Challenges As a Team Physician

Challenges as a Team Phsyician 5/8/2017 Conflict of Interest Disclosure James R. Andrews, M.D. Disclosure Information Challenges as a Team The following relationships exist: Consulting – Bauerfiend Physician Consulting – Biomet Sports Medicine Consulting – Theralase Consulting – MiMedx Medical Director – Physiotherapy Associates Stock Shareholder – Andrews Patient Connection James R. Andrews, M.D. Stock Shareholder – Connection Orthopaedics Stock Holder & Board Member – FastHealth Corporation Orthopaedic Sports The Modern Sports Hand Surgeon Medicine Team Neurosurgeon Medicine Sports Doctor Dentist Whatever it is, it’s a “team Sports Orthopedist/Arthroscopist Sports Chiropractor effort”! Athletic Trainer Massage Therapist Physical Therapist Nutritionist Psychologist Sports medicine Strength and Conditioning Specialists encompasses a number of EMT Medical specialist Bioengineer / Biomechanist medical disciplines! + Other para-medical personnel Hallmarks of a Good The Athletic Trainer is the Sports Medicine Physician Glue That Keeps This S.M. Team on track • Availability • Compassion • Gentleness • Honesty • Communication • True love of being helpful to those who show good sportsmanship IIF_2017 1 Challenges as a Team Phsyician 5/8/2017 By the way: “Duties of the Medical Team” I can ’t emphasize how important physical therapy is in my practice: Physicians, athletic trainers and other para- medical personnel are responsible for the health and well being of the athlete.. For me, rehabilitation is often more important than the actual surgical procedure i.e. “Sports Medicine”. The team physician and athletic trainers must be itself . prepared to identify and plan for medical care and services that promote the safety of the athlete, limit injury and provide medical care at the site of practice or competition or thereafter! Priorities related to Responsibilities of The Sports Medicine Team Remember if #1: To the player “Mother Ain’t Happy #2: To the parents Nobody’s Happy ” Then to the: team, coaches and to management / ownership Andrews Patient Philosophy • Always be open-minded • Attitude, responsibility, knowledge, • Do not be the first person to make desire and availability are always the BIG statement necessary to be successful • The patient is always right • One must always be able to read the • Make the patient feel he is treated patient Challenges as a Team properly by his previous physician • The physician must be confident • Do not say anything bad about with his skills. His confidence is Physician in College another physician, for that matter reflected back and perceived by the another person patient • Listen to the patient • Try to make every patient feel as though they are special!! 12 IIF_2017 2 Challenges as a Team Phsyician 5/8/2017 Pre-participation / Medical Eligibility Decision Who decides return to play after an Who Decides? Team physician vs. outside injury in the heat of the battle or week doctor to week practice? • It is pretty well accepted in the sports Absolutely the answer is the head team physician medicine world, that the head team physician has the final word on “ ” disqualification for participation The team physician must use good judgment and • He can certainly utilize outside can ’t be caught up as a fan in the heat of the consultants to help in HIS decision! battle Medical Exemption (Disqualification) NCAA Rule Medical Communication • If an athlete has a medical/orthopaedic condition of a sever nature that continued participation in The Health Insurance Portability their sport would in all likelihood result in adverse long term sequalae and Accountability Act (HIPAA) – The athlete receives the remainder of their Educational scholarship regulates the way the team – He/she no longer counts against that sport ’s total scholarship number physician and members of the – He/she can not take part in another sport at that institution health care team communicate – He/she can not change their mind and return to play for and handle patient medical that institution in any sport – He/she CAN transfer and play for another school!!! information I know we have to abide by federal The HIPAA law is a real paradox in this communication age of the new regulations, but as with all of us in millennium. It certainly make life sports medicine… difficult for the sports medicine team! The HIPAA Rule “GETS IN MY WAY ”! IIF_2017 3 Challenges as a Team Phsyician 5/8/2017 Unique Challenges Faced by the Team Unique Challenges Faced by the Team Physician “Conflicting Healthcare Goals ” Physician “Conflicting Healthcare Goals ” Case Presentation Case Presentation – The star college running back is hurt “ ” – Its playoff time – If severe enough this urgent injury may require – Rapid rehabilitation may do it surgical decision. – Get him back at all cost “Pressure Pressure ”! – That decision is complicated by what ’s best – New healing enhancement miracle drugs are exciting and hopefully spectacular!! for long haul and career vs. what gets the – They are usually not scientifically proven to be player back quickest for the playoffs helpful, and may even be