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Do you perform Special Olympic Clearance Exams?


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If you aren't the PCP for these patients and you're asked to clear a patient who is not able to comply with basic requests such as taking a breath, opening their mouth, etc., do you perform and sign off on these exams?  Rather specific questions and PE comments are requested to be addressed.  Note the question about cervical instability in the absence of being able to obtain a c-spine film as in my setting.

https://media.specialolympics.org/resources/health/medical-forms/US-Medical-Form-fillable.pdf

 

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Never been asked, but I've gotten a ton of other weird forms, from missionary work to race car driving.  My basic rule is that if I can fill out the form competently and correctly, I'll do the exam.  In the case you're describing, it sounds like more of an issue with the patient than you, but still... I never sign off on what I can't attest to, and in this case as you describe it, I'd defer.  Special Olympics should have some way to accommodate those sorts of issues, I would think, so if the form doesn't cut it, write a good note and include that too, and let the organization decide based on the observations you've made.

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Reason I ask is that we’re going round and round with a parent (for months and now getting legal involved) saying that we’re being discriminatory against her child when we do school athletic PE clearances on other kids.  We’ve tried to explain the difference but non-medical people just don’t get it.  Ultimately this may require us to stop offering the service for all kids.  Sad thing is that one of our SP’s offered to do it, no charge, in his office, and the parent declined.  They’re right down the highway  one exit.

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The parent in your scenario sounds a bit off - and unreasonable.

A special needs child should have not only a PCP but likely a slew of specialists if they have genetic issues.

I did these for our FP patients in the practice but not outsiders. We could order outside films if needed. I did it for Cornelia DeLange twins - thankfully not high risk for cardiac issues or CSpine issues. 

Not doing them in your case does not sound discriminatory- it sounds like logical medical care. A walk in clinic is no place for someone with chromosomal abnormalities or high risk cardiac/ortho to be looking for sports clearance. 

Perhaps this person’s actual PCP who remains unknown would not clear this person and now parent/guardian has a chip on said shoulder. 

Stay strong!

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"Discrimination" has become a crutch for "I'm not getting my way". We all have to do what is medically correct and ethical. Don't give in to what amounts to emotional extortion. I have a special needs granddaughter. Her medical issues are soooooo totally beyond me it defies description. We have to stay in our lane.

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Never use common sense when Legal can get involved and complicate things.  Previously both SP's, myself, and our other provider have all been consistent in our agreement that these evaluations are not appropriate in our setting.  Today, Legal says you need to show us what is different with regard to the Special Olympics paperwork and the state school participation forms.  If unable to do so, regardless of the risk level of the individual being evaluated, it is considered discrimination.  Options are to do them, and in my case turf every last one out if the patient is not able to comply with basic commands; or do NO activity/participation examinations at all.  Clinic manager discussed with primary SP this afternoon but I don't know the response as of yet.

Edited by GetMeOuttaThisMess
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Guest UVAPAC

Why not do the examination, and state you can not clear them as they are at increased risk for cardiac event.  Refer to Cardiology for echo/stress test and cardiac clearance letter for participation in athletics.  Then have them return with a written/signed letter from Cardiology clearing the patient to partake in athletics.  

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30 minutes ago, UVAPAC said:

Why not do the examination, and state you can not clear them as they are at increased risk for cardiac event.  Refer to Cardiology for echo/stress test and cardiac clearance letter for participation in athletics.  Then have them return with a written/signed letter from Cardiology clearing the patient to partake in athletics.  

Because they then get upset having paid a totally unreasonable $10 administrative fee to be seen (like all employees, they think their employer should pay for everything).  My population tends to wait till the last minute to get these done like I'm sure everyone else does.  If they actually took a moment to think about it, their PCP co-pay is cheaper than jumping through these hoops and less time consuming.  Bottom line, they need to be seen by someone who is familiar with the details of their medical history.

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59 minutes ago, GetMeOuttaThisMess said:

Because they then get upset having paid a totally unreasonable $10 administrative fee to be seen (like all employees, they think their employer should pay for everything).  My population tends to wait till the last minute to get these done like I'm sure everyone else does.  If they actually took a moment to think about it, their PCP co-pay is cheaper than jumping through these hoops and less time consuming.  Bottom line, they need to be seen by someone who is familiar with the details of their medical history.

I am so glad I do not work in an organization that would not back me up on that.  Honestly, saying "pay the fee, we're going to deny the clearance because of XYZ" is probably several dozen times cheaper than getting a lawyer involved.

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Another reason I am glad to not do Sports Physicals or DOTs any more. I am at the VA and do not do those - or L&I or MVAs or personal injury.

Medicine is not McDonalds.

The private doc I worked for tried to coerce me to do things for DOT patients because "think of their career and paycheck" - while I was thinking - think of the busload of kids in the next lane.

Sports Physicals are not pay the fee and get the form - at 8 pm the night before practice starts. I have found heart murmurs, hip dysplasia in TEENS and all kinds of other crap including concussion histories that need to be dealt with.

DOTs - no more threats to my personal safety or finding out Mr. 385 lbs is NOT 70% compliant at least 4 hrs a night on CPAP.

I am sorry OP that your employer is not standing up for medical ethics. That sucks.

Stick to your ethics and do right by the patient.

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Email response that I read from from our primary SP this morning said essentially “No way, Jose”.  Legal wishes to back us but can’t unless we can delineate as to why we can do “normal” PE’s but not these.  We can’t turf them automatically either for the same reason.  If the individual is communicative and can follow directions then I don’t have an issue with them.  I can check for Hoffman sx., hyperreflexia, and clonus as easily as anyone else.  Bottom line, we’ll probably end up throwing out the baby with the bath water and stop doing all of them.  This will allow me more time to partake in reading novels.

 

 

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