Undergraduate perspective on Sport & Exercise Medicine – a BJSM blog series

By Manroy Sahni (@manroysahni)

Performance vs Safety

Team success, winning and performance are undoubtedly at the heart of elite sport. The concept of “marginal gains” and the pursuit of miniscule improvements that ultimately tip the balance between winning and losing mean that “performance” is a growing theme within sports medicine. However, performance and safety should never compete. Elite sport will never be 100% safe- that is an unrealistic expectation given the intrinsic risk associated with high-level physical competition. However, it is reasonable to expect that we should take steps to reduce the likelihood of harm, whether this be through modifying the playing environment, optimising technique or analysing and learning from previous incidents. This begs the question, who is responsible for the care of an athlete?

Who is responsible for the care of the athlete?

Within the hospital environment, doctors and the multidisciplinary health care team have a duty of care for patients on their wards. Things are not so clear cut within the sporting arena. Sports doctors of course still have a duty of care for their players but this duty of care is shared with the Employer. For example, football players will be employed by a club, whether that be at Premier League level or in the lower leagues, and player safety is therefore also the responsibility of the club. This is written in law under the Health and Safety at Work Act (1974). Consequently, within a sporting context the duty of care of the player falls on both the Doctor and the Employer. The Doctor must be competent and work within their “scope of practice” and the Employer must take reasonable steps to mitigate the risk to their employees through operating safely.

A Sports Physician’s Scope of Practice

It is of fundamental importance for all doctors to recognise their limitations and only work within their scope of practice. This remains true for doctors working within the dynamic and unpredictable world of professional sport. There are various routes into SEM so the training background for sports doctors can vary considerably. Typically, team doctors will have a General Practice background with a Postgraduate SEM qualification or have completed the SEM specialty pathway (https://blogs.bmj.com/bjsm/2017/04/24/postgraduate-perspective-sem-training-programme-undergraduates/).

For football, the Premier league and football league also require all team doctors to have a postgraduate qualification in SEM, up-to-date ATLS training in the form of Advanced Trauma Medical Management in Football (ATMMIF) and appropriate ultrasound accreditation if necessary. On top of this, a multitude of skills are required from the knowledge and capacity to travel with teams, the flexibility to work within a specialist MDT and the character required to cope with the very particular demands of the competitive environment . An appreciation for occupational health is often overlooked within this varied skill set.

Relevance of Occupational Health

In professional sport, the doctor is working for both an athlete and an employer. This means that the role of a sports medicine doctor has striking similarities with occupational medicine. The doctor must respect the fundamental importance of patient / athlete confidentiality whilst at the same time communicating pertinent information to the employer that may impact on an employee’s capability to work. Furthermore, sports doctors will often find themselves communicating player’s health reports to non-medical staff- whether this be members of the coaching team or club management. It is vital that in these scenarios, the team doctor understands the limits of what they can and cannot disclose.

Additionally, a team doctor may be asked to provide a medical opinion during a discussion regarding termination of a player’s contract, fitness to return to sport following serious injury or to advise on the impact of a mental or physical disability. These tasks come under the realm of occupational health and require the consent of the employee who has a right to see any report submitted.

What I hope to highlight in this short blog, is that doctors and employers have a shared interest in the wellbeing of athletes. Also, that the role of a sports doctor is evolving to fit in line with health, safety and employment law. These key messages are important to underline to an undergraduate audience, namely the representatives of the future of SEM.

For further detail and background on the points raised in this blog please read the following resources:

1. Duty of Care in Professional Football, Dr Matt Perry, BASEM Today Issue 38, Spring 2017
2. The Occupational Health of Sports Medicine, Dr John Ballard, BASEM Today Issue 38, Spring 2017
3. A Doctor’s Duty of Care When Attending a Football Game, BASEM Position Statement
4. Ethics Guidance for Occupational Health Practice; The Faculty of Occupational Medicine December 2011

Manroy Sahni (@manroysahni) coordinates the BJSM Undergraduate Perspective blog series. He is an academic foundation doctor in the West Midlands and serves as Education Officer for the Undergraduate Sports and Exercise Medicine Society (USEMS) committee.