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The team physician is the medical team leader who is ultimately responsible for the safety and care of the athlete. The day-to-day role of the team physician varies dependent on the situation and the members of the sports medicine team that may include an athletic trainer, school nurse, dentist, nutritionist, psychologist, and other physician specialists. The team physician's role should be a formal relationship with the team, even if volunteer. This agreement, among other things, should include complete autonomy in medical decisions and guarantees against acts of coercion. It is important to specifically avoid conflicts of interest, so that the safety and health of the athlete are the first priority of the physician.
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The Team Physician Consensus Statements (Appendixes 32-1 and 32-2) outline the qualifications and responsibilities of the team physician and provide guidance for sideline preparedness for the team physician.1,2
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The consensus statement further defines the duties of the team physician.1 A full range of Consensus and Position Statements relevant to team physician are easily accessible at the websites for the American College of Sports Medicine (www.acsm.org) and the American Academy of Family Physicians (www.aafp.org), and all physicians assuming responsibilities of a team physician should be familiar with these guidelines.1–5
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The responsibilities of the team physician present a few unique medicolegal situations. One major difference that may exist is that athletes are typically highly motivated and may aggressively push to return to play. In addition, there may be third parties such as parents or coaches that challenge physician decisions regarding delay of return-to-play. In the case of the a young athlete, the physician should be cognizant of the parent–child relationship that may interfere with treatment or return-to-play. Additionally, there is a potential conflict-or-interest when the physician is employed by the sports team. The team physician must specifically be aware of and avoid or mitigate conflicts of interest and be mindful that their primary responsibility is to the safety and health of the athlete.
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When acting as a treating physician, the physician–athlete relationship remains fiduciary in nature. Therefore, the same principles apply in sports medicine as in the general practice of medicine. The team physician must use the knowledge, skills, and care that are ordinarily possessed by prudent members of their specialty, given the state of medical science at the time care was rendered.6 Evaluations and medical decision making must be documented whether in-office, athletic training room, gym, or on the field. The same principles of informed consent apply to the team physician. In general, the athlete, and if a minor, his or her parents, must have all material information regarding the diagnoses, treatment options, as well as risks and benefits of those options explained in lay terms, so that they may make a truly informed decision. The team physician must also be mindful of issues ...