BOX 4: KEY POINTS ABOUT MEDICAL INFORMATION

n You may often be asked “reasonable” questions about an athlete’s health by a coach or manager

n You must respect confidentiality of every athlete in your care

n You must obtain specific consent from the athlete every time you divulge information

n You can only share information from a pre-participation physical screen on completion of the screen

n You may have a signed waiver for an athlete’s information but he or she can revoke it at any time

n How do they differ from the other medical personnel in the club? Some NGBs do have detailed recommendations for the role of the team doctor or physiotherapist, but other NGBs do not. Be sure to know whether your sport has and be aware that they may be stipulated at an international as well as national level. If you are working with a minority sport, with no formal medical guidelines, then it is up to you as the medical practitioner to ensure you are enacting best practice. There are some excellent generic

models of sport and exercise medicine standards and procedures which can very readily adapted to a particular sport, so don’t be afraid to seek external advice if you are unsure. This would be particularly important for the doctor or therapist just starting out at a non-elite level. Bear in mind that if something goes wrong at this level, the immediate response of the team officials is likely to be: “We assumed the doctor/physio would sort out all the medical stuff.” And the law might well take the same view. So be sure that your roles and responsibilities are clearly defined and that the club are aware of what they are. They cannot alter, add to or subtract from these without your consent. The responsibilities must also be in line with the rules of the sport and the prevailing bylaws. You have a duty to know about them, and must abide by them, whether they are general (e.g. how to enter the field of play and remove a player from the field) or more specific (e.g. what to do about blood-borne disorders and how to deal with concussion). One of your main activities will be

keeping medical records. Don’t forget the case of Brady vs Sunderland

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Football Club (see Box 1) where the lack of such records formed a major part of the case when a professional footballer claimed that his club and hospital consultants failed to diagnose and properly treat a serious career- ending condition.

MEDICAL RECORD KEEPING Medical records should be kept and they should be individualised, but whose property are they? They are the property of those who prepare them (medical professionals). They are not the property of those about whom they are concerned (patients). However, patients have a right to privacy with respect to information within the records. These two interests sometimes conflict with each other when it comes to releasing medical records to outside parties. Some third parties (e.g. coaching

staff) may have another interest at stake. For example, you might hear the comment: “I see Player X is unfit again. What exactly is wrong with him?” This is a reasonable enquiry from a frustrated coach or manager to make of the team’s healthcare professional. But how you answer will require tact and awareness. Again you must be prepared. First and foremost there is the

common law concept of a duty of confidentiality relating to doctor–patient confidentiality. This binds a medical professional from revealing or disclosing what he or she may know about a person’s medical condition. This level of confidentiality covers all medical records, including x-rays and laboratory reports, as well as any communications between the patient and doctor, and it generally includes communications between the patient and other professional staff working with the

doctor. Once a medical professional is under a duty of confidentiality, he or she cannot divulge any medical information to any third party without the patient’s consent. This law was purported to shield medical information about a person from unauthorised release or disclosure, but there continues to be a substantial number of “grey areas”, each of which is susceptible to varying interpretations and applications. Consider, for example, whether

“medical records” include pre-signing physical examination records. I think, in the context of sport, this is the only distinction we have. An athlete agrees to have a pre-participation physical screen to see if he or she is eligible to sign. By its very nature, this agreement means waiving the athlete’s right to confidentiality. However, once it is completed and the relevant information is shared with the club, the sharing ends. The common law about medical professional–athlete confidentiality comes back into play. One important point to remember is that it is totally irrelevant who pays your wages or who is your line- manager. Your duty of care is to your athlete, and you cannot share medical information about him or her unless he or she has given you prior consent on each and every occasion to do so. A waiver can be signed by the athlete pre-season that gives you permission to share medical information with the coach on various occasions about his or her fitness to participate. However, the athlete will have the right to revoke this consent at any time, irrespective of a signature on a piece of paper.

MEDICAL EQUIPMENT Another major part of the job is selecting equipment to take to an event to cover the injuries that you know could occur at any time. Obviously you should know the major injuries associated with each sport you work within, and you should have a plan to deal with whatever situation may arise. You are also responsible for checking you have the necessary equipment to

QUALIFICATIONS TO UNDERTAKE THE DUTY

ENSURE YOU HAVE THE APPROPRIATE

sportEX medicine 2010;46(Oct):17-22