Going all the way back to ancient Greece, the sense of trust a caretaker gives patients is paramount. The Hippocratic Oath says to “first do no harm” and it is supposed to take precedent to any further clinical decision-making Modern sports medicine has inherent conflicts of interest: Teams hire, pay and fire caregivers based on the work they do with athletes, not the other way around. Government regulations for personal health information, known as HIPAA (Health Insurance Portability and Accountability Act, enacted in 1996), are supposed to provide the modern moral guidance by establishing severe penalties for transgressors.
The work relationships in sports between teams, clinicians and athletes now usually involve contracts which waive HIPAA compliance, often put in place so a trainer can answer questions from coaches without having to ask athletes’ permission. But the number of clinical voices, many of them collecting (formally or informally) athlete health information is growing as the athlete performance enterprise takes higher stakes and becomes more complex. More teams in more sports coordinate the athlete performance collaboration through a director/manager position (either Athlete Performance director/manager or Sports Science director/manager). It keeps a lid on finger pointing (and shouting matches) that might otherwise occur between sports medicine, sports training, therapy, nutrition, data analysis, coaches and front office.
The point is that athletes’ health information is not some Wild Wild West (like what was described by ESPN NBA writers). Long held caretaker norms exist, government regulations exist, and more and more standards of good practice for teams exist. For example, performance trainer Derek Hansen gave his recommendations for teams that come to him asking how they should provide in-season massage therapy interventions, a benefit for players’ recovery and a cost that might be prohibitive in terms of time and money. Hansen writes that the best case is to have top quality message therapists do the work they do best, which is working individually with the patients under their care and using what they learn in the process to improve athlete recovery.
Many people will continue to debate the efficacy of massage for recovery. I am more in favor of lobbying for good practitioners rather than argue over whether or not massage, in general, is useful. A good manual therapist will be able to individualize treatments for each player, depending on that player’s immediate and specific needs. Once a consistent, trusting relationship is developed between the athletes and service providers, tremendous results can be achieved in-season. …
Will Carroll calls it a “death spiral,” when injuries mount and reactive care interventions overrun a team’s prevention and maintenance regimens. The challenge to avoid a death spiral is greater when an organization is attempting sports science that has lots of moving pieces in collaboration, and more challenging if the organization is experimenting and looking to create advantages in their approach.
I think the guidelines outlined by Hansen for massage in his article provide rules of thumb for managing integrated care across sports science:
- expert caregivers
- personalized attention
- prioritize preventive care and long term athlete health
- clear lines of communication about health information
- experiment sensibly
- do what makes sense for everyone and limit downside risk
The list reads to me as what organizations that have their shit together would do normally. That competence should go hand in hand with an evolving standard for health care that shouldn’t make athletes nervous about the privacy of their health information.