How do you want to be remembered? I worked with a football coach that often repeated this to his team, and find it an interesting question for athletic trainers and anyone involved in helping provide healthcare to consider. At Relation, we care about helping our clients lead safer and healthier lives—that’s at the core of how we operate, and it’s one of the things we want people to remember about us.
That service mindset really resonates with me because I spent my entire athletic training career caring for and supporting student athletes, and striving to keep athletes at the center of every decision. My mentor consistently modeled this for me as he cared for the players and managed the conflicting interests, especially with coaches who tried to influence medical decisions.
Today, athletic trainers are still confronted with outside pressures that might not have the best interests of the athletes at heart. But, over the years, the field has seen an increased awareness of, and emphasis on, athlete-centered care in sports medicine, which has significantly influenced the decision-making process for both healthcare providers and athletes.
Practicing Athlete-Centered Care
It is now understood that one of the primary obligations as an ATC is to provide athletes (patients)—or, if applicable, their families or healthcare surrogate—with the information they need to make an autonomous decision about their healthcare. The healthcare provider should educate the patient about their specific illness/injury, the best practice available for their condition, and options for care based on the evidence, coupled with the short and long-term risk/benefits of each option. Additionally, the healthcare provider should determine the athlete’s values and goals that may influence the recommended course of treatment. (“Managing the Health of the Elite Athlete,” published in the British Journal of Sports Medicine, has some interesting thoughts on this subject.)
As an example of how athletic-centered care can look in practice, one orthopedist I worked with always followed the same multi-step method of educating patients: first, the doctor laid out the current research and evidence, then discussed their personal experience dealing with the condition, and then would offer three to four options for care and potential outcomes. The options could range from doing nothing to surgery, and it was up to the patient to take all of that information and decide their course of treatment.
The Importance of Transparency and Trust
After receiving all the information, the athlete and/or their parent usually asked me for my thoughts. They trusted me to be an unbiased voice of reason, especially pertaining to treatment and return-to-play decisions, and how that decision could impact the athlete later in life.
Giving a recommendation requires weighing the evidence, the physician preference, and the athletes’ goals in a delicate and deliberate way that gives attention to all parties and avoids conflict of interest. Keeping the patient at the center of the decision also requires an athletic trainer to strive to find a balance between evidence and preference. “Evidence, Preferences, Recommendations — Finding the Right Balance in Patient Care” by Timothy E. Quill, M.D. and Robert G. Holloway, M.D is a useful read about reconciling this tension.
When I offered advice, I was very mindful that my ultimate responsibility is always to the patient and their welfare, both immediate and long term. Many times I reminded the athlete to not only consider the present, but also think down the road—how will this decision affect them in 20 years? I asked about their life goals and listened closely to contextualize how their present-day healthcare choices could impact those goals: “You say that you want kids, and here is how this choice could impact your ability to run and play with them.” In these moments, I found transparency and trust to be essential, and the human connection that was required to discuss honestly often had the added benefit of forging life-long relationships.
Athlete-Centered Care’s Long-term Impact
Following these patient-centered principles does not always ensure a good outcome, but it does ensure that the patient had the information to make the best decision at the time. The athlete is the one who will have to deal with the impact of the decision for the rest of their life, so it is important to empower and support them in the decision-making process.
An athlete-centered approach also has the side benefit of having people remember you as someone who was honest and truly cared. Two years ago, an athlete I treated in 1985 called me looking for a surgeon recommendation because they trusted me and knew, even all these years later, that I would help them. And, earlier this year, a former football athlete reached out to my wife on Facebook with an affirming message to pass on to me:
As I get ready to go to bed and turn 40 tomorrow, please tell Andy that he was right. As I sat in the fieldhouse with the doctor getting ready to inject me so I could play and not lose my starting position, Andy looked at me and said, “You’re going to regret this when you’re 40,” and I said “I may not make it to 40.” Well I made it and Andy was right…but I am pretty sure I wouldn’t trade it for anything. Just let Andy know how much I appreciated him. I knew he was on our side and cared for us and I am, and always will be, grateful.
Keep the athlete at the center of all you do, and it will positively impact them—and you—for longer than you may know!
Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.
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