AAOS Bulletin - August, 2005

Responses to sports medicine scenarios

By David D. Teuscher, MD

In the Summer 2005 issue of Orthopaedic Medical Legal Advisor (OMLA), several scenarios were provided for your opinion in the article on “Moral Reasoning of the Team Physician.” The article and questions can be viewed on the AAOS Web site under Library & Archives. What follows is a consensus of the AAOS fellows who responded on line.

When faced with treating an injured player who makes a threat of intentional physical retaliation, physicians have an obligation to help prevent someone else from harm. Fellows advised that you notify the team official/employee most appropriate for the situation, probably the team trainer and/or coach.

The practice of paying for the right to serve as team physicians raised concerns about the primary allegiance to the patient-athlete and whether the best qualified physician would handle the injured athlete’s case. NFL Commissioner Tagliabue banned the practice of sponsorship agreements that “involve a commitment to provide medical services by team physicians” on September 7, 2004. Though it may be permitted in other sports, it was considered a “slippery slope” and respondents recommended it be avoided or eliminated. The AOSSM recently adopted a position statement on “Principles for Selecting Team Medical Coverage,” which you can view at www.sportsmed.org.

Requests by management to “re-evaluate” a player with the implication that you would change your assessment for nonclinical reasons raised ethical concerns. While re-evaluation is not inherently wrong—especially if the condition is “difficult to evaluate objectively,” maintaining the independence and objectivity of your clinical judgment is critical. If there remains doubt by the athlete or team, a second opinion from another reputable physician is advised.

A policy of “no comment” and referral of all questions by the media on the status and prognosis of a player’s injury to the player and team spokesman/sports information director is highly advised. If you have already made comment and find yourself with threat of potential litigation, consult with your attorney before making any more comments.

Fellows advised against the practice of mischaracterizing the location or nature of an injury. Instead, characterizing this as an “undisclosed injury” and letting the team spokesman elaborate further would be the prudent course. Again, if you refrain from public comment as a matter of policy, there is no problem.

An inquiry from collegiate recruiters or professional teams regarding the health status of an amateur athlete under your care presents a myriad of legal issues with serious pitfalls. If the athlete is a minor, the parents absolutely must be involved, and it is good policy to seek parental participation even if the athlete has reached majority. Under HIPAA, personal health information cannot be shared without the patient’s express permission. It would be prudent to advise the athlete and his parents of your honest and independent opinion before receiving this permission. A dictated counseling note in the presence of the athlete and his parents can serve as an excellent reminder in case someone gets amnesia and threatens legal action.

AOSSM joins the discussion

The American Orthopaedic Society for Sports Medicine (AOSSM) would like to add to the AAOS discussion on “The Ethics of Being a Team Physician” and related articles covered in the summer 2005 issue of Orthopaedic Medical Legal Advisor. The practice of medicine includes many ethical dilemmas, and team service in orthopaedic sports medicine is no exception. We would like to mention several resources that would add to orthopaedic surgeons’ effectiveness as team physicians.

First, we believe it would be useful for Academy members to have a clearer delineation of the team physician’s role and responsibility. A useful, widely accepted definition of a team physician was developed and adopted by leading medical organizations, including the AOSSM, American College of Sports Medicine, the American Medical Society for Sports Medicine, the American Osteopathic Academy of Sports Medicine, the American Academy of Family Physicians and the AAOS. A free copy of that consensus statement is available on the AOSSM Web site.

Second, while the document outlines some of the potential conflicts of the team physician, there are many other factors that may affect an athlete’s health. These issues are illustrated in a forthcoming DVD “Playing Hurt,” produced by Fred Friendly Seminars at AOSSM’s 2004 Annual Meeting and soon to be released for public television. The program is a Socratic dialogue among athletes, agents, coaches, attorneys, athletic trainers and team physicians that explores the different factors that influence decisions about an athlete’s care. A copy of that program will be available to the general public beginning in August from Films for the Humanities and Sciences.

Finally, rather than discourage orthopaedic surgeons from serving as team physicians because of the potential challenges, we would encourage Academy members to make full use of many of the resources available so that they can effectively and ethically serve as team physicians. Following are a few resources that are available to Academy members from the AOSSM Web site:

    1. Principles for Selecting Team Medical Coverage, AOSSM 2005

    2. Team Physicians and Return to Play, Consensus Statement, July 2002

    3. Sideline Preparedness for the Team Physician, Consensus Statement, May 2001

    4. Conditioning of Athletes, Consensus Statement, Jan. 2000

    5. Female Athlete Issues for the Team Physician, Oct. 2003

A new consensus statement on the management of concussion will be available later this year.

Being a team physician is a serious responsibility but one that orthopaedic surgeons can be especially well-positioned to fulfill. We encourage Academy members to make good use of the available resources so they can manage their risk while serving the athletic community.

William A. Grana, MD

President, AOSSM

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