Sports medicine doctors sometimes need to separate ‘sports’ and ‘medicine’

When medicine collides with the big business of running a sports franchise, ethical problems may develop. Among these are a lack of credibility for the medical opinions of physicians employed by teams and false medical information generated by teams.

The relationships of sports medicine physicians generally fall into two broad categories:

1. Consulting Physician. In this situation, a physician’s primary responsibility is to provide advice to a client. That advice may include formulating appropriate procedures to be followed regarding prevention and treatment of injuries. It often involves recommending appropriate referral and treatment for athletes.
2. Treating Physician. This role involves a traditional doctor-patient relationship where the only obligation is to do what is best for the athlete, regardless of the interests of a team or other organization.

Sometimes these responsibilities become confused and ethical dilemmas arise.

In boxing, ringside physicians serve as consultants to the boxing commission. The physicians are responsible for making sure that only fighters in excellent health are allowed to participate by carefully screening medical reports and examining each participant before a match.

Ringside physicians also have the authority to end a fight if they believe one fighter is being severely injured. After a fight, the physician must re-examine each fighter and arrange for medical attention if needed.

Ringside physicians must be impartial and are never treating physicians for fighters. They should not be employed by a promoter who stands to financially gain by allowing a questionable fight to proceed.

Confidentiality is imperative in either relationship. Physicians are obligated to share information only with their client or the athlete. Often an athlete or organization may choose to share information with the press. This information may also be a strategic move. Medical information is sometimes concealed because of gambling.

Although sports medicine has created increasingly complex relationships, wise physicians will take a step back and make sure medical ethics are always of paramount importance.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. He also serves as a ringside physician for the Connecticut State Boxing Commission. E-mail him at aalessi@wwbh.org, or listen to his podcasts, comment on his blog or buy his book at backushospital.org.