CHAPTER 2 • ETHICAL CONSIDERATIONS IN SPORTS MEDICINE 7- When a sports physician is employed by a school,
team, or similar entity, the expectations of both ath-
lete–patient and sports physician are agreed on at the
outset. That sports physician must always maintain his
or her position as an advocate for the athlete–patient’s
welfare. - An employed sports physician must still respect the
athlete–patient’s autonomy in medical decision
making, while advising against any decision that
could compromise the patient’s future health and ath-
letic career.
RELATIONSHIP WITH COLLEAGUES
- Among the problems that can arise for a team physi-
cian are those involving other physicians participating
in the care of the athlete–patient. There must be sen-
sitivity demonstrated to the relationship of all medical
professionals involved. - The sports physician must never criticize the actions
of another physician to the athlete–patient. Private
discussions with the primary care physician regarding
recommended therapy should be undertaken. - The sports physician is in a position to positively
influence his or her colleague’s care of athletes in the
future by such positive input. - If playing restrictions have been imposed on an ath-
lete by a primary care physician, while not counter-
manding them, the sports physician must always insist
on an individual assessment of the athlete’s return to
play status. - Consultation between the sports physician and the
athlete’s primary care physician usually solves the
problem and provides an opportunity for education. - Sports medicine is a team effort involving physicians
and many paramedical disciplines. The sport’s physi-
cian recognizes that these can be helpful while coor-
dinating the athlete’s care. The sports physician must
insist that such assistants adhere to the same high eth-
ical standards he or she practices. - The sports medicine physician has an obligation to
expose quackery and unproved practices employed in
the guise of improving performance, thus protecting
athletes and their careers.
FEAR OF LEGAL ENTANGLEMENT
- There is always a question as to what the sports med-
icine physician should do in the presence of a life-
threatening situation or a potentially disabling
condition. Under these circumstances, the physician
must be cautious and recommend against participa-
tion.- When operating at the highest ethical level with
support from the medical literature and the medical
community, such an event should never alter a
physician’s role in the future evaluation of other
athletes.
•A sports physician not afraid to make the difficult call
should be sought out by other physicians and athletes.
SUMMARY- Sports medicine offers awesome responsibilities and a
magnitude of potential problems exceeding many
other specialties.
•Familiarity with many disease states that can affect an
athlete’s ability to participate is required. - Athletes can only be allowed to participate if they do
not endanger themselves or others. - The physician must be familiar with unethical means
to enhance performance. - The physician must be aware of resources available to
aid him or her in rendering an authoritative opinion. - The physician must be devoted to the rules of confi-
dentiality, informed consent, and truthfulness. - The physician must be aware that occasional deci-
sions may require legal enforcement. - The physician must be aware that there is no table of
contents to refer to for every decision. A backbone,
on occasion, is more important than an ethics
primer.
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Mitten MJ.: Medicolegal issues, in Williams RA (ed.): The
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