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Dr Sarah Townley outlines the medico-legal challenges in caring for patients participating at a high sporting level
‘Elite’ sportspeople refer to individuals who are employed or contracted as a professional sportsperson, or who have the potential to earn a significant income through sport, media, or endorsements. This group includes professional athletes, academy players, Olympic prospects, and high-performance amateurs who may not yet have contracts, but with the potential to become a world-class professional athlete.
The medical treatment of elite and professional sportspeople is widely recognised as an area of particular medico-legal risk. While the clinical presentations may appear similar to those of non-sporting patients, the financial, professional and reputational consequences of injury can be vastly different. For clinicians, it is useful to be aware of some of the risks and challenges that arise when treating sportspeople who are your patients.
The treatment of elite and professional athletes carries heightened medico-legal risk for several reasons:
▶ Financial impact: Loss of function, even temporarily, can affect earnings, sponsorship and career trajectory, particularly in highly remunerated sports.
▶ Reputational consequences: High-profile patients increase the risk of public or media scrutiny.
▶ Performance impact: Clinical decisions may have long-term implications for athletic ability or performance.
As a result, claims arising from the treatment of elite sportspeople can lead to substantially higher damages due to the potential loss of earnings.
Key challenges
1. Pressure for rapid return to sport
Sportspeople, coaches, agents, and team clinicians may apply pressure for expedited treatment or early return to play.
For example, a patient presenting with a torn anterior cruciate ligament may be managed conservatively in many scenarios. However, with an elite sportsperson, there may be pressure for rapid return to play, resulting in earlier surgical intervention, high doses of pain medication, or accelerated rehabilitation.
Clinicians must ensure that any treatment decisions are based on appropriate medical evidence and the best interests of the individual, rather than external expectations.
2. Third-party influence
Treating elite sportspeople means that outside influences, such as doctors or physiotherapists, and management teams with vested interests in their wellbeing, may attempt to influence decisions on behalf of their client.
In this situation, it is imperative that the best interests of the patient remain at the centre of any advice or treatment provided, and that the patient has the opportunity to discuss any elements of their treatment without third-party influences, if necessary.
3. Informed consent
For consent to be valid, it must be informed and given voluntarily without undue duress and influence. The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners (ninth edition) states that patients “must receive sufficient information about any proposed treatment in a way that they can understand”.
As the treating doctor, you remain responsible for ensuring that the patient has been given the opportunity to provide informed consent. As with any patient, clinicians should ensure they include details of all discussions, including any refusal of treatment, in the medical records.
Practical guidance for clinicians
Clinicians treating sportspeople are advised to ensure that they conduct themselves in such a way that they can demonstrate that any duty of care is limited to the patient and is not influenced by the patient’s employer.
To minimise liability, Medical Protection strongly advises doctors who treat elite or professional athletes that they should:
▶ Not enter into a written or oral contract with a third party (ie, someone who is not their patient) to treat a professional or elite sportsperson for reward.
▶ Only accept referrals from other independent healthcare professionals and not from clubs directly or from healthcare professionals working for them.
▶ Address any professional fee notes to the patient and not a third party. If fees are to be settled by a third party, the patient should be asked to forward them on. Alternatively, written confirmation may be obtained from the patient that all fee notes should be sent to the club, employer, or their medical insurers.
Therefore, we urge any members already providing services to patients who are elite or professional athletes to review any contracts held with a third party so that they are aware of their potential liabilities.
Conclusion
Treating elite sportspeople requires clinicians to navigate unique medico-legal challenges. At all times the key principle remains – the clinician’s duty of care is to the patient.
Case study
Dr B is an orthopaedic surgeon in Dublin. He regularly treats musculoskeletal injuries and receives a referral from a local GP for Mr M, who is a rugby player.
Mr M is part of a high-performance national development squad. He is considered an elite sportsperson due to his potential to play at a national level and linked commercial opportunities.
Mr M presents with a persistent knee pain following an injury sustained during a championship match. Initial assessment suggests a partial anterior cruciate ligament tear. In some patients, a conservative treatment option might be considered.
However, for Mr M missing the championship season could affect:
▶ His position on the team.
▶ His future selection and reputation as a player.
▶ His long-term athletic performance.
Following the consultation, further issues arise. The team’s physiotherapist contacts Dr B directly requesting updates and pushing for a quick return to play. The team has offered to cover the cost of any treatment.
These elements create possible medico-legal risks for Dr B:
▶ External influence on patient decisions.
▶ Potential conflict of interest between patient and third-party interests.
▶ Financial arrangements involving third parties.
▶ Ensuring appropriate patient confidentiality is maintained.
How Medical Protection assisted
Medical Protection assigned a medico-legal consultant to provide advice on the following issues:
▶ Guidance on managing the multiple conflicts of interest that had arisen, between the patient and their management team.
▶ The importance of ensuring that all patient information remains confidential and should not be disclosed to any third party without the patient’s express consent.
▶ Guidance on ensuring the primary focus remains the patient’s clinical care and treatment rather than any external influences
▶ The importance of clear documentation of all consultations and discussions.
Key learnings for Dr B
Focus on patient best interests: Dr B prioritises the patient’s individual health by carefully explaining the risks and benefits of all the potential treatment options including the option of conservative management. Using this approach the patient had the opportunity to make an informed choice, by ensuring that any decision was free from external influence, and with sufficient time to consider their options.
Patient confidentiality: Dr B avoids entering into any informal discussions with the team management and ensures any personal or medical information is shared only with Mr M’s informed consent.
Financial arrangements: All invoices must be addressed to Mr M.
Avoiding third-party contracts: Dr B declines any suggestion of ongoing formal arrangements with the team. Dr B documents all interactions carefully to maintain clear professional boundaries.
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