Team Physician Role and Responsibilities
The team physician is the medical team leader who is ultimately responsible for the safety and care of the athlete. The day-to-day role of the team physician varies dependent on the situation and the members of the sports medicine team that may include an athletic trainer, school nurse, dentist, nutritionist, psychologist, and other physician specialists. The team physician’s role should be a formal relationship with the team, even if volunteer. This agreement, among other things, should include complete autonomy in medical decisions and guarantees against acts of coercion. It is important to specifically avoid conflicts of interest, so that the safety and health of the athlete are the first priority of the physician.
The consensus statement further defines the duties of the team physician.1 A full range of Consensus and Position Statements relevant to team physician are easily accessible at the websites for the American College of Sports Medicine (www.acsm.org) and the American Academy of Family Physicians (www.aafp.org), and all physicians assuming responsibilities of a team physician should be familiar with these guidelines.1–5
The responsibilities of the team physician present a few unique medicolegal situations. One major difference that may exist is that athletes are typically highly motivated and may aggressively push to return to play. In addition, there may be third parties such as parents or coaches that challenge physician decisions regarding delay of return-to-play. In the case of the a young athlete, the physician should be cognizant of the parent–child relationship that may interfere with treatment or return-to-play. Additionally, there is a potential conflict-or-interest when the physician is employed by the sports team. The team physician must specifically be aware of and avoid or mitigate conflicts of interest and be mindful that their primary responsibility is to the safety and health of the athlete.
When acting as a treating physician, the physician–athlete relationship remains fiduciary in nature. Therefore, the same principles apply in sports medicine as in the general practice of medicine. The team physician must use the knowledge, skills, and care that are ordinarily possessed by prudent members of their specialty, given the state of medical science at the time care was rendered.6 Evaluations and medical decision making must be documented whether in-office, athletic training room, gym, or on the field. The same principles of informed consent apply to the team physician. In general, the athlete, and if a minor, his or her parents, must have all material information regarding the diagnoses, treatment options, as well as risks and benefits of those options explained in lay terms, so that they may make a truly informed decision. The team physician must also be mindful of issues related to disclosure of information. Generally, there should be explicit written consent for information to be provided to parties other than the athlete. However, in the case of the physician employed by the team, where records are the property of the team, the physician must be mindful of the implications of what records may contain.
Issues regarding exclusion of athletic participation are another area of potential legal action. If a physician is performing a preparticipation medical screening for the purpose of athletic participation, and there is not a treatment relationship present, the courts have set the precedent that the traditional patient–physician relationship is not present and torts for medical malpractice have been dismissed. However, a contractual relationship exists and the physician is still responsible to inform the athlete of findings made during the examination, and need for further investigations and care. Additionally, athletes should be informed of the limits of the screening examination. As long as exclusions from participation are based on the best medical information available, the courts have upheld these medical exclusions. The Rehabilitation Act and the Americans with Disabilities Act require balancing the physical disabilities a person may have with the personal risks and safety of the sport. Ultimately any decision for exclusion should include evaluation of the condition, risks to the athlete and others, and safety equipment that may mitigate risks. The legal atmosphere in sports medicine continues to evolve and the team physician should continue to monitor those changes, through participation in national and local medical societies.
As with all aspects of medical care, the on-field emergency starts with the basic life support (BLS) principles of the primary survey. The primary survey includes initial evaluation of the ABCDs: (1) airway, (2) breathing, (3) circulation, and (4) defibrillation. Fortunately, in most athletic settings, this is easily accomplished when seeing the athlete with a major injury calling out in pain. However, the physician should always remember to return to the primary survey should the situation fail to improve, or worse yet, deteriorate. Once the primary survey is complete, the physician can continue to the secondary survey following the principles of advance cardiac life support (ACLS), pediatric advanced life support (PALS), and advanced trauma life support (ATLS). The secondary survey includes a head-to-toe evaluation of the ABCDEs as listed in Table 32-1. Any injury that is serious or of potential seriousness should prompt the physician to activate the medical protocol for emergent or urgent transport to an appropriate facility for continued evaluation and treatment.
|A → Airway|
|Need for advanced/definitive airway|
|B → Breathing|
|Need for beta agonist|
|C → Circulation|
|Jugular venous distension (tension pneumothorax, tamponade)|
|D → Deformity/disability|
|Altered level of consciousness|
|Major joint dislocation|
|E → Exposure/environment|
|Checking occult injuries|
Appendix 32-1: Team Physician Consensus Statement
The objective of the Team Physician Consensus Statement is to provide physicians, school administrators, team owners, the general public, and individuals who are responsible for making decisions regarding the medical care of athletes and teams with guidelines for choosing a qualified team physician and an outline of the duties expected of a team physician. Ultimately, by educating decision makers about the need for a qualified team physician, the goal is to ensure athletes and teams are provided the very best medical care.
The Consensus Statement was developed by the collaboration of six major professional associations concerned about clinical sports medicine issues: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine. These organizations have committed to forming an ongoing project-based alliance to “bring together sports medicine organizations to best serve active people and athletes.”
- Stanley A. Herring, M.D., Chair, Seattle, Washington
- John A. Bergfeld, M.D., Cleveland, Ohio
- Joel Boyd, M.D., Edina, Minnesota
- William G. Clancy, Jr., M.D., Birmingham, Alabama
- H. Royer Collins, M.D., Phoenix, Arizona
- Brian C. Halpern, M.D., Marlboro, New Jersey
- Rebecca Jaffe, M.D., Chadds Ford, Pennsylvania
- W. Ben Kibler, M.D., Lexington, Kentucky
- E. Lee Rice, D.O., San Diego, California
- David C. Thorson, M.D., White Bear Lake, Minnesota