The Professional Code of Conduct of medical andscientific support staff limits their freedom to report injuries, illnesses and other problems identified to anyone else other than the athlete (individual) directly concerned. The British Olympic Association recognises how important it is that coaches, managers, administrators and other team officials are fully aware of the limitations on communication imposed by this duty of confidentiality.
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This recognition catalysed the production of this document, which is intended to be in the best interests of the athlete and his/her medical, scientific and other support staff.
For the purpose of this document the following definitions will apply:
Medical and scientific support staff - members of the team/athletes' support staff who are bound by professional codes of conduct with regard to confidentiality e.g. doctors, chartered and/or state registered physiotherapists, state registered dietitians, psychologists, sports scientists.
Other support staff - members of the team/athletes' support staff who are not bound by professional codes of conduct with regard to confidentiality e.g. performance director, coach, manager, relative.
Support staff would always wish to have the best possible medical and scientific support staff for their athletes. In most cases these people will be bound by a professional code of conduct.
1. PROFESSIONAL CODES OF CONDUCT
All members of the medical and scientific support staff are bound by professional codes of conduct. They must ensure confidentiality of information.
Medical and scientific support staff must ensure the confidentiality and security of information acquired in a professional capacity. All statutory registered health professionals and members of the British Association of Sport and Exercise Sciences (BASES) are bound by professional codes of conduct.
All support staff must be aware of the requirements and must abide by the Data Protection Act 1998.
2. EXCHANGE OF CONFIDENTIAL INFORMATION
Much valuable information can be exchanged within multi-disciplinary support staff meetings. The athlete must be told who will be present and consent for open discussion of their case should be obtained in advance. Uninvolved medical, scientific and other support staff can be included, if the athlete(s) represented have given consent.
Much valuable and necessary information is exchanged within multi-disciplinary support team meetings. It is therefore important that all members of the team are aware that confidential information is being exchanged. If it is not possible for the athlete to be present they must give their consent to the exchange of information. Only medical and scientific support staff involved with the care of the athlete should be involved/engaged in the discussion. Thus medical, scientific and other support team members not directly concerned, should not be included in such multi-disciplinary support team meetings unless specific consent has been given by the athlete.
3. INFORMING OTHER SUPPORT STAFF INVOLVED WITH SELECTION
Coaches wish to be informed of athletes' problems. This can only occur with the consent of the individual athlete.
Coaches may feel that they should be informed about any problems relating to their squad in order to make an informed decision regarding selection.
If the support staff have a proven track record with the squad, most athletes usually respect their judgement and readily agree to a `round table' discussion of the injury, illness or problem. This can only occur with the consent of the athlete, who must realise that coaches are not bound by confidentiality.
The relationship between the athlete and the support staff means that in the great majority of cases, the athlete can be reassured and convinced that the coach should be informed. This highlights the crucial importance of a consistent and stable medical and scientific support team. A refusal by an athlete to consent to disclosure should be respected unless the failure to disclose information may expose the athlete or a third party to risk of death or serious harm.
4. SEEKING ADVICE OR TREATMENT FROM SPORTS MEDICINE PROVIDERS AND SPORTS SCIENTISTS WHO ARE NOT PART OF THE RECOGNISED MEDICAL AND SCIENTIFIC SUPPORT TEAM
Athletes may deliberately seek advice from sports medicine providers and sports scientists who are not part of the recognised medical and scientific support team if they think that the medical and scientific support team will not respect their request for confidentiality. The sports medicine provider/sports scientist advising the athlete may not have athlete, or sports-specific knowledge and may not be able to provide the same standard of care.
The athlete should request the “outside” sports medicine provider/sports scientist to seek information from, and to relay relevant information to the medical and scientific support staff, to ensure consistent and informed advice or treatment.
However, if athletes are not completely convinced that the medical and scientific support team will respect their request for confidentiality, especially in discussions regarding selection, they may feel obliged to seek advice or treatment elsewhere. The person providing the second opinion may not be properly qualified, may have less sports medicine/sports science experience, less sports-specific experience, no case notes and be unaware of the athlete's medical and sporting history. Almost certainly these “outside” sports medicine providers/sports scientists will not report to the coaching staff. Such scenarios are highly undesirable for both the athlete and the support staff.
5. MEDICAL AND SCIENTIFIC SUPPORT TEAM - CONTRACTUAL OBLIGATIONS
Medical and scientific support staff who sign a contract with the governing body may be in breach of their professional code of conduct, if they breach their duties of confidentiality.
The governing body/coach may feel that members of the medical and scientific support team are contractually obliged to keep them fully informed. However, it is unreasonable to ask medical and scientific support staff to sign such a contract with a governing body, since if an athlete requests confidentiality they will have to either break the contract or be in breach of their own profession's code of conduct.
6. CONFIDENTIALITY AND INFORMED CONSENT
Athletes who have signed a consent form (see below) may still withhold consent for any specific consultation, test or treatment. For routine follow-up consultations, recorded verbal consent is sufficient.
If an athlete insists on confidentiality in the course of a consultation, the results obtained during the consultation cannot be released, even where there has been informed consent beforehand. Medical, scientific and other support staff can be told there is refusal of release but no other details. This particularly applies when a pre-season or pre-Games medical examination is performed or after the collection of fitness test data. It is essential that the athlete understands what information may be disclosed, to whom the information (from the consultation) will be made available, and the likely consequences, especially if the medical examination or consultation is a hurdle to further participation.
Involvement in selection, at even the most informal level, may compromise the position of professional medical and scientific support staff and could lead to a breach of confidentiality.
Nevertheless, medical and scientific support staff can be fully involved in pre-competition assessment. They may release information to the selectors, providing the athlete has given informed consent and understands what will and what will not be disclosed.
8. PROHIBITED SUBSTANCES
A refusal to consent to disclosure must be respected even in the event of an athlete taking a prohibited substance.
Support staff must appreciate that it would be classified as a breach of confidentiality if a member of the medical and scientific support staff revealed that an athlete was taking a prohibited substance, unless the athlete or individual had specifically given their consent.
9. SUPPORT STAFF WHO DO NOT HAVE A CODE OF CONDUCT
Some members of the support team may not be obliged to abide by a professional code of conduct, and may therefore not have any restrictions regarding confidentiality.
Medical, scientific and other support staff should be aware that some support staff may not be obliged to abide by a professional code of conduct. In order to avoid breaches of confidentiality it is essential to establish that everyone concerned with the discussion is restrained by an appropriate code of conduct.
10. INFORMATION FROM PROFESSIONAL BODIES
If situations arise that are difficult to resolve, advice can be sought from professional bodies such as the British Medical Association, the General Medical Council, the Chartered Society of Physiotherapy, the British Dietetic Association, British Association of Sport and Exercise Sciences or defence bodies such as the Medical Defence Union or Medical Protection Society.
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