The customary ethical norms of the doctor-patient relationship, such as patient autonomy and confidentiality, are often challenged when the doctor is a team physician and the patient is an athlete.
The doctor-patient dyad becomes the doctor-patient-team triad, where a team’s priorities can conflict (or sometimes replace) those of the patient-athlete. There is no widely accepted code of ethics for sports medicine that adequately addresses these issues.
An article by Warren R. Dunn, MD, MPH, of the Vanderbilt Sports Medicine Center, Nashville, TN, and coauthors, reviews such issues as third-party influences, informed consent, competition in vying for a team medical contract, patient confidentiality, and drugs in sports. Team physicians face implicit or explicit pressure from multiple sources, such as management, coaches, and agents, to improve an athlete’s performance in the short term rather than preserve the long-term health of the patient-athlete.
“Many ethical issues are unique to sports medicine because of the unusual clinical environment of caring for athletes within the context of a team whose primary goal is to win,” the authors write. “The tension that can arise when trying to balance medical means with nonmedical ends can be challenging. The sports medicine physician must carefully examine continually changing ethical standards and direct the care of the athlete accordingly.”