ATC vs Coaches: How Did We Get Here?

Written by admin on March 31, 2014 – 10:26 am -

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The author addresses a recent, growing and troubling trend in modern medicine. Medical decisions are increasingly influenced, if not driven, by the profit center concept rather than the best interest or the medical well-being of the patient. This represents further erosion in the doctor-patient relationship and an involuntary separation between the doctor and his Hippocratic Oath. This wedge of separation assumes a variety of names: hospital CEO, Board of Directors, Insurance Company, (Insert Name of Government Agency/Politician here), or as highlighted in the referenced article, collegiate athletic directors and head coaches. Many are unaware that Licensure of athletic trainers is dependent upon and subordinate to the medical oversight of their supervising medical doctor. Sports medicine professionals have allowed the athletic directors and universities to suborn this relationship. This has not been a conscious decision or a voluntary submission, rather a gradual erosion by the weight of financial expectations borne of the pressure to “win” above all else. The importune actions of others, including decisions by Universities to place athletic training providers under the purview of head coaches, does not abrogate medical-legal responsibility and does not supersede the doctor-patient relationship. Unfortunately, the team doctor and the athletic trainer can be replaced by the athletic director or head coach at whim, so as a result, the Athletic Director or Head Coach becomes the de facto supervising medical provider. The ATC and Team Physician are thus pressured to make decisions that put athletes on the field when they otherwise should not be allowed to play. How is this done? Providers that make decisions that anger the head coach/AD are not renewed for the next season or are dismissed, and the message is sent. Conversely, those providers that are malleable become the “coach’s guy.” When the coach gets a new job, he brings with him his own hand-picked personnel replacing the previous staff. Last season, during the NFL playoffs, we were all afforded a rare glimpse into these operations when the Redskins’ team physician publicly disagreed with team officials regarding the availability of an injured RGIII. We all know how that story ended. This is the exception—a team MD with the stature to defend the rights of his athlete, but highlights the inner-workings of the industry. Co-opt the MD and the ATC into making decisions in the best interest of the Club rather than in the best interests of the patient (the athlete).
The team physician must be afforded the autonomy for adjudicating the medical care of a patient, and the Athletic Trainer, as an extension of the Team Physician, must be accorded the same freedom. Athletic trainers and medical doctors cede this right only at their great and grave peril and at the expense of the athletes entrusted to their care. It is incumbent upon all health care providers, athletic trainers, and team physicians alike, to protect the health, well being, and rights of their patients whether or not they are athletes or weekend warriors. The excuse “I was just following orders (of the athletic director, the head coach, etc.)” is and ever has been unacceptable. It will stand neither the test of time in the court of law nor the court of public opinion. It not only fails the ethical responsibilities and obligations of the health care provider to the patient, but also shouldn’t we expect more from ourselves and other health care providers? It is ridiculous to suggest or operate under a different set of rules simply because the patient is a scholarship athlete and or under contract. Indeed, it can be argued that these patients, as they are subjected to higher levels of stress and danger of injury, should be even more closely protected than the average patient – not less so. Given the recent legal decisions regarding players’ safety in the NFL, the ever-increasing awareness of athletic-related injuries, and diminished longevity of playing careers at all levels, we should remain steadfast to our Hippocratic Oath and to our desire to always protect our patients above all else. Unfortunately, if we relinquish these rights, there are many who will be only too happy and quick to assume our responsibilities, as currently evident at the highest levels of athletics and sports medicine. If we are truly serious about protecting the rights and health of our athletes – our sons and daughters – then we must reclaim our position and our responsibilities as the preeminent decision makers in healthcare matters at all levels of athletics and sports medicine.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, and is the Supervising Physician for over 20 ATCs in NC


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