Dr. Pete Indelicato: “Who Answers To Whom Around Here?” How The Protocol Works For Injured Players

Who decides when an injured player can return to action? "Situations like this arise fairly frequently in real time. The question is: how do they get resolved?" -- Former Florida Team Physician Pete Indelicato.

By Peter A. Indelicato MD

Emeritus Head Team Physician University of Florida Gators

The titled question is, out of necessity, being asked more and more frequently with regards to the medical care “chain of command” concerning the health care of student athletes at the University of Florida.

A simple example may help explain the situation at hand. Player “X” sustains an injury to his/her knee during practice a few weeks prior to the start of the season. The athletic trainer and team physician decide that the injury is significant enough to warrant an MRI. The results, a few days later, reveals a torn meniscus that, given today’s advances in sports medicine could either be sutured together or partially removed.

If sutured and allowed to heal, the long-term benefit would most likely be lowering of the likelihood to develop arthritis in that knee in the future. However, if sutured, the player will probably miss the entire season in order to allow required protection and rehabilitation of the repair. If removed, on the other hand, the athlete probably could return to competition within a few weeks, thus not missing a significant period of play. Obviously, this can present as a dilemma for both the athlete, parents, teammates and coaches.

They may feel that he/she should have the damaged meniscus removed (rather than repaired) thus, allowing him/her a opportunity to return to competition relatively soon. On the other hand, the sports medicine Health Care Team may recommend an attempt to repair the damage thus, once healed, would very likely decrease the likelihood of further knee problems in later life. And there lies the dilemma that athletes, athletic trainers, team physicians, parents, coaches and administrators face on a regular basis.

Situations like this arise fairly frequently in real time. The question is: how do they get resolved? The correct answer is based on two accepted points:

(1) That the ultimate primary purpose of the designated Sports Medicine Health Care Team (Team Physician, athletic trainers, strength and conditioning coaches, physical therapist, nutritionist, sports psychologist) is both the short- and long-term health care of the student athlete. The University Athletic Association not only needs to recognize this but also empower and support its Health Care Team to be successful in accomplishing this singular goal. In addition, it needs to be recognized by everyone involved (including coaches) that the unquestionable leader of that team is the Head Team Physician.

(2) That the player (like any patient) always maintains a certain level of autonomy in the decision-making process: namely, that he/she needs to participate actively in that process (ie, it is a shared and informed decision-making process…shared between the athlete, team physician and any other qualified health care professional).

"I have never been challenged by any coach and/or administrator' -- Dr. Pete Indelicato

(Photo courtesy Pete Indelicato)

Patient autonomy is one of the basic tenets of medical ethics. Athletes face some unique challenges when making informed decisions regarding medical treatment when it involves return to play issues. They routinely must tackle external pressures from coaches, teammates as well as internal drives and individual goals that they set for themselves which may influence their treatment decisions.

At the University of Florida I can personally attest to the fact that, over my 35-year tenure as Head Team Physician, I have never been challenged by any coach and/or administrator as to what I thought was the best option for treating and injured athlete. I have been blessed with coaches and administrators that shared the unchallengeable goal of providing excellent health care advice and management to all of our student athletes.

This has not always been the situation at other NCAA institutions as evidence by the fact that a few years ago, the NCAA stated that every member institution had to adopt a clear administrative statement that coaches were to have no influence on medical decisions made by the institutions Sports Health Care Team.

To be perfectly frank, the media further complicate matters. Media coverage introduces another distinctive aspect in the decision making in sports medicine because the physicians care comes under an added level of scrutiny that can have either a positive or negative influence on the physician’s practice and, consequently, his or her career. Today, public perception of the athlete’s outcome may influence the public’s perception of the physician’s competence. This was never a problem years ago.

Stated briefly, the Head Team Physician at the University of Florida, should be and is, the head to the chain of command when it comes to the safety and health of all the student athletes. He/she continues to have the full support of the administration and my personal experience with all the coaches that I have had the privilege to work with over my tenure have been nothing but supportive of our overriding goal of quality health care of the student athlete for both the short and long term.