Orthopedic sports medicine can be defined as “the care of the muscles, bones and joints of athletically active individuals.” The sports medicine physician has multiple responsibilities to athletes and must possess the following characteristics: availability, compassion, gentleness, honesty, communication and a true love of helping those who show good sportsmanship.
Accordingly, the duties of the sports medical team, including the physicians, athletic trainers and other paramedical personnel, are to responsible for the health and well-being of the athlete. The team physician and athletic trainer must be prepared to identify and plan for medical care and services that promote the safety of athletes, prevention of injury and provision of medical care at the site of practice, competition or thereafter. It is also important to remember the athletic trainer is the glue that keeps the sports medicine team on track.
Responsible team physicians at all levels must remember to be able to put their priorities in order. The first priority is always to the player and the second priority is to the parents. Then comes the team, coaches, management, ownership and others.
There are certain specific challenges associated with being a team physician at any level. In this Blog, I highlight the challenges of team physicians for college athletes. In the next Blog, I will highlight the challenges of team physicians for professional athletes.
NCAA rules, HIPAA regulations
Being a team physician in college has its own unique challenges. The team physician has the responsibility for pre-participation or medical eligibility decisions. The challenge is who decides medical eligibility – the team physician or an outside physician. It is well accepted in the sports medicine world that the head team physician has the power of disqualification or participation. He or she can certainly utilize outside consultants to help with the decisions, but again, he or she has the final decision.
The next challenge is deciding who can return to play after an injury in the heat of the battle or week-to-week practice. Absolutely, the answer is the head team physician. The team physician must use good judgement and cannot be caught up as a fan. Medical exemption and disqualification, according to the NCAA rules, can be confusing. If the athlete has a medical or orthopedic condition of a severe nature, then continued participation in the sport will result in a long-term adverse result in all likelihood. If so, the athlete can receive the remainder of the educational scholarship and he or she will no longer count against the sports total scholarship number. Under these circumstances, the athletes cannot take part in another sport at that institution and cannot change their minds and return to play for the institution in any sport. He or she can transfer to another school and play for that school depending on passage of the physical examination by that institution.
The Health Insurance Portability and Accountability Act (HIPAA) regulates the way team physicians and members of the health care team communicate and handle patient medical information. However, HIPAA is a real paradox in today’s communication age. It certainly makes life difficult for the sports medicine team physician. However, we must abide by federal regulations and protect the private medical information of all athletes.
Conflicting health care goals
There are some unique challenges faced by the college team physician in regards to conflicting health care goals. I present a case presentation here. The star college running back is hurt and it is the playoffs. Rest and rehabilitation may do it, but there is pressure to get him back on the field at all costs. Newly enhanced miracle drugs are exciting and hopefully spectacular. However, they are usually not scientifically proven to be helpful and even may be harmful. To make it more complicated, with “miracle drugs” also comes sensationalism from the player and public. If severe enough, the urgent injury may require a surgical decision.
That decision is complicated by what is best for the long haul of the career vs. what gets the college player back quickly just for the playoffs. For example, if it is a torn meniscus, do you take the torn meniscus out, which can get him back early? Or do you repair it, which will not get him back to playing for 3 to 4 months?
The lesson to be learned from this case presentation is the medical team must inform the patient of his options, and at all times inform him of what is best for his career in the long term. The other thing to learn from this case is that doing what is best for the player in the long run is generally what is best for the team.
Advertising, marketing challenges
Advertising has its own challenges for sports medicine physicians in college athletics. Medical advertising, including sports team’s affiliations, raises a particular difficult ethical question in sports medicine. Obviously these physicians have marketing advantages, however, these advantages should not be fueled by aggressive self-promotion. There is no question notoriety as a team physician comes with some ethical price. To summarize this, the American Academy of Orthopaedic Surgeons Ethics Committee has recommended an orthopedic surgeon not to use publicity in an untruthful, misleading or deceptive manner.
Medical economics has its own challenges. To be successful in sports medicine, you must also be successful in medical economics. However, you should never let economics interfere with doing what is best in the medical care for the patient-athlete.