CHAPTER 1 • THE TEAM PHYSICIAN 3regarding the player’s condition to those who need to
know, coordinates the rehabilitation process, and
determines when the athlete is able to compete again.
This essential process involves activecommunication
with athletes, parents, athletic trainers, physical thera-
pists, coaches, administrators, and other medical spe-
cialists as necessary (Rice, 2002).- Pursuing active follow-up with medical specialists is a
critical duty. Team physicians may refer athletes to
subspecialty providers to assist in treatment or with
clearance for athletic participation; however, informa-
tion from these visits does not naturally flow back to
the team physician. Assuming that the specialty
provider will call with any important information, or
that all pertinent information will flow back through
the health care system, will result in confusion for the
team physician and danger for the athletes. Shadow
files, tickler lists, and other reminder systems can help
team doctors actively and personally follow up on
referrals, thus preventing the always embarrassing and
often dangerous situations that result from incomplete
medical communication between subspecialists and
the team physician. - Documentation of medical care is often mistakenly
neglected in the team setting. The team physician
needs to keep formal and confidential medical records
that detail communication with consultants, give
treatment and follow-up instructions, and provide
details for insurance and reimbursement purposes
(Rice, 2002). - The team physician should have final say of when an
athlete is initially cleared to begin competition and
when a previously injured athlete may return to play
(Herring et al, 2000a).
ADMINISTRATIVE RESPONSIBILITIES OF THE
TEAM PHYSICIAN
- The team physician’s primary concern is the coordi-
nation of medical supervision. This organization
includes: making sure qualified medical personnel are
attending practices and competitions as needed,
designing a plan for sideline evaluation, and having
necessary medical equipment readily available. The
team physician encourages defined roles and respon-
sibilities for all involved in the medical care of the
team, along with establishing a medical chain of com-
mand. The team physician may not make all the daily
decisions but should have full authority concerning
medical policy-making. - The team physician needs to lead the planning for and
practicing of medical emergencies and urgencies. In
addition to having an emergency treatment and transport
plan, the team physician also must know the medical
capabilities of surrounding hospitals—particularly
around away competitions sites—so that injured ath-
letes are brought to medical facilities that are best
equipped to handle their specific medical problem
(Herring et al, 2000a).- The team physician should implement protocols that
facilitate timely and quality medical care for situa-
tions when he or she is not immediately available.
Preestablished guidelines for return to play are very
helpful, especially when injuries to impact athletes
result in high pressure for returning to competition
before appropriate healing has occurred (Herring et al,
2000 b). The ACSM consensus statement on return-to-
play issues more fully details the responsibilities of
the team physician when returning athletes to compe-
tition (Herring et al, 2002). - The team physician oversees the playing environment.
He or she should evaluate both practice and game
facilities for safety. A safe playing environment also
involves appropriate and properly fitting protective
equipment, available hydration, and an activity level
appropriate for the climate.
COMMUNICATION RESPONSIBILITIES OF THE
TEAM PHYSICIAN•For a team to receive optimal medical care, the team
physician and trainer must communicate openly and
clearly. Even before the season, they need to discuss
medical treatment protocols, which preferably are
documented in writing (Rice, 2002). When an injury
occurs there can be no confusion over who will go on
the field for initial evaluation and who will communi-
cate to the coach the extent of an athlete’s injury and
playing status.
•A team physician needs to develop good rapport with
the coach. Offering injury prevention suggestions and
player health education may demonstrate to the coach
a shared desire to assist the team attaining their goals.
Most importantly, a team physician must keep the
coach informed of an injured player’s ability to con-
tinue to compete safely. Without breaching player
confidentially, the team physician should provide the
coach a timeframe for further evaluation or the
player’s return. In general, this should be communi-
cated in terms of a sport-specific timeline, such as: the
player is out for a play, out for a series, reassessment
will be done at half-time or game’s end, or the player
is likely lost for the remaining part of the season.
•A team physician may also be required to discuss a
player’s medical condition with the school officials.
Administrators often need to know specifics regarding