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Part C medical form and genitalia

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I'm a female, so I'm at a loss here. Why is there a checkbox for genitalia on the Medical Part C exam, what does it have to do with participating in summer camp, and in reality what are the expectations of the typical practitioner in filling out these forms? From what I've seen when taking my son to the doctor for his annual physical, they are not examining his genitals.

 

We had a grandfather come in tonight to our meeting to do physicals for our boys going to summer camp. The grandfather is a cardiologist. I'm in charge of medical forms. The form that came out of the first boy's physical was missing checkboxes for abdomen, genitalia, musculoskeletal, and neurological. I told them that that wasn't acceptable and sent them back in to get all the items on the list checked. I figured that a half-completed form is as good as no form. Apparently the MD didn't feel like he had all the equipment he needed to do the routine check, but he eventually acquiesced and completed all the check boxes. I didn't expect the MD to actually do a genital check, just like I didn't expect him to run an MRI to check for neurological issues. What has been your experience in getting these forms completed, and how thorough are the exams?

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We've had a physician associated with the troop, a pulmonologist, help with physicals with the boys for years, he also does not check the genitalia.  No one at summer camp check-in has ever questioned this.  My own experience with my sons is that a really thorough physical exam by their pediatrician does involve a physical check of the genitalia but not every time.  There's some medical value to it, but it doesn't seem critical to summer camp

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Genital examination helps detect a number of conditions, one of the most relevant for scouts being hernias. A week at camp will end quickly if an undetected hernia ruptures. I can't imagine any doctor thinking that it could be ignored in a youth.

 

It's not clear to me what equipment is needed besides gloves (for the examiner's universal precaution) and a mallet (for neuro-muscular screening) to complete this.

 

As scouts get older, these screen for venereal disease and pregnancy (in girls), pubertal delay, as well as child abuse. Those may not have anything to do with participation in summer camp, but by requiring an annual physical it gives at-risk youth and their parents a chance to make lifesaving decisions.

 

Do many scout parents gloss over these? Yes. But that's why we all go through this exercise every year. Hopefully in even the most shoddy of physicals, something will get caught.

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Sadly many youth don't see a doctor on a regular basis. I've been an allied health care provider for 25 years, not a doctor. I work with young adults on a daily basis. I find it scary, sad, and in some ways disgraceful that some of my college freshmen have no regular doctor or dentist and have never had a proper physical or dental exam. I had one incoming college freshman this school year that had NEVER been to a dentist, 18 years old and no dental visits ever!!  Others have only ever seen the walk in clinic for pre sports physicals for $25 and the emergency room for illnesses and injuries.

 

Doc in the box physicals miss so much its scary. They don't screen for hernias, scoliosis, testicular masses (young men in the boy scout age range to college age have one of the highest rates of testicular cancer), muscle imbalances, urine samples for diabetes and neuro problems. Basically, if you walk in under your own power and have a pulse and are breathing you get the sign off you wish. That's exactly what they are designed for but it doesn't make them right.

 

While health insurance is expensive there are many programs that insure youth get coverage and services they need. The health forms from the BSA, high school sports, other camps are written to help health care providers by giving them guidance as to areas to check. When an OB/Gyn does a troop of boy scouts physicals because he/she has a kid in the troop they're really not helping out that much, IMHO. They are extending the problem. Just because someone has a DO, MD, PA, or RN after their name it doesn't make them the right person to provide the service. I'd be concerned if a psychiatrist offered to sign off my troops' physicals. Sure he/she is a an MD or DO but when was the last time they listened to a heartbeat, felt an abdomen, med school maybe?

 

Scout son was found to have a heart murmur at his camp physical a couple of years ago, luckily it turned out to be nothing major. It was found by his regular doctor and hadn't been there in the past. Who would a doc in the box or someone else that he'd never seen before know if it was a new thing or not. Having had a couple of athletes over the last 25 nearly die of heart problems on the field I am a little sensitive to this subject.

 

To sum it up, the forms ask for checks that should be done not ignored, to make sure the scout is healthy enough to partake and no new underlying conditions have occurred since their full physical. Pre-camp/sports physicals can and do play a vital role in the health care of young people. They shouldn't be brushed off as an pain in the butt that most parents, leaders/coaches, and providers consider them to be.

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http://www.scouting.org/scoutsource/HealthandSafety/Resources/MedicalFormFAQs.aspx

 

The very first FAQ is the "why" answer to your question.  

 

If you want to go exploring what the medical profession considers a good exam, I'd suggest researching what folks like the American Academy of Pediatrics suggest for youth.  

 

And don't forget that the pre-participation exam also applies to adults as well as youth.   

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Paramedic here, so I can offer a bit of insight.

 

"Why is there a checkbox for genitalia on the Medical Part C exam?"

Genitalia represent one of the major organ systems, examination is a component of a comprehensive physical.  

 

"what does it have to do with participating in summer camp"

The physical serves two purposes from the BSA's standpoint: the first being assuring that each participant has a clean bill of health before participating in somewhat strenuous activity.  The second being to provide a baseline assessment which a provider can refer to in the unlikely event that a scout is hospitalized, and access to his medical history can not be obtained.  In the first case, hernia is a common concern to check for.  In the second, various endocrine issues, for example, can be detected via a genital exam.

 

"in reality what are the expectations of the typical practitioner in filling out these forms"

Short answer: the form should be filled out completely.  Longer answer: Providers are rightfully reluctant to document something which they did not assess.  A provider familiar with a patient, who knows that the patient does not have any significant findings in a particular area, may defer the assessment - but then they won't document that they performed it.  Likewise, if a patient or family members requests that they defer a particular assessment, the provider may do so, but also not document it as completed.  I can understand a doctor, who is not the primary care provider for these kids, operating not in a doctors office, not wanting to perform genital exams on these children.  As a paramedic who is often on the receiving ends of these forms (as in, serving as medical staff at BSA events), I'm usually content as long as an appropriate provider has signed off on the form.

 

I believe very strongly that these physicals should be completed by the scout's primary care doctor.  Its very beneficial for children to be seen by the same doctor, or at least the same practice, from year to year.  That allows the doctor to focus his assessment based on that particular child's needs.  It also a more appropriate setting for assessing and discussing more sensitive areas, such as what we're talking about here.  I really, really dislike the idea of bringing in a specialist (cardiologist?) who has no doctor-patient relationship with these children, and asking him, a complete stranger, to provide a comprehensive physical.  For starters, a cardiologist specializes in cardiology, while a pediatrician specializes in pediatrics.  A pediatrician is far more qualified to be providing physicals to scouts.  Not to mention, it's far more appropriate for a patient's primary care provider to discuss and assess sensitive topics in his or her office - not at the troop's meeting place.  Now I understand that its not always possible or feasible to ask scouts to get the physical from their primary care doc, for financial or other reasons.  But I'd still say that should be the goal whenever possible.

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In my limited experience with the issue, this seems to be part of a thorough physical examination of a teenage-ish boy.

 

Just wait till he's a few decades older, but hopefully by that time he will no longer be living with you and you will no longer be aware of the intimate details of his medical exams.   :)

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This topic would be funny if it wasn't so serious.

 

Our athletic program requires a complete medical exam for all athletes when they start school sports in fifth grade. This includes a genital examination.

 

We have had several boys diagnosed with undescended testicles (requiring surgery) during these exams.  I think it is ridiculous that this condition could go unnoticed for 10 years, but it happens.  

 

I agree that boys don't need to have a genital exam at every checkup, but they do need it every once in a while.  If your son has never had a complete medical exam, it is time to schedule one.  

 

I would suggest that the boy be told about it in advance, to let him get used to the idea, and be given privacy during the exam.

Edited by David CO
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We have had several boys diagnosed with undescended testicles (requiring surgery) during these exams.  I think it is ridiculous that this condition could go unnoticed for 10 years, but it happens. 

 

We had a brand new 10.5 year old Scout also get diagnosed with a undescended testicle at his BSA physical.  Luckily it was caught in time so that he could have it fixed and attend summer camp.

 

As others have mentioned is is part of a standard physical, and can ID a hernia. A friend of mine had a hernia discovered at a BSA physical, and was unable to go to camp that year because the problem was not caught in time.

 

As far back as my first summer camp, that procedure has been SOP.

 

This topic would be funny if it wasn't so serious.

 

Yes, getting a physical is VERY serious and important, but I gotta tell this funny story.  My introduction to Youth Protection came from a physical. We had a MD, also a cardiologist by specialty, do physicals for free. We would go into a room, he'd do the check up, and we are done.

 

Well the first year youth protection became mandatory, the physician, also an ASM with the troop, had the CC in the room in order to have 2 deep. I asked, " Mr. K_____, why are you here?" His reply was, "It's this new youth protection thing, we can't be alone with Scouts anymore." My response was "let me get this straight, We're concerned about Doc _________ Molesting us?!?!?!  Yeah right with 12 kids and the 13th on the way, I don't think we need to worry." And of course we all laughed.

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I'm a female, so I'm at a loss here. Why is there a checkbox for genitalia on the Medical Part C exam, what does it have to do with participating in summer camp, and in reality what are the expectations of the typical practitioner in filling out these forms? From what I've seen when taking my son to the doctor for his annual physical, they are not examining his genitals.

 

We had a grandfather come in tonight to our meeting to do physicals for our boys going to summer camp. The grandfather is a cardiologist. I'm in charge of medical forms. The form that came out of the first boy's physical was missing checkboxes for abdomen, genitalia, musculoskeletal, and neurological. I told them that that wasn't acceptable and sent them back in to get all the items on the list checked. I figured that a half-completed form is as good as no form. Apparently the MD didn't feel like he had all the equipment he needed to do the routine check, but he eventually acquiesced and completed all the check boxes. I didn't expect the MD to actually do a genital check, just like I didn't expect him to run an MRI to check for neurological issues. What has been your experience in getting these forms completed, and how thorough are the exams?

Well, according to my sons, they just do a quick hernia check.  

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Ex-military brat and military here. I cannot recall a year I didn't have at least one "annual" exam. Top to bottom, inside and out. Raised the kids the same way.

 

Flight surgeons check everything. Makes you feel like they are doing pre-flight on you. ;)

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A quick hernia check followed by an annual "digital exam" is what I get from my doctor. My son only gets the hernia check.

Edited by deanofmac

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