Experts agree that the preparticipation physical examination (PPE), or sports physical, is best conducted by the young athlete’s primary care physician in the office setting. However, procrastination on the part of parents, lack of a medical home, or financial constraints often lead athletic directors and/or athletic trainers to arrange for the PPE to be done in a mass screening that typically involves multiple medical providers at the school or a local clinic a few weeks prior to the start of the sports season.
Physicians will often volunteer or be asked to participate in mass screening events. Physicians may see it as an opportunity to provide a community service, already have a relationship with the school, or view it as a marketing tool for a growing practice. While these are all understandable motivators, physicians should be aware that the medical/legal risks may outweigh the return on investment of increased community goodwill, patient volume, or revenue.
The following strategies will help you to reduce the liability risks associated with PPEs.
Depending on the legal venue, a court may hold that conducting a PPE creates a physician-patient relationship with the same legal duties as that of an established private practice patient. To limit this risk, consider the following strategies, communicated in writing:
Nearly all state athletic associations require a PPE for participation in interscholastic sports, while the requirements for club sports vary. The often quick and cursory manner in which an exam is performed may be problematic. If there is a perception that an exam was inadequate, a complaint of negligence can occur if it failed to uncover a medical condition.
The goal of the exam is to identify serious conditions that may prevent safe athletic participation. Conditions that may result in increased risk for sudden cardiac arrest are a particular concern. More recently, concussion risk and sequelae of traumatic brain injuries have received a great deal of attention, making an evaluation of cognitive function another important consideration. Strategies to reduce risk include the following:
When referring an individual for specialty evaluation, make sure that the athlete and parent or guardian understand that the child has not been cleared for participation and that determining eligibility requires completing all follow-up consults and testing.
If the patient requires further evaluation and has a primary care provider, contact the provider to facilitate the evaluation and ensure appropriate follow-up.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.