What is Our Focus?

15 Dec

Two recent articles have me thinking about what our role as Athletic Trainers is towards the athletes that we provide health care to.  In a New York Times article, a former Denver Bronco Nate Jackson calls out athletic trainers in the NFL.  He says:

This harsh reality is softened by human relationships. Football players spend every day with the members of their team’s medical staff. They learn to trust them. The athletic trainers nurse the players back to health when they are injured. The team doctors perform their operations. Friendships are formed and bonds are created. But underneath it all hums the machine.

Athletic trainers are paid to keep the machine humming. The long-term health of the individual player is not their first concern; the health of the team is. The faster a trainer gets his players back on the field, the more likely he’ll be to keep his job. Trainers are under pressure to do this by masking a player’s pain with drugs and designing a hasty rehabilitation schedule, even if it inevitably trades one injury for the next.

Jackson does point out that the athletic trainers are competent and caring professionals.  I don’t feel he is disparaging the profession.  I think he is trying to improve the health care focus that is given to NFL players by the medical staffs.

I have no experience in the NFL.  The only professional experience I have had as an athletic trainer is at the semi-pro minor league hockey and soccer.  I know the pressure place on ATs in the setting is enormous.  This pressure comes from the coach, the GM and even the players themselves.  ATs in all levels, but especially at the pro level, are measured by their ability to get athletes back into play as soon as possible.  The sole focus is getting players back to the game.  This is the inherent problem.  The athletic trainers provide care for athletes, but get paid by the owners.  The 3rd party is the problem.  The owners lose money if certain players aren’t on the field (cough, Peyton Manning, cough, cough).  If the medical staff worked for the NFL and answered to the NFLPA, there would be major changes.

Case in point – Colt McCoy’s concussion.

But McCoy’s father, Brad, a longtime high school football coach, had been critical of the Browns’ handling of his son, saying Colt couldn’t remember the play that briefly knocked him out of the game.

“I talked to Colt this morning and he said, ‘Dad, I don’t know what happened, but I know I lost the game. I know I let the team down. What happened?’ ” Brad McCoy said, according to The Plain Dealer of Cleveland.

McCoy told Shurmur “he was ready to go” before going back in, the Browns coach said. Shurmur was adamant that if McCoy had been symptomatic “he would not have gone back in the game — absolutely not.”

Is returning an athlete to play as soon as possible solely what our focus as health care professionals should be?

To his credit, Jackson is just whining and writing sour grapes about his experience in the NFL.  He points out the problem AND he gives a solution:

If the N.F.L. is serious about protecting its players, it should appoint a league-wide medical body, unaffiliated with any specific team, to oversee players’ health. Such an institution would be able to provide care to the athlete without the interests of his team distorting treatment.

Colt McCoy’s father did have this to say:

“I certainly didn’t think he’d be out only a play,” the elder McCoy said. “It would’ve taken my high school [athletic] trainer longer than that to determine if he was OK after a hit like that.”

I am certainly biased, but that statement makes me feel good as a high school AT.  But it also illustrates the problem.  ATs in the professional setting are under inordinate pressure to return players to play entirely too soon.  It is easy for me in the high school setting to throw stones, but I am not under that immense pressure.  The only thing on the line for me is college scholarships, and few student athletes are really at that level.  All ATs feel pressure to return players to play as soon as possible, it just seems very high at the professional level.  Much of the concussion issues in the NFL and NHL today wouldn’t be a problem if this pressure was much less intense.  I personally know a former NHL AT who resigned from his post due to the ethic issues he had with returning players to the ice too soon.  He couldn’t justify what he was doing and couldn’t look the “Man in the Glass” every night with pride.

So, what is your focus?  How do you respond to coaches, parents and players who put pressure on you to return a player too soon?  Do you think about short term outcomes?  Do you contemplate the long term effects on health?  Is long term health a primary focus that an athletic trainer should have?

Comments are welcome!

4 Responses to “What is Our Focus?”

  1. Mike December 15, 2011 at 12:42 pm #

    It’s a never ending balancing act. That being said, I always tell my athletes and parents that this young athlete has a whole life ahead of them. I would hate to see an athlete permenantly debilitated because I wasn’t concerned enough about the whole athlete.

  2. Michael Hopper December 15, 2011 at 7:57 pm #

    Paul,

    I think one problem that exists is we don’t know who exactly is making these determinations as far as return to play goes. Is it the Athletic Trainer? Is it a Physician? Who?

    I think that is one positive for us working in the secondary schools. Probably the majority of us are on the sidelines by ourselves. We may be lucky to have a physician with us, but we as athletic trainers make a lot of decisions. In the professional level, it’s possible those athletic trainers get overridden..

  3. Paul LaDuke, ATC December 16, 2011 at 9:15 am #

    The NATA officially responded to the NY Times article:

    http://www.nytimes.com/2011/12/16/opinion/athletic-trainers.html

    Well done!

  4. tapingthroughlife January 2, 2012 at 9:02 pm #

    I think you are right on point in saying that this is a little more complicated then these athletes make it. As someone who previously working in minor league baseball I know first hand how much money changes the game. The fact is that even in the minor league system the GM wants certain people on the field, to them it is all about the numbers and the fact is that will never change. In my opinion, it is the athletic trainers job to stand their ground of these issues. However, the physician is that one who is overseeing the athletic trainer and in most of these cases the physician is that one who is making the final decision in these matters, especially in these high profile cases. The athletic trainers are the easy ones to point the finger at because they are overseeing the medical care of theses athletes on a daily basis, but that doesn’t necessarily mean that is where the blame should fall. In saying that I am not ignorant to the fact that there are some athletic trainers out there do not make the appropriate decisions due to the immense pressure they are put under on a daily basis. Like any profession there are a lot of great athletic trainers out there doing great things, but there are also athletic trainers out there who are not doing there jobs appropriately. The choice lies in each of us as athletic trainers to do out best in every situation that we are put in, no matter how gray the area may be.

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