THE SPORTS PHYSICIAN’S RESPONSIBILITIES

An athlete’s autonomy, his or her interests and desires,
and the third principle of medical ethics must always
be taken into consideration in any decision made by a
sports physician. Such decisions should always be
made in the athlete’s best interest.


Whether the decision involves a diagnostic test or the
athlete’s eligibility, its end result is the maintenance of
good health with the least risk to the athlete.


Conflict between physician and athlete should always
be minimal or absent.


While autonomy is respected, most athletes can and
should rely on their sports physician to lead them in
the decision making process.


It is quickly recognized by the sports physician that
one solution rarely fits all with the same problem. The
same set of circumstances can lead to a different suggested
solution by the same sports physician.


Exactness and infallibility, while desirable, are not traits
of even the finest sports physicians (Maron, 1994).


The sports physician’s primary duty is to make the
best effort to maintain or restore health and functional
ability (Howe, 1988).


The athlete’s welfare must guide all efforts.


To be a good sports physician, he or she must have a
genuine appreciation for the importance of athletics in
his or her client’s life. The precepts of Dr. O’Donoghue
for sports physicians are timeless: accept athletics, avoid
expediency, adopt the best methods, act promptly, and
try to achieve perfection (O’ Donoghue, 1984).


The injured athlete must know the diagnosis, understand
its implications, and participate in all therapeutic
decisions.


Despite the athlete’s wishes, the sports physician
cannot do less than seek the best possible outcome.


All sports medicine physicians gain knowledge and
better judgment with experience, soon recognizing
many recommendations or forms of therapy have
risks as well as benefits.


Harm can come to the athlete-patient from unnecessary
or excessive restriction as well as from failure to
restrict activity when appropriate.


The sports physician does not operate in a vacuum. To
make sports oriented medical decisions, one must be
well versed in current recommendations for eligibility
and continued participation and not depend on his or
her own limited personal experience or unscientific
reasoning (Mitten, 1999).


Recognizing the wide range of opinions and individual
fallibility, athlete-patients can assert their right to
another opinion.


Continuing education of the sports physician aids in the
development of a suitable level of skill and knowledge
and their maintenance (26th Bethesda Conference,
1994).


While sports physicians will be able to treat most
referrals, they must be aware of their own level of
competence. They must know when and where to
refer for specialized consultation or therapy. It is
essential to know their colleague’s ability, personality,
and empathy for athletes in order to make competent
referrals (Rizve and Thompson, 2002).


The referred patient should not be abandoned. The
consultant may gain insight from the referring physician.
This affords the athlete continuing support from
his or her primary sports physician.


There is no obligation to accept without question the
recommendations of consultants, especially if incongruent
with the referring physician’s knowledge of the
patient.


All the above lead to trust established between athlete
and physician, allowing for more comfortable resolution
of the decision making process.