Who should conduct the PPE?
A child's primary care physician is usually well-qualified to conduct a PPE, given his or her broad training and because he or she knows when to consult with specialists if problems requiring further clinical expertise are detected (2).
Parents should not assume, however, that their child's doctor knows how to conduct a complete PPE and should make sure their child's doctor is knowledgeable about the required elements in today's PPE, which is much more sophisticated than the general health exam previously used.
Parents should ask their child's doctor for the manual Preparticipation Physical Evaluation developed jointly by the American Academy of Family Physicians, the American Academy of Pediatrics, the American Medical Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine, which includes specific questions to ask in taking a medical history and instructions on how to conduct a sports-related musculoskeletal examination (see below)Where should a PPE be performed?
There are three basic types of settings for the PPE: office-based, assembly line, and station, each with its own advantages and disadvantages:1. Office-Based (primary care physicians in the office)(considered the ideal location for the PPE)(2)
- Advantages:
- Familiarity with patient: The doctor's familiarity with the athlete makes it easier to complete the PPE form more thoroughly because a complete medical history from prior exams should be available.
- Privacy which facilitates open communication: The doctor may have more time and privacy to educate and counsel the athlete on sensitive health issues (drugs, alcohol, use of performance enhancing drugs, female athlete triad etc.)
- Continuity of care: If athlete has seen the same doctor year after year, the continuity of care offers a critical advantage in detecting, evaluating and treating conditions discovered during the PPE.
- Disadvantages
- Time constraints: The doctor's busy office schedule may allow for only a short general health screen, which may not be adequate to detect conditions predisposing an athlete to injury.
- Lack of expertise: A primary care physician may lack interest in or knowledge of sports-related medical problems, and may feel uncomfortable or unqualified to determine whether an athlete should receive medical clearance to play sports.
- No continuity of care: An athlete may not have an ongoing relationship with a particular physician or practice.
- Cost. Not all athletes can afford private, office-based PPE (high co-pay or deductible or no health insurance coverage at all)
2. Assembly-line (single physician examines one athlete after the other)
- Advantages:
- Cost
- Time
- Disadvantages
- Possible communication problems
- Lack of individual attention
- Increased risk that insufficient medical history will be takenl
- Lack of continuity from year to year (assuming different physicians conduct exams)
3. Station (multiple examiners conduct discrete portions of PPE in sequence)
- Advantages:
- Time- and cost-efficient: Hundreds of PPEs can be performed in single day with well-trained staff.
- Better communication: An athlete may talk more openly with medical personnel in a "team" setting. A station-exam is likely to impart greater knowledge to all members of medical team and coaches of individual athlete's medical condition)
- Specialized expertise: The station approach allows the use of physicians with specialized expertise (cardiologist, orthopedist etc.).
- Disadvantages:
- Noise and confusion. The setting itself can become confusing and noisy.
- Lack of privacy: An athlete may be reluctant to discuss intimate personal health concerns in such an open setting
- Time constraints: An athlete may feel rushed. Time constraints may restrict the opportunity to educate and counsel athlete.
- Care may be compromised: The lack of time and privacy may make it difficult for the athlete and his parents to fully understand the need for additional testing or basis for disqualification. Coordination of care may be compromised because medical personnel may not know athlete previously.
