MS>>     If so, do you consider even that an appropriate thing...?
PT>>Of course it's appropriate! How do you expect to check for hernias 
PT>>and developmental delays? Part of a physical *is* "turn your head 
PT>>and cough"; we all know that.
 KU>     The touchiness was largely because many people felt (quite
 KU> rightly IMHO) that it wasn't the school's business to do this in the 
 KU> first place. 
Well, who will pick up that splenomegaly before the kid dies on the 
football field from a ruptured spleen?
Who will pick up that scoliosis before it becomes a crippling deformity?
Who will pick up on that testicular cancer which is so easily curable when 
caught early, and so deadly when found by the times there are symptoms an 
adolescent boy would notice?
If the school doesn't require a physical prior to sports, who is to blame 
for that kid's ruptured spleen (and how many millions will the settlement 
be worth)?
We do well-baby checks up until about 2 y/o, then we do another check 
prior to kindergarten. Without the school physicals, pre-college admission 
physicals, etc, how will we pick up those with correctable problems? I 
realize that the Canadians are quite particular about what screening they 
consider worthwhile and that the Canadian Task Force demands clear and 
substantial benefit before it agrees that a screening exam of any kind is 
acceptable, but in America we tend to think that even one undetected 
testicular cancer is too many and are willing to screen thousands for 
every one picked up.
As for the physicals being performed at the school itself, from my 
experience that is purely for the convenience of the parents and the kids. 
The doctors & nurses will get together and donate their time in the 
evening and set up an assembly-line physical (a nurse to check the vision 
& hearing, another to screen the back, a doc in a private room to check 
the abdomen, lungs, heart and genitalia) which gets the kids in and out 
quickly. If possible, lady doctors do the girls and male docs do the guys. 
Once when I participated as a resident, one doc did just the GU exam and 
took that opportunity to discuss sexual/pubertal issues with the kids. 
(Gimme a break! this was California after all !)
The younger kids are embarassed, but it's a rite of passage just like 
showering in the locker room or doing a math problem on the blackboard.
I see nothing wrong with a school requiring a physical, though they should 
certainly allow the parents to pay for it at his own doctor's office. Of 
course, the kid'll probably have to miss a morning of school to get this 
done. The free "assembly-line" in the gym seems preferable to me.
ÚÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄ¿
³Phil Thwing, MD (Family Practice)³
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