:17 AM > To: practiceimprovement1 > Subject: Sports physicals > > > > I saw this abstract criticizing our method of doing sports physicals > > > Support for Exercise ECG During Preparticipation Screening of Athletes > > Using exercise electrocardiography to screen athletes identifies significant cardiac > abnormalities that may otherwise go undetected, according to an observational study > published online in BMJ. > > The study included some 30,000 Italian athletes (mean age, 30) who were referred for > screening - including resting and exercise ECG - before participating in competitive > sports. (Preparticipation ECG is standard in Europe.) > > Exercise ECG detected abnormalities in some 1230 participants in whom resting ECG > patterns had been normal. Ultimately, some 160 athletes (0.5% overall) were > disqualified from competing because of cardiac anomalies; of these, 80% had normal > resting ECGs, and 96% had normal personal histories and physical examinations. > > In an accompanying review article, British researchers call the American model of > preparticipation screening, which relies on medical history and physical examination > alone, " cheap but relatively ineffective. " They note that 80% of athletes who die > from sudden cardiac death have no symptoms, and " physical examination identifies few > implicated disorders. " > > > -- > M.D. > www.elainemd.com > Office: > Go in the directions of your dreams and live the life you've imagined. > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
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