Be on the ball in sports expertise
The recent well-publicised disagreement between Chelsea Football Club manager José Mourinho and the team’s doctor Eva Carneiro has highlighted some difficulties that may arise when working in sport. Dr Rachel Birch outlines what you need to know before you take to the field as a sports team medic.
Before agreeing to be involved in a sporting event as a doctor, you should find out as much as you can about the role and the expectations that would be placed on you. You must ensure you have appropriate professional protection, whatever aspect of sports or spectator medicine you are undertaking.
Even if your participation in a sporting event is voluntary, you should approach it as you would any paid employment and ensure you meet the certification requirements for the sport.
GMC registration and a licence to practise are mandatory. But some semi-professional and amateur events may require further certification and training.
When assessing if you have the appropriate skills, as a general rule of thumb, ask yourself ‘would I feel comfortable acting in the required capacity in the course of my everyday work?’
Specific expertise
You must ensure you have the specific expertise required for the role and that your skills are up to date. Ideally, you should also acquire an adequate knowledge of the sport, including the risks and possible injuries that participants may sustain and ensure you are familiar with the guidance of the sport’s ruling body.
At professional boxing matches, for example, an anaesthetist must be present in case of injury that compromises the airway.
You should clarify whether the venue will provide appropriate equipment or whether you are expected to bring your own.
It is your responsibility to ensure that equipment is in good working order, regardless of who provides it.
So it is worth checking any equipment available complies with the ruling body’s requirements. Some regulated sports, such as horseracing, require specific equipment to be available at the racecourse.
Even though you may be providing medical services to a semi-professional team or individual, be aware you may also need to provide first aid for spectators. If you are, remember that you are expected to act within your competence and you may need to refer serious matters to a local hospital’s accident and emergency department.
There may be an ambulance crew present at the site and you should be familiar with the local emergency services and any relevant protocols.
You may wish to contact the Faculty of Sport and Exercise Medicine or the British Association of Sport and Exercise Medicine for training and further advice.
Specialist treatment
As a specialist, sportspeople may be referred to you for a variety of reasons, such as health screening or treatment of specific injuries.
We advise specialist consultants to avoid working in a way that might create the expectation that a duty of care is owed to the club rather than the sportsperson. It is important to avoid complications that may arise with regard to paperwork.
Medical Protection advises doctors here to:
Not enter into a written or oral contract with an employer (team or club) to treat employees (the sportsperson) for financial or other reward.
Only accept referrals from other healthcare professionals, not from clubs or coaches directly.
Address any professional fee notes to the patient and not their employer. If fees are to be settled by the employer or their medical defence organisation, the patient should be asked to forward them on.
Alternatively, written confirmation may be obtained from the patient that all fee notes should be sent to the employer or their medical defence organisation.
Review any existing relationship with a patient’s employer carefully to ensure there is no liability placed on you to employers or third parties. This would be done by reviewing existing contracts or arrangements.
Conflicts of interest
You may be faced with pressure, expectation and even criticism from clubs, sponsors and agents. You may also find yourself pressured by individual sports players to stay on the pitch or go back to their game earlier than you would recommend.
The interests of the patient are paramount and there are risks to the sportsperson if you do not put their best interests first at all times.
There may also be risks to you as a doctor if you do not act with integrity and honesty.
You should be mindful of GMC guidance:
You must make the care of the patient your first concern;
You must provide a good standard of practice and care;
You must be honest and trustworthy in all your communication with patients and colleagues;
You must work in partnership with patients, sharing with them the information they will need to make decisions about their care.
Additionally, the Faculty of Sports and Exercise Medicine has published its ‘FSEM Professional code (2010)’. This reiterates and refers to GMC advice and also states specifically:
The health and the welfare of a patient must prevail over the interests of any competition, economic or political considerations;
Decisions on fitness of a patient who is a professional sportsperson to perform physical activity should be determined on clinical grounds and should not under most circumstances be influenced by third parties such as coaches, management or family members of the patient;
When the health of a patient is at risk, a practitioner must strongly discourage the patient from continuing training or competition and inform them of the risks of continuation.
Confidentiality and communication
If you treat sportspeople who are in the public spotlight, you may receive media attention.
As with all patients, confidentiality must be maintained at all times and you should not offer any comment to the press about the patient.
If you are a GP in practice, even the fact that a patient is registered or has been seen is confidential information and should not be disclosed.
If you are treating a well-known sportsperson at your practice, ensure that all reception staff are warned of the possibility of inquisitive journalists and advised not to provide any comment.
Your primary responsibility is to the patient, even if you are a club GP. You must not disclose any medical information to the club, or anyone else, without the express consent of the patient. This is the case even if there are financial or employment regulations in place.
If you see a patient as a one-off or outside of the club, you should seek the consent of the patient to inform the team medic or any specialists.
You should explain the purpose of such communication – to ensure ongoing care and monitoring – but if consent is withheld, you should not disclose any information.
If you are required to provide treatment to any sportsperson or spectator, you should document your assessment and treatment clearly and retain this record.
This will be important should the patient require follow-up treatment. It will also provide evidence of the care provided and advice given, in the event of a complaint or claim.
GP services
Many doctors agree to provide GP services to a club or sportsperson and, in many cases, the work might be identical to their day-to-day work.
But it is worth remembering that sportspeople may have concerns specific to their sport. For example, an injured muscle in a sportsperson is going to have important implications for their ability to continue in the sport and they are going to want the issue resolved quickly.
You may have a lower threshold for referral to orthopaedics and physiotherapy in these circumstances.
As a GP, familiarise yourself with the effects of any medicine you prescribe to a sportsperson. While it is their responsibility to ensure they do not take anything that could be seen as performance enhancing, certain medications can enhance performance, including some available over the counter, so take care when prescribing.
Finally, make sure your work with any sports teams or people does not conflict with the care you offer other patients.
Appropriate professional protection
Any commitment outside your regular work should be adequately protected and you should contact your medical defence organisation to discuss the matter further with them.
If you wish to work with a sporting team or sportsperson, you must be clear on the indemnity arrangements beforehand. If you are agreeing to be a doctor for a club or for individual players, it may be that clubs and sports associations could provide the professional cover.
As the GMC states, it is your professional responsibility to ensure that you have adequate indemnity cover for every role that you undertake.
Dr Rachel Birch is a medico-legal adviser at Medical Protection
