Thursday, January 27, 2005

Terrell Owens wants to play in the Superbowl. Well, who doesn't?

His doctor hasn't cleared him. What does that mean? Well, it means that the doctor has told him that, if he plays, he has a risk of serious injury. KevinMD says that if the doctor clears him to play, "it's the physician's butt on the line in court."

Whenever a bunch of sports med docs get together, we frequently talk about this issue, and this one. Which are really both the same issue. The athlete, the team or both wants the athlete cleared for participation in the sport. We can never guarantee that the athlete won't get hurt in a game. So how can we ever clear any athlete for participation.

If I clear an athlete to participate in a sport, how much liablity do I have? Most physicians have participated to some degree in athletic physicals. We are supposed to reassure that 250 pound 14 year old and his parents that he won't drop dead during 2 a day football practices in Tennessee in August. I can't do that.

What I can do is explain where the uncertainty is and why. I can explain ways to reduce risk and try to ensure the safest possible play. Certainly, I can try to discourage play. I can try to educate the athlete and his parents and I can refuse to sign the physical. But he'll eventually find a doc who will sign it. By maintaining engagement, I can reduce my liability and provide the best advice possible.

When working with professional athletes, we are usually employed by the team. So there is a perception of a conflict, and sometimes there is a real conflict. In the Owens case, both the athlete and the team have the same goals, for him to play, so the physician doesn't have a conflict between responsibility to his employer, the team, and to his patient, Owens.

However, he does have an obligation to provide the best advice and care possible. Should he just throw up his hands and say, "I'm out of this!" If he does, he can deny subsequent liability, but he may well loose his job. There are plenty of Sports Med and Ortho docs out there to replace him.

Look at it like this. How many times in clinic today did you give advice that you knew or suspected wasn't going to be followed? Did you throw up your hands and refuse to participate in that patient's care anymore? Or did you realize that to adhere or not is the patient's decision and your best option was to give the best advice you could and deal with the results of the patient's decisions? I bet you routinely choose the latter.

Owens is a man who desperately wants to play in this game. Is there a risk of life here? No. Is there a risk of a career ending injury? Yes. Well, just tell him this and let him balance the issues. Would most of us risk a career ending injury for what may be our only opportunity to play in the Superbowl, especially if we were financially secure? Maybe we would.