Sports Physicians Face Ethics Challenges

Bert R. Mandelbaum, MD, DHL (Hon)

Disclosures

January 05, 2018

As more and more allegations of sexual harassment and abuse become known, it's time for sports physicians to take stock of the ethical standards in our profession.

Nothing matters more in our work than our moral authority. We seem to live in a valueless society, one where accruing wealth is the major goal, without any higher purpose, mission, or vision. In sports, this turpitude takes many forms, including steroid abuse, cheating, and falsifying birth certificates for youth sports. Sports physicians must provide both reason and leadership in this arena.

Source: Stephen B. Morton/AP

Too many in our profession fall short of that calling. I'm thinking of those physicians who supplied performance-enhancing drugs to such star athletes as Mark McGwire and Lance Armstrong.

I'm also thinking of Larry Nassar, MD, who has confessed to molesting young gymnasts. Some of the victims have complained that the sports establishment around Dr Nassar, including some involved with the Olympics, covered up for him, pressuring them to stay silent.

Challenges That Sports Physicians Face

It's hard being a doctor in the current environment of struggle and conflict. You have to be informed and nimble and work harder as reimbursements get lower. And because of the public attention focused on our patients, sports medicine specialists are under particular pressure.

All doctors are bound by the Physician Payments Sunshine Act requiring disclosure of relationships to pharmaceutical and medical implant companies. But for sports physicians, these conflicts are compounded by marketing arrangements from our teams, schools, and health centers.

All doctors feel pressure to treat patients even when we have no good treatment to offer. Sports physicians face the added pressure to help our patients' teams win at all costs and to violate our patients' privacy when we get calls from the news media.

All doctors face temptations because of the trust our patients put in us. Sports physicians must also grapple with distorted perspectives because of the importance attached to our patients, which can give us the impression that the rules don't apply to us.

As the great UCLA basketball coach and my omnipresent mentor John Wooden said, "It is best not to drink too deeply from a cup full of fame. It can be intoxicating, and intoxicated people often do foolish things."[1,2]

Consequences of Illegal and Unethical Actions

You don't have to look far in the sporting world to find examples of the fall from grace. Mark McGwire will be remembered as much for doping as for hitting home runs.

Source: Amy Sancetta/AP

Joe Paterno's record as one of the greatest coaches of all time is forever stained by allegations of failing to follow up on child-molestation charges against assistant coach Jerry Sandusky.

I truly believe that character is the true foundation for all of success. You may possess money, position, and power, but without good character you cannot be successful.

Personal Mission Statement and Moral Course of Action

Where can we find guidance around these moral pitfalls? Our profession has one of the oldest codes of conduct, dating back 2500 years to the Hippocratic Oath, which calls on physicians to maintain their patients' confidentiality and avoid "any voluntary act of impropriety or corruption, including the seduction of women or men."

But I also believe that every physician should write a personal mission statement. Here's mine:

  1. I will accept that I am what I eat, drink, think, and do.

  2. I will live life optimistically, motivating the people around me.

  3. I will discover adventure and passion in all things I do.

  4. I will cultivate good relationships with my patients and a home team with my family.

  5. I will put character and values ahead of everything else.

In my own career, I've usually found that the biggest challenge is not finding the moral course of action. It is remembering that I must never deviate from that course. I always remind myself of the great former Olympic and University of Portland coach Clive Charles, who said, "Do the right thing a hundred percent of the time."

When I'm filing my taxes, I say to my accountant, "Find the line and go two steps back." I use the same principle when I decide on canceling a surgical patient who has a cold. I don't want to look back on a decision to operate and say, "My patient has an infection, and I could have avoided it."

You're not being a good doctor if you give 16-year-olds steroids because you think they will like you more. You're not being a good doctor if you give a stem cell injection when you know there is no true evidence for the benefit. These breaches exploit the gap between patient hope and knowledge while jeopardizing legitimacy.

To succeed, we have to remember that our goal is not only to heal but also to inspire and educate our patients and our community and to motivate them to be the best they can be. Achieving that goal doesn't require steroids, it doesn't require cheating, and it doesn't require mistreatment of people for your own interests, whether they are sexual or financial.

It requires the moral courage, strength, and wisdom to deliver the right and best tools to our patients so that they can achieve their own goals. It requires the integrity to match what we say and what we do within our organization and to convey these messages to our patients and the outside world. And it requires nurturing our patients by understanding that they have sought us out because the issues in and of themselves are challenging. That will make all the difference.

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