‘He didn’t want to let his team down’: the challenge of dual loyalty for team physicians

The intersubjective accomplishment of power by medical professionals within unregulated combat sports

“…As demonstrated in Waddington and Roderick's (2002) study of doctors and physiotherapists in English football, when medical professionals' employment is determined by coaches or managers, whose overarching aim is to improve competitive performance, it becomes 'difficult for them to resist threats to their clinical autonomy and/or maintain ethical standards' (Malcolm et al, 2017(Malcolm et al, : 1053. Within highly commercialised sports, additional pressures from team owners, corporate sponsors or sports broadcasters may further impinge upon medical autonomy in this way (Anderson and Jackson, 2012;Hanson, 2018). In some circumstances, this foreclosure of autonomy, or its accommodation within a performance-oriented agenda, not only means that athletes miss out on unbiased medical advice; it also invites ethical abuses which place their welfare at risk (Roderick et al, 2000).…”

‘This Must Be Done Right, So We Don’t Lose the Income’: Medical Care and Commercial Imperatives in Mixed Martial Arts

“…As such, exploring pertinent sociocultural factors within sports environments becomes vital in understanding the working practices of sports medics. This would include such phenomena as the well-evidenced notion of the 'culture of risk' that shapes athletes' health-related behaviours (Donnelly, 2004;Nixon, 1992;Matthews and Jordan, 2019;Pike, 2004;Safai, 2003;Theberge, 1997; the influence of commercial pressures on individual athletes, coaches and teams to prioritise performance over health (Hoberman, 1992;Malcolm, 2017;Malcolm and Scott, 2014;Safai, 2003;Young, 1993;Waddington and Roderick, 2000;Theberge, 2006); and the wider political economy shaping various sports organisations' ability to provide particular types of medical care to athletes (Boyd, 2007;Hanson, 2018;Malcolm, 2006;Malcolm and Safai, 2012;Malcolm and Sheard, 2002;Waddington et al, 2001).…”

“…Here, the compromised loyalties of 'team doctors', whose employment by their patients' bosses generates potential conflicts of interest, has been evidenced numerous times (Malcolm, 2006;Malcolm and Safai, 2012;Waddington et al, 2001). Commercial pressures produced by the 'spectacularisation' of televised sport, or the high premiums associated with winning for securing sponsorship deals, may diminish the situational importance of medics when their advice runs contra to athletes' ability to produce exciting and effective performances (Anderson and Jackson, 2012;Hanson, 2018;Malcolm, 2017;Malcolm and Sheard, 2002). In less-commercialised sports, budgetary restraints combined with the relatively expensive nature of medical support has been shown to impact upon the quality of care athletes can expect to receive (Liston et al, 2009;Malcolm, 2017;Walk, 1997).…”