Sports Medicine: Just the Facts

employed sports physician’s objective professional

duties are compromised by personal interests, e.g., the

financial reward of his or her association with a pro-

fessional team as well as the publicity and high visi-

bility one gets from such a position.

• It is an ethical breach for anything but the athlete’s
  health interest to be considered, again, recognizing
  judgment errors in too conservative or too liberal ther-
  apy can occur.
  •The ultimate welfare of the athlete may seem in con-
  flict with the wishes of parents or spouse, coaches or
  team management. The fact that an organization or
  someone other than the athlete pays the physician is
  immaterial. The loyalty of the sports physician is to
  the continued healthy physician–patient relation-
  ship.


• Decisions must be made solely based on sound med-
  ical judgment. A reasonable third party, e.g. a univer-
  sity or professional team, will understand this. If it
  does not, the physician should remove his or her serv-
  ices from that party.


• Occasionally, wishes of the athlete-patient conflict
  with what the physician believes are in the athlete’s
  best interest. If after negotiation and additional con-
  sultation the sports physician feels uncomfortable
  with another’s recommendation, continued care of
  the athlete-patient could be difficult or impossible.
  The athlete should be reassigned to another physi-
  cian.
  •For the professional athlete, the unfavorable mix of
  high salaries and short careers can make for risky
  decision making by both the athlete and the physician.
  Coaches often encourage physicians to rush players
  back on to the field to win games. Players themselves
  often desire to rush back too quickly.
  •Teammates should not be allowed to pressure injured
  athletes by suggesting they are malingering while col-
  lecting a substantial income. Under these circum-
  stances many physicians play by the rules of the
  coaching staff.


• An untimely death or worsening injury sets the stage
  for lack of trust in the team physician.


• By actions alone, the team physician demonstrates
  that his or her utmost responsibility is to protect the
  players. If a player should not be on the playing field,
  that players will not be there.

DRUG USE

• It is common knowledge that there is illicit drug use
  by athletes at all levels: recreational drugs, anabolic
  steroids, pain controlling agents, ergogenics, and
  alcohol.
  
  
  • Therapeutic medications are an integral part of sports
    medicine. Used appropriately, they control pain and
    inflammation, speed recovery, and hasten return to
    function.
  
  
  • It is the obligation of the sports physician to know
    each drug thoroughly, especially its potential effect(s)
    on the safety or effectiveness of the athlete’s perform-
    ance. Appropriately prescribed drugs must not expose
    the athlete to potential disqualification, e.g., as in the
    prevention of exercise-induced asthma, when an
    effective legal medication can be found.
    •Nowadays, available testing makes it impossible to
    catch all participants who use banned substances.
    That is rapidly changing.
  
  
  • There are those who would remove all bans on
    enhancing agents, hormones for instance, allowing for
    a “free-for-all” with unrestricted use.
  
  
  • There are two major arguments against such an atti-
    tude: one should not condone cheating; and the essence
    of sport itself.
  
  
  
  

CONFIDENTIALITY

• There is nograde to confidentiality: more for a high
  profile athlete; less for one with a lesser public persona.


• Confidentiality must be inviolate, despite the fact that
  athletes are very public persons.


• Society wants to know the most intimate details of
  athletes’ lives, including medical evaluations and
  treatments.


• No athletes forfeit their right to medical privacy.


• All inquiries made of sports physicians by the press or
  other interested parties should go unanswered unless
  specifically permitted by the athlete.
  •Even with permission, the sports physician must be
  extraordinarily sensitive about details revealed.
  •Despite claims regarding the public’s “right to know,”
  the right to privacy remains with the athlete–patient.


• The press is very resourceful in gaining information—
  inaccurate on more than a few occasions. If inaccurate
  information is printed, the physician may, with the
  athlete’s permission, attempt to correct it.


• On occasion, the sports physician will advise the ath-
  lete–patient about the amount of information to
  release to coaches. This is important when restriction
  from practice or competition is necessary. The athlete
  usually grants such permission. Here we refer to the
  athlete’s private sports physician, not one employed
  by a school or professional team.


• No greater breach of confidentiality can occur than if
  any health information is released to anyone remotely
  related to the athlete’s career without forewarning the
  individual.

6 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE