James R. Andrews, MD, is a founding partner and medical director of the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. He also is a co-founder of the American Sports Medicine Institute in Birmingham, Ala. His blog adds perspective and commentary on current sport medicine initiatives and other related orthopedic news.

BLOG: Team physicians for professional athletes have specific challenges

There are many specific and unique challenges facing a team physician who takes care of professional athletes. One of the major challenges is making return-to-play decisions. The team physician has to estimate the player’s injury severity and predict his management quickly, yet the decision can be still somewhat unpredictable. Players and agents can have their own time table, which makes the team physician’s decision even more complicated as they can be caught in the middle. Ultimately, decisions should be made on known time tables and objective results, rather than solely on subjective findings. If there is a grey area, then more tests may be needed.

There are many other challenges unique to team physicians of professional sports. One that comes to mind is when the athlete underestimates his or her injury and subsequent sequelae. Team physician must explain the short-term and long-term sequelae and informed consent is necessary. It can be tricky from a legal standpoint. The informed consent should be in subtle terms that the athlete can understand and he or she should be willing to sign it.

Second opinions

Second opinions are not an uncommon need in professional sports. Oftentimes, multiple second opinions are sought after and can create conflict and controversy in solving the athletes’ specific problems. In other words, second opinions can be good or bad. Most second opinion physicians will not know the player and the medical situation as well as the day-to-day team physician. As a second opinion physician myself, I know this first hand. Open communication between the second opinion physician and team physician and team athletic trainer is critical. A common game plan is optimal and essential. In other words, second opinion physicians need to get on the same page with all the medical staff as well as the player’s agent.

Another special challenge in professional sports is an overactive role by agents and representatives of the player in health care decisions. The role of the agents in professional sports is to make sure their players/clients have the best care possible. However, the team physician has a complicated and delicate responsibility when dealing with overactive agents and representatives who certainly mean well

Open communication critical

Communication is the most critical aspect in taking care of any athlete, especially professional athletes. Speaking of communication, you must know who releases the medical information for a specific professional athlete and team. There is no real established way to do this and, unfortunately, sometimes the message can sometimes be unclear and confusing.

Some teams have the policy that the head coach releases the medical information. For other teams, the head athletic trainer or team physician releases the medical information. However, most often the sports information department release the medical information based on accurate information from the medical staff.

In other words, for all those involved in the care of professional athletes, we must know how a specific team wants medical information released. All medical information about a specific player is basically guarded health care information and should be treated with confidentiality. For me, I rarely ever talk directly to the press about a player’s condition and direct all inquiries to the team’s sports information director.

These are just some of the special challenges of a team physician and for a second opinion physician involved in professional sports. Future blogs will focus on the special situation that arise in the National Football League, Major League Baseball, National Basketball Association and the National Hockey League.

James R. Andrews, MD, is a founding partner and medical director of the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. He also is a co-founder of the American Sports Medicine Institute in Birmingham, Ala. He can be reached at the Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Pkwy., Suite 203, Gulf Breeze, FL 32561; email: info@theandrewsinstitute.com.