Physical Exams Required for Prep Athletes, but Questions Linger

After 23 years of performing annual physical examinations on athletes at Osbourn High School, Fred Parker still worries if he's doing all he can.

"I think every night: 'Did I get every kid? Did I miss anything?' " said Parker, who also has been a team physician for the George Washington University athletic department since 1998. "Every time a kid drops and dies, you're crushed because you know someone did a physical. Did something slip through the cracks?

"It is obviously not a thorough exam, but I wish it were. It could be done."

As tryouts for winter high school sports begin this month, students will pile into doctors' offices for their annual physicals, seeking medical clearance to play. Many health-care experts agree with Parker that these exams fall far short of being a complete check of a teenager's fitness for athletics. Among the problems they cite:

· The exams can be performed in as little as five minutes.

· The exam itself relies more on a series of questions -- and the skill of the questioner -- than an actual physical examination, forcing teenagers and their parents to be honest and perceptive about their medical history.

· In many states, several different types of doctors are permitted to conduct the exam, including chiropractors in 36 states.

· The lack of a national standard for the exams.

The National Federation of State High School Associations (NFHS) said more than 7 million students participated in high school-sponsored sports during the last school year. Each was subject to a brief examination and battery of medical history questions to find the often-subtle indicators that could raise a red flag before a student is allowed on the playing field.

According to an annual survey of high school athletes by the National Center for Catastrophic Sports Injury Research, the number of deaths related to indirect catastrophic injuries -- fatalities brought on by a condition that could have been spotted during a physical, such as the death of Stafford High football player Joey Roberson in August -- has increased by 33 percent over the previous 10 years.

"We can create the best form in the world," said Vito Perriello, a Charlottesville pediatrician who is the chairman of the Sports Medicine Advisory Committee for both the NFHS and Virginia High School League. "But we have no control over what goes on when doctors see the patients."

Said Gordon Matheson, director of sports medicine at Stanford University: "What works against the physical exam is you don't have a lot of things to pick up. It's not fundamentally medical. It's fundamentally athletic."