harmful!! – Sensationalism for the player and to the public is a problem I.E. Do you take out the torn meniscus or do you repair it? The lesson to learn in this Challenges Faced by the Team case presentation is.. Physician The medical team must inform The bottom line though is doing what ’s patient of his options and at all best for the player in the long run is ’ times inform him of what is best usually what s best for the team! for his career over the long haul! Advertising Medical advertising including sports team affiliation raises particularly difficult The committee on Ethics for the ethical questions in sports medicine AAOS has recommended that orthopaedic surgeons not use • There is no question that these physicians have publicity in an untruthful, marketing advantages. • These advantages should not be fueled by misleading or deceptive manner aggressive self promotion. • There is no question that this notoriety comes with some ethical price. IIF_2017 4 Challenges as a Team Phsyician 5/8/2017 Challenges in Professional Medical Economics Sports To be successful in sports medicine, • Return to play decision making must be predicted quickly to enable coaches about fielding a team next you must also be successful week and / or for the rest of the year!! in medical economics! But never let – Estimate to coaches and management ’ – Players and agents will have their own time table economics interfere with doing what s – Physicians are caught in the middle best in medical care for the patient / – Decisions should be made on known time tables and subjective / objective findings athlete – Get more tests as needed!! Special Challenges in Challenges in Professional Sports Multiple 2 nd Opinions • 2nd opinions can be good or bad • Patient underestimates his injury and subsequent – No 2 nd opinion physician will know the player and his sequalae medical situation as well as the day to day team – Team physician must explain to athlete short term as physician well as long term sequalae – As a 2 nd opinion MD on many occasions I know this 1 st – Informed consent is necessary however it is tricky hand from a legal standpoint – Communication with the Team Physician and Team – The informed consent should be in simple terms that Athletic Trainer is critical the athlete can understand and he should be willing to – A common “Game Plan” is optimum and essential sign it. “GET ON THE SAME PAGE” Special Challenges in Communication Lines in Professional Sports Sports Medicine • Who releases the medical information? • The over active role by agents and • There is no uniform way to do this – It is the policy of some teams for the head coach to do it representatives in Players Healthcare – For some it is the athletic trainer decisions can be complicated – For others it is the team physician • Most often it is the Sports Information Department • As an outside physician, I must know how a specific team • If can be disruptive and lead to inferior wants medical information released. As a general rule, I don ’t ever talk directly to the press about a player Healthcare condition and direct all inquiries back to the team’s sports information director!! IIF_2017 5 Challenges as a Team Phsyician 5/8/2017 Challenges Faced by the Team Challenges in The NFL Physician in the NFL • Player under reports his condition – Not unusual especially for a lower level athlete trying to make the team or trying not to get cut • Injury settlement – Must have a trusting relationship with the athletic trainer – Common problem for filler players used in pre-season practice – An honest pre-participation “““history ””” is essential and games – Teams want a quick release & minimal settlement, players wants the most they can get! • Player over reports his injury – PE based on subjective complaints – The problem often arises in preseason for avoidance of mini- camp, OTA and preseason workouts and games – No great solution – Team physician is really put in a tough spot!! Challenges Faced by the Team Special Challenges as a Physician in Professional Baseball “NBA Team Physician” • 40 man roster problems – Player is sent down to minors – then claims injury while in the majors • Collective bargaining and guaranteed – Young players quite frequently hide injuries trying to make a major league team and when they don ’t they get sent down! contracts – This creates a medical / legal controversy • When did a chronic injury occur? – Presents special considerations related to – Today this problem is compounded by frequent trades, free agency, and time spent on multiple teams injuries – Therefore who or which team is responsible for injury treatment and / or compensation? – Motivation for recovery and medical I.E. when did the tire tread start to wear and when decisions can be difficult! did it blow out?????? Challenges Faced by the Team Physician Team Coverage In dealing with these challenging issues, the The AOSSM established team physician gets caught in the middle and the ART is keeping both the player the following guidelines and the team happy!..Its like playing both in 2005 ends from the middle.

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