Abstract
When a competitive athlete is injured, there are a number of pressures on the treating physician to provide optimal care for the athlete. Pressure often comes from the athletes themselves because of their motivation to recover and compete. Pressure may come from family members who live vicariously through the life of their son or daughter. Pressure may also come from teammates who value the talent of the injured athlete and view their participation as an important component for team success. Sadly, pressure can also come from coaches who value their success on the field over the health and welfare of the athlete. Understanding the sources of these phenomena and managing them is a central feature in the job of a team physician. These are ethical issues that team physicians face. Thankfully, there are clear guidelines to protect the autonomy of medical decision making. 1
Unfortunately, the most difficult pressure for the team physician to resist may come from coaches. This scenario arises because team physicians usually serve at the pleasure of athletic departments that strive to keep coaches happy. Team physicians can be replaced too easily if they take unpopular stands on medical issues.
Five years ago, in an editorial on the team physician, I wrote of the sad situation faced by Dr. Scott Lynch at Penn State University. 7 Scott is a well-respected, ethical orthopaedic surgeon who was the Director of Athletic Medicine at Penn State and team physician for the football team. 4 He was fired from those positions for speaking out against attempts by the coaching staff to interfere in medical decision making. At the time, I lamented that most of these bad situations are settled out of court and out of the public eye. Fortunately, this time that did not happen. Dr. Lynch did not go quietly when he was fired. Because of his nature, a former college wrestler who does not quit, he persisted and fought the system through legal counsel. Thankfully the wrong was righted by jury trial this year, and Dr. Lynch was awarded US$5.25 million judgment. 3 As Scott presents in his letter to the editor in this issue of Sports Health, this occurred in the heart of Penn State County, where many jurors are Penn State fans. 4 The evidence must have been overwhelming for such a verdict and financial penalty in this locale.
While some may claim that this interference by coaches in medical decision making is an isolated situation, I fear that it is not. Thus, Dr. Lynch’s letter is a call to action. 4 Physicians must speak out to protect the health and welfare of vulnerable athletes. Resisting pressures to alter appropriate medical care is difficult, but is ethically required of team physicians. 6
To date, there has been no response from the NCAA or the Big Ten Conference on the verdict against Penn State, despite bylaws addressing the medical autonomy of team physicians. 2 NCAA bylaws require schools to protect “the unchallengeable autonomous authority of the primary athletics health care providers.” 5 As Dr. Lynch points out, they must be too busy trying to catch and penalize those trying to intercept play signals on the football sidelines.
Dr. Lynch’s call to action comes at a turbulent time in college football. With the portal mimicking professional free agency and Name, Image, Likeness (NIL) escalating the financial bonanza of the game, medical management of injuries is becoming an even more foreboding issue. These factors highlight the ethical questions that arise when medical decisions are influenced improperly.
I sincerely hope that the Penn State verdict shocks the NCAA, the Big Ten, and all other conferences into action. Protecting the team physician’s autonomy in every sport is critical to ensuring the proper medical care for athletes. This should be a very high priority for those administrations in charge at colleges and universities, conferences, and the NCAA.