Annual physical examination for adolescents: a reassessment.

In his review of 12 studies of the results of more than 20,000 physical examinations of adolescents, Dr. Stickler of the Mayo Clinic calls into question the value of annual physical examinations in adolescents. I There are actually three separate and important questions here. First is whether there is a medical reason that adolescents have a physician-performed physical examination before they can participate in sports. Second is whether annual physical examinations are beneficial for adolescents. Third is whether a physical examination is good or costefficient only when it finds something medically serious that was not previously known. There have been concerns about the necessity of physician involvement in obtaining medical permission for adolescent sports participation. By reviewing the literature, Dr. Stickler does show there is little evidence that physician-directed or -performed physical examinations are obligatory for sports participation. Although he does not compare the data as rigorously as he would in a meta-analysis, and he dismisses facts that do not fit the hypothesis, in more than 7900 examinations done by a physician, no particular severe medical problem was found that would keep an adolescent athlete from participating in sports. Any medical problem found was already known. It might be time to unbind physician physical examinations from sports participation, and for this argument, the article by Dr. Stickler is important. Unbinding has been suggested in other areas as well. Grimes,2 a long-time crusader against unplanned pregnancy, in a refreshing suggestion that supports consumer, patient, and feminist rights, has called for the unbinding of Papanicolaou tests and birth control prescriptions. "Why should a woman be obligated to have a Papanicolaou test so she can get birth control? He readily admits that yearly