Editor’s note: Megan Ranney, MD, MPH, is assistant dean of the School of Public Health at Brown University and professor of emergency medicine at the University’s Warren Alpert School of Medicine. The opinions expressed in this statement are her own. Read more comments on CNN.
As a physician, public health professional and parent of a teenage daughter, I’ve been following the news of a Florida school district’s decision to digitize the children’s school athletic records with interest – and concern.
What should be a simple decision about best medical practice has turned into a Gordian knot of not only health, but also policy, politics, technology and bodily autonomy.
Being active is obviously important for children, in general. We should do all we can to encourage all young people to get involved in physical activity, whether through organized sport or informal activity. Although women have traditionally been less likely to be competitive athletes, the number of female-identifying US high school athletes has increased more than 10-fold over the past five decades. last. This growth deserves support.
For children of all genders to safely participate in competitive sports, a consortium of medical organizations has agreed on a standard pre-sports screening and physical exam. The exact rules and regulations vary between states, but the primary goal of a sports physical is to allow physicians (or other appropriate clinicians) to identify and then minimize harm from youth sports participation.
The pre-sport evaluation form used by the Florida High School Athletic Association, and by extension the Palm Beach County School District, includes screening for everything from a family history of heart disorders to concussions, depression and eating disorders. These questions are included for good reason. Competitive athletes of all genders are prone to energy deficits, whether due to disordered eating or excessive energy consumption during practices. This lack of energy can cause long-term harm, especially for teenagers.
When amenorrhea is accompanied by the energy deficit (lack of period), it is especially worrisome, as the metabolic and endocrine side effects can weaken athletes’ bones, increase the risk of stress fractures and increase the risk of long-term osteoporosis . Therefore, it is medically appropriate to ask athletes about signs of disordered eating, amenorrhea, and other signs of physical danger when deciding whether an athlete is safe to practice and exercise. competition. This is also the reason why the screening form also includes four questions for “women only” about menstruation.
However, there is a big difference between a physician or other trained health care professional asking these questions privately, as part of a clinical assessment, and the physician sharing all the details with third parties.
I am deeply concerned that some states may share the full physical exam and screening — including information about youth athletes’ menstrual cycles — with school districts, state officials and third-party digital record keeping companies. -party. The harshness of the post-Dobbs world, the reality of today’s tech world and the suggestive examples of other situations where these intersections have left women and girls vulnerable may put parents and doctors there the inevitable situation.
From a purely medical point of view, the pre-participation test forms are approved by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Association for Sports Medicine, American Orthopedic Association for Sports Medicine, and Academy American Osteopathic. of Sports Medicine, specify that only the final decision (eg, whether or not a patient is cleared for sports, and whether there are restrictions) should be shared with a school district. They specifically state that the medical exam and screening questions should remain with the evaluating clinician or physician.
These guidelines highlight the importance of protecting the privacy of the patient-physician relationship. Confidentiality of clinical discussions is important in general, but more so for adolescents. And reproductive and gynecological care, including discussions about menstruation, are rightly considered even more private than, say, a lung or heart or knee exam.
But my concern about the reported sharing of data goes beyond fears of harming the patient-physician relationship. The current social, political and technological environment creates a perfect storm for this sharing of information to put young people at risk in a number of ways.
First, laws regarding reproductive health, sex and abortion are being rapidly rewritten across the country. In Texas and Oklahoma, those states are effectively offering a bounty to anyone who reports a suspected abortion. In other states, being transgender can lead to exclusion from organized sports. One could easily imagine a world in which – if school officials or coaches are expected to follow an athlete’s menstrual cycle – some youth would be reported up the ranks (rightly or wrongly) for lost times. For some young people, this statement may lead to inappropriate and invasive gynecological examinations. For other young people, this could lead to them and their parents being charged with a crime. And knowing a child’s periods could put schools in a position of liability.
Second, the security of third-party software systems (such as those used by Florida districts) is often questionable. While I cannot judge the level of security of a particular software program being used in Florida, many of us have spoken about our concerns about poorly designed “time tracking apps” and poorly protected. Cyber-enhancement of electronic health records continues to grow. Even the most security-conscious healthcare organizations are at risk, and data from reproductive health organizations has been particularly targeted and shared. As soon as we share menstrual data with a digital application, we also have to worry about it being accessed by those with malicious intentions.
I doubt most school systems are prepared for these legal and security risks.
Finally, as a mother of a teenager (and a former high school athlete, myself) I cringe at the thought of a coach – even with the best of intentions! – after a child’s menstrual cycle for signs of missed periods. Even in my state (which protects abortion as health care, albeit with parental consent), this kind of discovery would be embarrassing at best and invasive at worst. And my concerns would be much greater if I were in a situation that limited my own and my children’s reproductive rights.
I am glad that Palm Beach County has reconsidered this dangerous policy and asked that questions about menstrual history be removed from Florida’s pre-sports evaluation form. Here’s hoping the Florida High School Athletic Association listens and does what’s right for kids, parents, coaches and schools.