Unethical?? Illegal??

In the April 2011 edition of Training & Conditioning there is an article entitled "Triple Trouble", written by a former Division I College Athletic Trainer now working at the high school level.  http://www.training-conditioning.com/2011/04/11/triple_trouble/index.php  It is the story of an athletic trainer's efforts to keep an athlete on the field after three separate injuries.  While I applaud the effort, I do take exception to some of the methods. In particular, the athlete sustains a a tear of the flexor tendon on the fourth finger. He is taken to the ER and eventually sees one orthopedist, who then refers him to a hand specialist. The hand specialist decides surgery is not warranted but the athlete will be out 6-8 weeks until the tendon heals.  Now comes my issue.


"I realized I would be going against what the specialist said, but he was a young physician and did not have much experience in sports medicine. I had treated several flexor tendon injuries and felt confident that I could devise a protective device and get Justin back on the field. I would not recommend a novice athletic trainer or one who hasn't dealt with this type of injury before do this, but I talked about my idea with Justin and his parents, and they had faith in my skills."


Any Athletic Trainer who takes it upon them-self to disregard a physician's instructions is in violation of their state's practice act and is crossing ethical boundaries. Parents consent or not it is outside the scope of our practice.  Other than the obvious scenario that the athlete suffers a long term disability from the actions of the athletic trainer, what precedent does it set?  What if the athlete suffers a concussion?  They are evaluated by a physician who says no play.  The parents and the athlete want to play.  What are you going to say?  The physician ruled him out?  You have already established that you can ignore the physician's direction. 




I have other issues with the article as well.  Particularly, this athlete suffered two separate tears of his plantar fascia on each foot with no mention of a physician's evaluation. Hopefully, that information was left out by the editors for the sake of brevity.


This story sends the wrong message to the public about the ability of athletic trainers to look out for the health and welfare of their athletes.  The obvious solution to the dilemma would have been to see another Orthopod for a second opinion who would agree with your plan for handling the injury. If they still do not agree, then the athlete sits, end of  discussion.