As a junior sport and exercise medicine trainee and part-time, lower league team doctor I often find myself in a position of ethical uncertainty. I have tried to establish clinical boundaries and set personal guidelines regarding the team doctor role, constantly revisiting conversations such as –
“Players should have their own General Practitioners (family doctor)”
“I would prefer to review a player in person rather than hand out antibiotics based on telephone calls alone”
These ‘rules’ however have slowly been ground down as reality sets in.
The roles and responsibilities of the team doctor vary based on the sport, level of competition, time requirements and attitudes of the management. General medical and musculoskeletal opinions are certainly required but sometimes the club doctor must say no!
Prescribing oral antibiotics to a player with cellulitis or an upper respiratory tract infection is reasonable, as is referring a player for an orthopaedic opinion regarding an injury sustained during a game. Should this information however be forwarded to the player’s General Practitioner (if they have one!) or purely kept on club-based records?
What if the player is prescribed sleeping pills from the club doctor then requests the same from their General Practitioner?
Dissemination of information is vital.
Even if the team doctor is confident about handling all of the above, what would the correct approach be if a player confides that he or she has noticed a lump in their abdomen with blood in the stool and loss of weight and appetite? Should the part-time team doctor be referring to secondary services for an urgent opinion regarding potential malignancy and are they equipped to manage the resultant barrage of information?
The NHS choices website suggests that all individuals should be registered with a GP; surely this includes elite sportsmen and women? Where does the club doctor role end and the GP role begin?
The GMC produces guidelines on being a good doctor in the UK but isn’t it about time that we developed specific ethical guidance for medical staff involved in sport?
Dr James Thing is a Sport and Exercise Medicine Trainee and General Practitioner in London, England