Team physician challenges in 2013: dealing with media and travelling across state borders

In the modern world it is imperative to understand the social and legal aspects of caring for the athlete. Two recent BJSM articles1 ,2 highlight important aspects of team physician practice. Confidentiality and protection of athletes medical information is increasingly challenging in the era of social media, which allows rapid dissemination of individuals’ personal details from a variety of sources.1 Additionally, as physicians travel both domestically and internationally to cover events, it is important to consider legal and social aspects of caring for the athlete. These may include: licensing issues, malpractice coverage, access to care at outside institutions and prescribing medications, including narcotics. As healthcare evolves in the USA and across the world, it is important for the team physician to be updated on the latest policies and factors, which may prevent them from providing necessary care in a timely fashion. Thus, these two articles1 ,2 are both timely, and should serve as a discussion point for further examination of these topics in other countries.

Ribbans et al 1 describe the reporting of athletes injuries in media sources in Britain. They note the difficulty in ascertaining the accuracy of information, with the majority of articles not reporting the source of medical information. However, when sources are reported, there is significant variation in the training and knowledge base for these individuals as club officials, explayers, families, friends and even referees provide further comment on injuries in many cases. In addition, the issue of consent to release information is increasingly relevant in sports given recent controversies over head injuries and long-term consequences. Moreover, many athletes have expressed concern over release of information, and public perception of injury.1 Ribbans et al 1 note that athletes are frequently naïve regarding controlling the release of information, but it is up to the league, team, physician and medical staff and public relations staff, to protect and educate athletes on their rights. As many athletes now control their own release of information through social media, it is important for them to be aware of the consequences of such actions. This article highlights how frequently the media reports injuries and the sources typically used to report such information. The article should serve as a springboard for discussion on the topic, as well as a basis for similar studies in the USA and other nations, where reporting of injuries and discussion of their implications is even more prevalent.

With increasing changes in healthcare at the state and national levels, physicians must be aware of how these policy changes can affect caring for the athlete. Viola et al 2 reported on state laws and insurance policies, which can impact physician's ability to care for athletes while travelling to events and games in the USA. Surveys were sent to state licensing boards to determine if they had pathways for out of state physicians to provide care for athletes. The authors noted that physicians who travel to other states with their teams are practicing without a license in 67% of the states that responded to their survey.2 Even more troubling, they note only 30% of states provide protective legislation for a travelling physician. Sports medicine can result in challenging cases with significant financial implications, even when a physician is not violating a licensing law, and many malpractice policies still will not provide coverage. Viola et al 2 note that a few states have exemptions for specific groups, for example Idaho grants an exemption if a physician comes for ski patrol, Massachusetts allows US Olympic Committee or World Cup Organizing Committee events, and Missouri will exempt physicians from bordering states. Six states (11%) have an exemption for a consultant, but the laws are not applicable to the team physician. Malpractice carriers were also surveyed, and most had specific regulations which governed whether physicians would be covered while travelling, and more than 1/3 would not provide coverage out of the home state, regardless of licensure.2

Physician professional societies, including the American Medical Sports Society for Medicine, American College of Sports Medicine and American Orthopaedic Society for Sports Medicine, should strive to make physicians aware of these topics and changing policies as they can impact the team physician significantly, and can make caring for the athlete even more complex. As laws change in the coming years, and as there is increasing attention paid to athletes’ injuries through the media, physicians’ professional societies should adopt policy statements to guide physicians on how to handle requests for patient information, and how to educate the athlete on release of information. Moreover, as policies change at the state and national level, physicians should be aware that their ability to provide care at national and international events can be impacted and they should be aware of all options to provide effective and timely care to their athletes. In this issue of BJSM, Viola et al 2 note that The American Medical Society for Sports Medicine is presently working on a Federal patch for this problem.