•Team physicians often neglect team practices. While
it is not necessary that all practices be attended, occa-
sional, brief appearances during practice will allow
the physician to gain insight into the environment and
conditions in which the athletes train, the team’s train-
ing regimen, and interactions between coaches and
players. A better appreciation of all these factors can
prove invaluable in the physician’s medical decision
making. Additionally, brief appearances at practice
help the physician build collegial relationships with
coaches and players, establishing his or her role as a
part of the team and distinguishing the physician from
other officials, support staff, and media representa-
tives who only participate in game-day activities.
- Amount of time spent at the actual competition
depends on the team physician’s role and availability,
as well as state laws and regulations of the governing
athletic association. Some laws mandate that a physi-
cian be in attendance for every game. Other laws
allow nonphysician medical personnel, such as an ath-
letic trainer, to cover an event with on-call physician
backup (Herring et al, 2000a).
•A doctor who is the team physician for an entire insti-
tution must decide whether to attend all the games for
a few teams, or to attend a few games for every team.
We recommend that team physicians attend at least
part of one practice and at least one game for each
team they supervise. Providing good team medicineis
very difficult without observing the interactions and
conditions of play and practice.
CORE KNOWLEDGE OF THE
TEAM PHYSICIAN
•To perform his or her duties effectively, a team phy-
sician needs an understanding of the medical conditions
common to the athlete. This knowledge should encom-
pass many areas of medicine, including but not limited
to—orthopedics, cardiopulmonary medicine, neurol-
ogy, dermatology, and sound principles of rehabilita-
tion (Herring et al, 2000b).
- The team physician also needs expertise in pharmacol-
ogy. Practical pharmacology for the team physician
includes not only knowing how to treat illnesses, but
also an understanding of performance enhancing drugs
and herbal medicines. Team physicians must be familiar
with the substances that are banned by the governing
athletic association so that an athlete does not inadver-
tently lose eligibility to compete (Melion et al, 1997).
•A team physician must have a general knowledge of
behavioral medicine and psychology. Mood distur-
bances and mental illnesses (like depression) affect
athletes and can be very common in injured athletes.
•A team physician’s knowledge of exercise science and
nutrition can help prevent injuries, as well as maximize
an athlete’s performance. Disordered eating and over-
training can prove devastating if not recognized early
and treated effectively (Herring et al, 2000b).MEDICAL RESPONSIBILITIES OF THE
TEAM PHYSICIAN- The first responsibility of a team physician is to deter-
mining whether an athlete is fit to participate. This
evaluation most commonly occurs during the prepar-
ticipation physical. This examination may or may not
be preformed by the team physician, but the team
physician should review the documentation of this
examination so that he or she will know of any con-
dition that may limit competition or predispose the
athlete or other participants to injury. This prepartici-
pation physical must be done prior to athletic training
or participation—preferably 6–8 weeks beforehand so
that all potentially disqualifying conditions can be
fully evaluated without missing jeopardizing sched-
uled participation (Herring et al, 2000a). - Sideline and event coverage is the most obvious respon-
sibility of the team physician. A physician should cover
all collision and high-risk sports. Other athletic events
can be covered by any allied health professional who is
trained in recognition and initial treatment of athletic
injuries (Herring et al, 2000a). A team physician must
continually remind himself or herself that he or she is
more than a spectator. The physician should be a
“dispassionate observer,” meaning that the emotions of
competition must not affect medical decision making.
Attention should be directed to the safety of the partici-
pants, not the immediate passions of the game. - The team physician should focus attention on aspects
of play and individuals who are more prone to injury.
In other words, the seasoned team physician will care-
fully follow the game, but not always follow the ball.
For instance, in American football relatively little injury
information can be gained by watching the flight of
the ball on punts, kickoffs, and passes. Rather, injuries
occur and attention should be focused on linemen, quar-
terbacks after releasing the ball, and wide-receivers after
catching the ball. In every sport, special attention should
be given to situations and players at high risk for injury. - The team physician must be prepared to handle non-
participant emergencies for it is not uncommon for the
team physician to be called on to treat an ill-fallen
coach, referee, or spectator. - The team physician insures accurate diagnosis through
use of additional studies and specialty consults, com-
municates information clearly and confidentially
2 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE