Practical responses to confidentiality dilemmas in elite sport medicine

Abstract

Citation: MALCOLM, D. and SCOTT, A., 2014. Practical responses to confidentiality dilemmas in elite sport medicine. British Journal of Sports Medicine, 48 (19), pp. 1410Medicine, 48 (19), pp. -1413 Additional Information:• Results: Clinicians identified three contextual factors which influenced issues related to patient confidentiality in sports medicine: the use of confidentiality waivers; the facilities available for treatment; and the cultural norms of elite sport. They further identified interpersonal strategies used to lessen or eradicate conflicts, including emphasising the benefits and avoidance of dis-benefits for athletes, and the potential negative consequences for others. Conclusions:Aspects of clinicians' practice environment should be designed to enable compliance with the highest levels of ethical conduct. Professional associations should establish guidelines for clinicians' interpersonal conduct in dealing with confidentiality issues and consider their provision of ethics-based CPD. They should also petition for the establishment of athletes' codes of conduct which identify a context-relevant understanding of 'serious harm' and how that might impact on information disclosure.

Confidentiality in Sports Medicine

“…Thirdly, Malcolm and Scott's research conducted with members of the British Olympic Association's Medical Committee and Physiotherapy Forum found much more consistent recognition of the privileged nature of patient information [24]. These interviewees again reported that athletes' contracts frequently required them to waive medical confidentiality but noted that, when athletes resisted these obligations, clinicians were required to develop interpersonal strategies to minimize conflicts of interest.…”

“…This environment may therefore expose the clinician to well-meaning questions from concerned teammates [23] and stimulates management demands for prognoses. The openness of sports medicine treatment is compounded by the design of treatment facilities in sport which conventionally have little regard for athlete-patients' privacy [7,24].…”

“…Others have advocated the use of an "athlete's charter" to identify which MSST personnel are bound by disclosure regulations [4,29]. A dialogue to establish what is deemed to constitute "serious harm" to third parties within sports teams is required as research identifies various interpretations of this notion [24]. Clarifying the appropriate balance of individual and group interests may alleviate pressures on disclosing confidential information.…”

“…For instance it has been argued that the contractual obligations of sports physicians should be limited to reduce the conflict between occupational expectations and medical ethical principles [37]. Similarly an athlete's consent to disclose must be specific rather than general, the exception not the norm, and must be free of any element of coercion [5,24]. Indeed research shows that such contracts are redundant as both doctors and athletes consistently disregard their terms with seemingly limited sanction.…”

“…In recognition of the variability in practice it is the duty of clinicians to ensure that they keep themselves updated on current ethical standards [4]. Calls have been made for sports organizations to develop and disseminate models of good practice [12], and enhance confidentiality-based continuous professional development [24]. Wider educational provision for sports psychologists [41] and coaching/training staff [4] has also been advocated which should be extended to all members of MSSTs.…”