Who Needs a Doctor?

 

One of the most frequent questions I receive takes the form of:
“Should I see a doctor?”
or
“How often should I see a doctor?”
If you’ve been reading here at the blog, you know that athletes take on special cardiovascular risks just by participating in their sports activities. And for that reason, they should see a doctor before they participate. The hope is that a careful physician can screen for potential underlying cardiovascular problems that might place the athlete at risk. And all of this is on top of the many other benefits that a careful physician might provide.
Here’s what I tell my friends who ask….
Student athletes
For middle school, high school, and college students who participate in athletics, their schools should provide guidelines about pre-participation physical examinations. The American Heart Association has developed guidelines to help physicians carefully screen for underlying cardiovascular conditions. The guidelines are written for medical professionals, so the text may be difficult for others to understand. In short, the AHA recommends that student athletes have a physical examination every 2 years during middle and high school and every year during college. Middle and high school students should have a careful medical history taken EVERY year, even if a physical examination is not performed.
The medical history should ask about:
1. Any chest pain or discomfort
2. Unexplained syncope or near syncope (blacking out or nearly blacking out)
3. Excessive shortness of breath during exertion
4. Previous recognition of a heart murmur
5. Elevated blood pressure
6. Family history of premature death (before 50 years) due to heart disease
7. Family history of disability due to heart disease in a relative younger than 50 years old

8. Family history of specific medical problems: Marfan syndrome, hypertrophic or dilated cardiomyopathy, long Q-T syndrome, or arrhythmias
The physical exam should pay attention to:
1. Heart murmur
2. Femoral pulses (to exclude coarctation of aorta)
3. Physical signs of Marfan syndrome
4. Blood pressure
Any abnormalities uncovered with this checklist should be evaluated further.
Young adult athletes, up to age 35
The AHA guidelines are probably also useful for young adult athletes. I tell my friends in this age group that they should see a physican yearly for a careful medical history and physical examination. The checklist for cardiovascular conditions above is also useful in this age group. This is also the age group where a baseline check on blood cholesterol and lipid levels and routine blood chemistries (glucose, creatinine, etc.) should be made.
Older adult athletes, over age 35
As athletes age, they confront an ever-increasing risk of events due to coronary artery disease (CAD, where plaque builds up in the arteries that supply the heart). A yearly visit to the physician for a medical history and physical examination is increasingly important. This is the age range when it is important, even aside from athletic reasons, that people should establish a long-term relationship with a family or internal medicine physician. In this age group, many female athletes will already see a physician regularly for gynecologic or obstetrical care, but “healthy” men are notoriouis for avoiding the doctor. The physician should continue to screen on a periodic basis for the risk factors for CAD: smoking, high blood pressure, obesity, diabetes or pre-diabetes, elevated blood cholesterol or lipids, and potentially others.
Athletes of any age, with medical problems
My suggestions above apply only to “healthy” athletes….those with NO chronic medical conditions. Athletes with ANY chronic medical condition will need to work with their physician to determine the frequency of visits to monitor those conditions. This will almost certainly require more than a single annual visit to the doctor.
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