high school. Upon questioning, he indicates that a physician never evaluated him, but that the AT at the high school evaluated his condition. This is a clear example of an AT functioning in an autonomous man- ner, which could have devastating consequences.
Several questions need to be asked. First, did the athletic pro- gram personnel and school admin- istrators believe that autonomous management of the athlete’s con- dition by an AT was appropriate? Second, were they unaware of the legal obligation for an AT to func- tion under the direction of a desig- nated physician? Finally, was the AT more concerned about upset- ting or disappointing coaches, fans or the injured athlete than acting in the role of the medical professional who is responsible for the athlete- patient’s best interests? Clearly, the availability of an AT and the designation of a team phy- sician do not automatically result in optimal care for athletes when the AT-physician working relation- ship is poorly defined. The AT is a health care professional who does not require a physician’s presence to provide services, but docu- mented physician authorization of specific procedures and close communication are absolutely es- sential. A vaguely defined and an indirect relationship of an AT to a team physician, combined with a clearly defined and direct employ- ment or contractual relationship to an athletic program, presents the potential for very serious conflict of interests and legal liability. Risk management strategies should include a critical review of the manner in which athletic medi- cal services are coordinated and provided. An editorial that was re- cently published in the Internation- al Journal of Athletic Therapy and Training3
provided the following
10 principles to guide the adminis- tration of sports medicine-athletic training services:
coachad.com
Any program that delivers athletic training services, in- cluding “outreach” services provid- ed to high schools or other athletic organizations, must always have a designated medical director.
1 2
ways practice in a manner that in- tegrates the best current research evidence with the preferences and values of each athlete-patient.
3
The clinical responsibilities of an athletic trainer must always be performed in a manner that is consistent with the written or verbal instructions of a physi- cian or standing orders and clinical management protocols that are ap- proved by the program’s designated medical director.
4
an athlete-patient who has an injury or illness must only be made by a properly credentialed health profes- sional (e.g., a physician or an ath- letic trainer who has a physician’s authorization to make the decision).
5
In every case that a physician has granted an athletic trainer the discretion to make decisions relating to an individual student- athlete’s injury management or sport participation status, all aspects of the care process and changes in the patient’s disposition must be thoroughly documented.
6
event or development of a disabling condition, coaches must not be al- lowed to impose demands that are inconsistent with guidelines and recommendations established by sports medicine-athletic training professional organizations.
7 trainer’s role delineation and em- 8
An inherent conflict of inter- ests exists when an athletic
To minimize the potential for occurrence of a catastrophic
Decisions that affect the cur- rent or future health status of
Sports medicine physicians and athletic trainers must al-
The physical and psychoso- cial welfare of the individual
athlete-patient must always be the highest priority of the athletic train- er and the team physician.
ployment status are primarily de- termined by coaches or athletic pro- gram administrators, which should be avoided through a formal admin- istrative role for a physician who provides medical direction.
An athletic trainer’s profes- sional qualifications and per- formance evaluations must not be primarily judged by administrative personnel who lack healthcare ex- pertise, particularly in the context of hiring, promotion and termina- tion decisions.
9
adopt an administrative structure for delivery of integrated sports medi- cine and athletic training services to minimize the potential for any con- flict of interests that could adversely affect the health and well being of student-athletes. The International Federation of Sports Medicine Code of Ethics4 states that physicians should “al- ways make the health of the athlete a priority; never do harm; and nev- er impose authority in a way that impinges on the individual right of the athlete to make his or her own decisions.”
10
These principles should be em- braced by all individuals who have a responsibility for student-athlete welfare. Simply using athletes as the means to win games is unethical and unacceptable. Consider what can you do to be an advocate for their health and safety.
References
1.
http://www.ncaa.com/news/ncaa/ article/2012-06-20/ncaa-hire-chief- medical-officer; accessed Jan. 31, 2012. 2. Prentice WE. Focusing the direc- tion of our profession: athletic trainers in America’s health care system. J Athl Train. 2013;48(1):7-8. 3. Wilkerson GB. Patient-centered
care and conflict of interests in sports medicine-athletic training. Int J Athl Ther Train. 2012;17(4):1-3. 4.
http://www.fims.org/en/general/ code-of-ethics/accessed Jan. 31, 2012.
March/April 2013 17
Universities, colleges and high schools should
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