Hi. I am Art Caplan, at the Division of Medical Ethics at the NYU Langone Medical Center in New York City. NYU is not a school that is known for its sports excellence. We certainly have pockets of athletic prowess, like fencing, but generally speaking, you certainly would not think of NYU when thinking of big-time sports. But all around the United States and indeed in Canada and elsewhere, there are plenty of schools where sports is a major activity for the university or the college. Obviously, professional sports, both in the United States and worldwide, is a huge business. Trillions of dollars are being spent -- some legally, some not -- on sports.
A key person involved in this is the physician, who acts as the doctor for the athlete. Time and again, we see situations come up where a doctor is asked by a coach, and even an owner, "Can this athlete play?" And time and again, people are thinking, "There are certain tests to do if you suspect a concussion; they ought to be administered before that person is allowed to return to the field." Other situations involve knee or leg injuries. Has the injury healed enough to allow that person to play, and play safely?
Patient safety should be the primary goal of the sports doctor, but sports medicine can easily yield to the pressures of "Hey, we've got to win this game" or "We've got to win this championship." Or even worse, the pressures that come up when people say, "If you don't get this person back on the field, then you may not be the team doctor next year." What is the ethical stance in terms of putting the athlete's health first and protecting the athlete's best interests vs the huge pressures from a gigantic industry, both college and pro (and even at the high school level), that can really weigh on those who try to protect athletes and their health?
A Modest Proposal
We need a change, at least at the pro level, and then we could see whether it might be extended elsewhere. The change is pretty simple: We should not let teams hire their own doctors. I believe the league should hire the physician for a pro franchise in hockey or football, or whatever the sport, and that physician should report to a head medical official. We have a model for this right in front of our eyes: referees. If you want a neutral referee, a disinterested referee, someone who is not easily swayed by the implications of coaches, owners, or even gamblers, then you have to make sure the referee is paid by the league, not by the team. You would not use an umpire paid by the team. Moreover, referees have to report to and be evaluated by other referees in the league office who are independent from everyone else. You want their performance to be measured on how well they do in making the tough calls, in being impartial, in doing a good job as a referee or an ump. Similarly, doctors and trainers should be held to the same kind of standard. They should report to their peers, not to the owners, not to the coaches. Do not pay for the right to be the team doctor, which some teams require. Do not keep doing it for the prestige, or getting freebies, or showing up in the newspaper in some cheap advertising.
Let us begin to upgrade by having the leagues hire doctors and trainers, who would report to chief health officers. I believe that if we could use that system, it would go a long way toward minimizing the current ethical challenges that exist when doctors report to coaches. Then, perhaps, success on the field would be secondary to the health of the athlete. I am Art Caplan, at the Division of Medical Ethics at the NYU Langone Medical Center. Thanks for watching.
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Cite this: Sports Teams Should Be Forbidden to Hire Their Own Doctors - Medscape - Jun 24, 2014.