Let’s Not Lose Sight of Our Ethical Responsibilities
Working in top level sport or with elite athletes is an ambition that most Sport and Exercise Medicine practitioners have when they enter into this extremely exciting but challenging environment. So, when knowledge, expertise, commitment and ability are recognised and the opportunity is offered, the challenge is then to stay working at such a level. Ironically, luck also has a major part to play in this, along with personality and the ability to get on with all of those individuals with whom the practitioner comes into contact.
However, Healthcare and/or Allied Health professionals must never lose sight of their professions’ codes and scope of practice. Similarly, any decisions taken must always be considered in the best interests of the ’patient’ and not necessarily the practitioner.
Over many years, one of the biggest areas for discussion has been who Healthcare and Allied Health professionals, employed within a sport and exercise medicine environment, are responsible to, in respect of their loyalties and decisions.
Consequently, whilst many will always state that the wellbeing and health of the ’patient’ is paramount, there are others who will argue that the team, club and/ or country who contract them to act on their behalf, is the priority. It is indeed a debate that is worth having but I will save that for another day.
My concern at this time relates to the increasing trend whereby individual sports personalities, who now earn significant amounts of money, employ their own Sport and Exercise Medicine and Science support team, dedicated to their healthcare and wellbeing alone. This basically means that the employment of every person within that support team is dependent upon the success of the individual they are looking after. Consequently, if that individual’s status and success rate diminishes, or if they do not compete and earn money for participating, then those employed are, technically, at risk of losing their roles. More importantly, if the sportsperson concerned can no longer compete at the level they once did because of injury and/or disability, then once again, the future of all concerned is at risk. This risk is then dramatically heightened or compounded if the sportsperson decides to retire.
With all of these factors to consider and the concerns that might occur if ‘the employer’ retires, how tempting could it be for inappropriate advice to be given? Advice that the practitioners know to be potentially wrong but the sportsperson believes because it is what they want to hear. It is the same dilemma that private practitioners could have when every patient they see contributes to rent, lighting, mortgage, food and everything else that is required to live comfortably and successfully. I am not stating that the continuation of treatments and interventions are done for reasons other than the needs of the patient , but the cynical side of me recognises the potential for ’false advice.’ Why could the same not happen in sport, especially where an individual is employing a team to solely look after them?
Therefore, whatever happens and whatever decisions are made by Health and Allied Healthcare professionals, they must always be done in the best interests of ’the patient’ and within the codes and scopes of practice, as detailed above. There must always be sound clinical reasoning as to why decisions are made in the knowledge that, at some time in the future, they may need to be justified and challenged by peers and legal entities. Consequently, some decisions may need to be made by practitioners in the knowledge that their own future and wellbeing could be affected in a detrimental way. Whatever, they should always be able to reflect that any decision made was within the ethos and philosophy of why they actually spent years of training and knowledge attainment, to allow them to work in the area in which they now find themselves. They should also know that, whilst in the short term, their decisions may not be appreciated or liked, in the long term they will often be proved right. It is knowing this that should be the motivator for making the right decision.