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Editor,—I read with interest the paper by Waddington et al1 highlighting the inadequacies of the football club doctor system in Britain. This paper confirms the situation that many people already knew to exist.Br J Sports Med 2001;35:281–284
Advertisements for club doctors are rarely published in medical journals, doctors normally being appointed on a “who you know” basis. It is also particularly disappointing that, at a time when the specialty of sports and exercise medicine is being established in this country, the majority of doctors working with professional footballers have no qualifications or little experience in the specialty. However, this is not confined to football clubs and probably also applies to rugby clubs and many other sporting associations.
One aspect not mentioned in the paper is medical litigation. It is to be hoped that doctors involved with football clubs have arranged medical defence cover, because, if a situation arises in which a player's sporting career is threatened by medical mismanagement and the doctor involved has no professionally recognised sports medicine qualification, he or she could be found guilty of medical negligence. With the amount of money involved in professional football, this could lead to dire consequences for the medical career of the practitioner involved.
From a report commissioned by the Football League on the Hillsborough tragedy, the concept of the “crowd doctor” was introduced, meaning that any doctor involved in the medical care of the crowd at a football stadium would be required to possess at least the Diploma in Immediate Medical Care.2 Before that, the situation was similar to that of the present club doctor system, and few doctors held any recognisable qualifications or training in medical emergencies and resuscitation.
A similar recommendation by sports medicine authorities is required to enhance the quality of service provided to football clubs and increase the stature of the specialty. However, it is not a one sided situation. Football clubs must realise the importance of a medical team in looking after their prime assets, the players. Advertising of jobs in medical journals, insisting on experience and qualifications, adequate remuneration, and the provision of job descriptions and contracts should all be implemented. By working together to improve the current situation, a service can be provided in which both professional football players and the medical profession can have confidence.
We welcome Dr Boyce's letter as a useful contribution to the debate generated by our article. Dr Boyce is quite correct to raise the issue of medical litigation. As the American College of Sports Medicine pointed out as long ago as 1991, what it called “the litigation epidemic” had at that time already “begun to engulf sports medicine” in the areas of negligence and malpractice, informed consent, counselling, re-entry to play decisions, and other matters.1 It is probable that we shall in future increasingly see such cases in the United Kingdom, and the club doctor without an appropriate specialist qualification may be held to be more at risk in such cases.
Dr Boyce is also correct to draw attention to the fact that, for the past 10 years, the “crowd doctor” at professional football matches has been required to hold a recognised specialist qualification in Immediate Medical Care. The fact that club doctors are not required to hold a comparable and appropriate specialist qualification is an anomaly that needs to be addressed as a matter of urgency by sports medicine authorities, by clubs, and by the Football Association. It goes without saying that he is also correct to point to the need for football clubs to adopt more realistic policies towards safeguarding their major assets, namely the health—and therefore also the playing ability—of their players.
Finally, we fully accept that, as Dr Boyce suggests, the situation that we documented in relation to professional football may not be unique to that sport. We agree that there is a need to investigate all aspects of the provision of medical and physiotherapy care in other sports. In this regard, your readers may be interested to know that two of our colleagues at Leicester, Dr Ken Sheard and Dominic Malcolm, are now carrying out a similar study to our own, but in rugby union.