Team physicians’ duties are to their patients as individuals, not to the team or to the school. The physician must have proper consent to provide medical care and must respect patient confidentiality. No matter how interested the coach may be in a star athlete, he or she has no right to participate in the medical care of the athlete without the patient’s permission. Medical decisions must be made on medical grounds by the physician responsible for the care.

The most difficult decision in sports medicine is determining when to allow injured athletes to play. The football player with a sprained ankle may miss the entire season if his activities are limited for as long as is usual in nonathletes. If he is allowed to play too soon, he has a greater chance of reinjuring the ankle and being disabled for a longer time. Blanket prohibitions on play for an extended period may encourage the athlete to ignore the physician’s advice altogether. If the athlete is an adult who can understand the risks of playing while injured, the physician may only need to provide accurate information on the risks of continued play. If the athlete is a child, the situation is more complicated. The parents must be involved in the decision and must be given full information about the risks.

When sports medicine physicians are dealing with athletes with less information and support than are available to professionals, they should be more conservative in balancing the need to get back to play against the probability of impairing permanent healing. For example, if a sprain can be adequately supported by tape, the athlete should be taught to tape and be allowed to play. If an injury would heal without surgery but surgery will speed the process, the athlete may choose to be operated on. Although a physician may aid a professional athlete in a calculated decision to compromise future healing for short-term gain, this should not be done for college and high school players. Using pain killers or steroids to get the player back on the field when this endangers permanent recovery is bad medicine and legally risky. The promising player who wants to be in the game when the pro scout is there will not be grateful if that game is his last because his injury becomes permanent.