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[EDITOR'S NOTES]

Maintaining Professionalism in the Athletic Environment

THE PHYSICIAN AND SPORTSMEDICINE - VOL 29 - NO. 2 - FEBRUARY 2001


Physicians often need to render a medical opinion at an athletic venue or in the midst of a crowded, noisy room. The setting is often one of urgency with the expectation of a black-and-white answer regarding return to play. This situation is a far cry from the consultation room, where the physician has more control over the environment and where the conditions have been created to optimize healthcare. Yet athletes expect the same accuracy of diagnosis they would receive in the consultation room. Athletes also desire the same confidentiality and bedside manner they would receive in an office setting, and so it behooves us to consider these issues.

Physicians are viewed as leaders in healthcare, and this leadership role is vital in setting the standard for professionalism and confidentiality in the athletic environment. The training room and sideline often lack the normal controls that most medical outpatient facilities have in place for optimal care. It is important to recognize this fact so that steps can be taken to offset potential drawbacks.

Aside from the triage care provided at events, the following are suggestions for maintaining a high standard of care in the athletic environment:

  • Whenever possible, insist on examining an athlete in the consulting rooms where the doors are closed, privacy ensured, confidentiality maintained, and disruptive traffic minimized.
  • Be sensitive to situations in which the athlete may not want another person in the room. If a coach or "agent" of the coach is present, an athlete may not feel free to discuss a medical issue openly. There is, after all, no need for nonmedical staff in the consulting room. Debriefing can take place after the consultation.
  • Spend adequate time and clearly communicate expectations for investigations and treatment. Communicate any new medical information (lab findings, surgical results) directly and first to the athlete, preferably with the trainer present, before communicating the results to the coaching staff or administrators. This is not only common courtesy, it is part of our obligation to confidentiality.
  • Be confident in communicating your working diagnosis and firm in your convictions when making recommendations that balance continued sport participation with health—don't be swayed by competition pressures.
  • Be explicit about plans for follow-up and return-to-sport guidelines and careful when suggesting time frames for return to sport. Athletes and coaches tend to hear the shortest number in a given range! No one can rightly expect a physician to predict the future, and it is wise not to put yourself in this position. Predicting the outcome of an injury or illness at its outset is fraught with error. An approach that works well is to put together a plan in measurable units of time such as 2-week intervals.
  • Finally, take responsibility for coordinating the management of a given case throughout its course even if another consultant becomes involved. This demonstrates commitment and places the team physician squarely in the middle of where he or she should be (making return-to-play decisions). It goes without saying that physicians should avoid making comments to athletic trainers, athletes, parents, or coaches about the care provided by other physicians. Any such issues should be discussed directly with the physician.

Those of us who work as team physicians enjoy the athletic milieu a great deal. But it is important to keep in mind that we are present because of a fundamental tension that exists between health and performance. Medicine concerns itself with health. Athletics concerns itself with performance. These two goals are often at odds. It is critical that the physician is seen, first and foremost, as one with a vested interest in the health of the athlete.

Best,
Gordon O. Matheson, MD, PhD
Editor-in-Chief


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