to the editor: Cardiovascular screening is not the only component of a preparticipation athletic screening. During such physical examinations in the past, I discovered a complete heart block in a husky 12-year-old boy, a heart murmur in a 15-year-old cross-country skier who turned out to have a patent ductus, and a venous hum showing anomalous return of a pulmonary artery with atrial septal defect in a 12-year-old student athlete. These patients needed treatment with a pacemaker, coil occlusion, and intracardiac surgery, respectively. These conditions would have surfaced at a later time, but the preparticipation physical examination was an opportunity to make a difference.

It is important during this examination that physicians look at other problems such as the inflexible athlete, the thrower with an unstable shoulder, the preteen with scoliosis, the high school student with an eating disorder, high-risk behaviors and poor self-image. It is becoming increasingly clear that we should also screen for assets.

By doing so, the preparticipation physical examination becomes an opportunity to set the stage for healthy choices with regard to physical, emotional, and spiritual health. It is a wonderful opportunity to practice preventive medicine, and it is hard to estimate the cost savings.