Our Readers as Leaders
THE PHYSICIAN AND SPORTSMEDICINE - VOL 27 - NO. 12 - NOVEMBER 99
You, our readers, don't often think of yourselves as being at the forefront of a medical trend—but, in fact, you are. That trend is the gradual emergence of a "health model" of medicine, with its roots in sports medicine and similar health-oriented clinical disciplines. You practice in this mode whenever you offer advice on prevention of disease or injury, prescribe exercise for fitness or rehabilitation, or find a way to help patients with asthma or osteoarthritis remain active.
Practicing in this model, you offer your patients a positive approach to healthcare, and you are part of the continuing growth of sports medicine as a clinical discipline. While this model's underpinnings are scientific, its emphasis is on function over structure, physiologic capacity over pathology, vitality over morbidity. Investigation, medical and surgical treatment, and rehabilitation are and always will be essential to what we do. But it is full recovery and enhancement of human performance (at whatever level) that are our joie de vivre.
The bulk of physicians don't practice "health medicine" full time, but instead see patients who benefit from this type of care interspersed with those for whom traditional disease- and technology-based management is perhaps more appropriate. But despite its part-time status, this is what we mean by the office-based model of sports medicine we discussed last month: the broad-based application of sports medicine—for use when the game is over, or the patient isn't even an athlete.
The growing emphasis on the office-based practice of sports medicine parallels the accumulation of research and comprehensive reports that urgently recommend exercise for people of all ages and abilities. The increasing recognition that so many "inevitable" chronic diseases are in fact self-inflicted—and the unnecessary expenses that accrue—promote this trend. So does the inadequacy of advances in healthcare to treat the many inactivity-related medical conditions. Patients also feed the trend: They want to influence their own healthcare, expect continued health and vitality, and seek empowerment through knowledge. The sports medicine/health medicine model is driven by patients for whom "not sick" is not well enough.
Clearly, office-based sports medicine excels in its relevance to multiple populations and in its continuity of care. But it can't meet all sports medicine needs. Much training is required for the team physician, for example, who must address on-field triage and care and the highly specialized needs of advanced athletes. Similarly, most physicians are not in a position to investigate the epidemiology of injury or implement a plan for injury prevention on a team. Nor does the office-based model in and of itself provide for education of its practitioners, or for a way for patients to readily find one (they can't look in the phone book under "health model").
Thus, the models will continue to coexist and complement each other and, we believe, continue to grow in scope and influence. As the field evolves, The Physician and Sportsmedicine will continue to meet the needs of sports medicine physicians practicing in all venues. Subjects in this issue we think will be useful to all readers include asthma (page 75), muscle cramps (page 109), and diagnostic enhancements possible with nuclear medicine (page 44). Team physicians, "hockey parents," and any physician with young players in his or her practice will be particularly interested in understanding why senior associate editorial board member William O. Roberts, MD, calls for eliminating hitting from youth hockey (page 35).
As always, we'll do our best to help you help your patients. Please let us know what more we can offer.