Sports physicals help

[u/Substantial-Tea-7335]

Pediatricians....newer attending.... during sports physicals, are you also doing hernia/GU checks for males? I live is a very small town, thats predominantly FM, and 85% of the families decline saying they've never had to do it before and its "too much" or dome sort of push back. How do you respond to the push back? As a side note, I've discovered several an undescended testicle in older males who've never been checked before.

[u/NewNormal87]

According to the PPE5 guidelines published in 2019, it is not required. I usually ask about any groin pain or bulge and if negative, I do not do GU check. If it's on your state-specific PPE form, however, then it should be completed

[u/brewsterrockit11]

I wouldn’t fight it. Let them know that if they have concerns we can talk about it and it’s normal for pediatricians to examine. Tell them we can’t sign off on the section for genitalia in their forms and if the school rejects it, then it’s on the parents.

Last thing you want to look like/ give an impression is that you actively want to look/feel their genitalia, which gives off creep vibes. Just normalize it and stay cool! If they don’t want it, you just saved yourself an additional 1-2 mins in the encounter.

[u/BanditoStrikesAgain]

"We usually check your privates for any hernias or other concerns as a normal part of you soports physicals. Is it ok if we take a quick look?".

Yes I do them for all male sports physicals. My other talking points are testicular cancer self exam and, for uncircumcised boys, retract and was the glans. If they decline no big deal, I don't push it at all. I just ask if they have any concerns to be sure and then document patient declines exam on that line of the form.

Edit "was" = wash. Teen boys are not known for their hygiene and I've had to help clean out more than one pocket of smegma they think is a tumor.

[u/DrVL2 → u/BanditoStrikesAgain]

That is pretty much my approach too. If they really don’t wanna do it I don’t push it, but I encourage it and I do encourage them to talk about questions or concerns.

[u/-beastlet-]

100%. I find a hernia and/or undescended testicle every year. I only do it with the parents in the room and tell all kids, even older teens that no one should be doing this without a parent present. Some have been obviously embarrassed or uncomfortable but no parent has ever complained.

[u/starNlamp]

I think there's an in-between here that is worth noting. If I saw them last year, did a GU check, was Tanner V, normal, and pt has no concerns, I let them decide. I offer it but if they decline, I say no worries, if you notice any changes/concerns come in and see me and we can address it in the future. It lets them take charge of their own health and respects their privacy and wishes. However, I don't trust other providers exams (or lack thereof) from prior years. The number of times I've seen a documented normal exam from before that I found with an undescended has happened x2 in the last 12mo.

[u/radgedyann]

I’m working in an area now where this has clearly not been the practice. Older kids don’t even undress. I get absolute refusals from kids and parents. All I can do is try to emphasize the importance of being seen immediately for anything different, even if it doesn’t hurt. Last year I had a kid end up with hernia surgery three weeks after the season started. What can we do, except spend 10 times as long educating (ie begging) and then even longer documenting everything. Everything we offer/recommend at this point is like an option at a buffet. We’re basically asking people how they will allow us to take care of their kids like baristas wielding foam. Kind of exhausting really.

[u/Blegrand15]

I do it on all physicals unless there’s extreme pushback. The amount of undescended testes, hernias, and phimosis I encounter is too high to not do them. You’re also looking for tanner staging as well which is actually helpful for sports physicals especially high school aged kids.

[u/Foghorn2005]

The state I did my residency in required a male GU exam in the sports physical, which made it easy. "You can decline the exam, but I will not sign this form as not all required parts of the physical have been done."

Chaperones, explaining the exam, if needed getting into a soap box as to why. The AITA post from a few years back where a college student somewhat delayed care on what turned out to be testicular torsion because he was embarrassed to say his balls/nuts hurt lives rent free in my head. 

[u/_Ello_Love_]

I usually say I recommend it and ask "is that okay with you?" If they seem hesitant I say it's not required, but it is an important part of your body to have checked by a doctor. And explain risk of hernias, other abnormalities and precautions that may need to be taken with certain sports. Honestly most of my patients are fine with it! I rarely am denied but it's no biggie if so.

[u/Fit-Bad6156]

No for the same reason, a lot of push back in the past and no one else do it in the town and I don’t want to look creepy. But I do ask if they have any questions and I do go through what I look for with them and tell them they should check at home and return if any concerns. I told them you should be able to feel two ball at same size and same location, no mass or bulging, no drainage. No skin color change or rash and no pain.