Management of medical confidentiality in English professional football clubs: some ethical problems and issues

Abstract

Objective: To examine the ways in which confidential matters are dealt with in the context of the relationship between the club doctor (or physiotherapist) and the player as patient in English professional football clubs. Methods: Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. Results: There is among club doctors and physiotherapists no commonly held code of ethics governing how much and what kind of information about players may properly be passed on to managers; associated with this, there is considerable variation from one club to another in terms of the amount and kind of information passed on to managers. In some clubs, medical staff attempt to operate more or less on the basis of the rules governing confidentiality that apply in general practice, but in other clubs, medical staff are more ready to pass on personal information about players. In some situations, this raises serious ethical questions. Conclusions: Guidelines dealing with confidentiality in practitioner-patient relationships in medical practice have long been available and have recently been restated, specifically in relation to the practice of sports medicine, by the British Olympic Association, the British Medical Association, and the Football Association. This is a welcome first step. However, if the guidelines are to have an impact on practice, detailed consideration needs to be given to ensuring their effective implementation; if this is to be achieved, consideration also needs to be given to identifying those aspects of the culture and organisation of professional football clubs that may hinder the full and effective implementation of those guidelines.

Professional relations in sport healthcare: Workplace responses to organisational change

“…Peculiarity in these contexts is manifest in the relative absence of clinical autonomy (Waddington, 2000), the tripartite negotiation of treatment between clinicians, athletes and managers (Safai, 2003), and the pressures clinicians experience in relation to patient confidentiality (Waddington & Roderick, 2002). Kotarba (2001) has drawn parallels between sports medicine and occupational medicine.…”

Medical Uncertainty and Clinician–Athlete Relations: The Management of Concussion Injuries in Rugby Union

“…Much of this work has concentrated on the "peculiarity" of sport as a context in which to practice (Walk, 1997). It focuses on the way that sport clinicians (a term used to encompass doctors, physiotherapists and student athletic trainers) are required to balance normal medical ethical considerations with the demands of employers and/or coaches (Waddington, 2000;Waddington & Roderick, 2002), considerations of "precaution" and "risk" (Safai, 2003(Safai, , 2004, and health relative to performance (Theberge, 2006). Malcolm (2006a) further illustrates why sport physicians often wield relatively limited power over their athlete-patients and physiotherapist colleagues, and Theberge (2008, p. 19) examines the "ongoing tensions" between different groups of health care providers within a "system of health professions."…”

Confidentiality in Sports Medicine

“…Waddington and Roderick identified a similar lack of behavioral uniformity in research focused on clinicians working in English professional football [12]. Doctors and physiotherapists reported practice which ranged from strictly respecting patient privacy to an almost total disregard based on the view that it was essential and beneficial for managers to have full information access.…”

“…While some explain this by locating sports medicine as a form of occupational medicine [11], it should be noted that even the Faculty of Occupational Medicine views patient confidentiality as a primary ethical issue [12], and that most ethical codes for sports medicine explicitly state that they add detail to, rather than replace, more widely recognized medical ethical principles [13,14]. The Code of Ethics published by the Fédération de Médecine du Sport (FIMS) explicitly states that "The physician's duty to the athlete must be his/her first concern and contractual and other responsibilities are of secondary importance" [15].…”