Doctors are repeatedly coming under pressure to compromise principles of good health care when treating athletes, reveals a small preliminary study in the Journal of Medical Ethics.
The researchers distributed surveys on some of the ethical dilemmas facing specialist doctors at a sports medicine conference and a postgraduate residential training course.
Of the 45 distributed, 18 were returned. The doctors had worked for 22 national teams, 20 regional teams, 13 club teams and five school teams between them in the preceding five years. On average they had worked in the field for more than eight years.
The most commonly cited ethical problem was confidentiality and privacy, with respondents saying that management and coaches frequently demanded information about a given player's health. The media also wanted this type of information.
Five doctors said that they had felt obliged to disclose highly sensitive information about players to a third party on the grounds of safety. This included revealing infection with hepatitis B, the use of performance enhancing drugs, and a pregnancy.
The sports doctors also said that it was difficult to maintain privacy in confined or shared facilities.
Half of the respondents felt under pressure to return players to the field after injury too quickly, with the potential to compromise long term health and welfare. This pressure often came from the players themselves as much as from coaches or other team members.
Players did not always reveal the full extent of an injury, for fear that the coach would be informed and they would lose their place on the team.
Half of the respondents declared that they were bound by contracts. In the event of difficulties over conflicting responsibilities, the doctors said that players' interests came first.
But some of the free text comments indicated that some of the doctors sometimes felt professionally isolated and unsupported when faced with difficult situations.
Other concerns included the use of painkillers or other techniques to allow injured players to continue, insufficient time to adequately assess a medical problem during play, and the high expectations of national and regional teams when the stakes are very high.
The authors conclude that while some of the problems faced by sports doctors are common to the medical profession as a whole, the sports doctor has a particular place in a hierarchy of sports management.
"Sports management does not have the same regard for traditional notions of confidentiality, privacy, or the patient's long term welfare," they say, and ask whether ethical guidelines for doctors in general adequately meet the needs of those working in sport.
Ms Lynley Anderson, Bioethics Center, University of Otago, Dunedin, New Zealand.
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