Physicians Have 'Ethical Duty' to Educate Youths About Concussions, Says Academy
Physicians have an ethical duty to educate youth-athletes about the potential short- and long-term risks associated with concussions, and must stand firm against parents, coaches, or school officials if they attempt to sway a return-to-play decision, the American Academy of Neurology suggests in a position paper released Wednesday.
The paper, released in advance of the academy's upcoming Sports Concussion Conference (to be held this weekend in Chicago), seeks to provide guidance regarding the handling of concussions to physicians who work with youth-athletes. It examines both the legal and ethical duties of such health-care providers when working with potentially concussed youths.
The position paper highlights the state-to-state differences for youth-concussion laws, specifically in terms of which health-care professionals are permitted to make return-to-play decisions. Some states also provide protection to volunteers who clear athletes to return to play in certain instances. The neurological academy thus urges physicians to be aware of the law in the state in which they work and where their patients live.
The paper also highlights some of the shortcomings of such laws:
"Unfortunately, the reporting schemes established by the laws may create potential conflicts between athletes and their care providers, and the laws are generally silent on the issue of protecting athletes from the harmful effects of repeated concussions."
Much of the position paper focuses on ethical concerns regarding the treatment of potentially concussed youth-athletes. For any physicians working with such athletes, the academy emphasizes the need for them to have "adequate training and experience in the existence and severity of potential brain injury." This includes familiarization with the latest concussion-management guidelines.
The academy also says "all physicians have an ethical duty to educate their athlete-patients and the patients' parents about concussion," specifically about "the evidence for potential short- and long-term neurocognitive and neurobehavioral risks associated with single and multiple concussions." This recommendation applies even for youth-athletes who have yet to suffer a concussion.
Critically, the paper addresses potential conflicts of interest that may arise if a physician is employed by an athletic team, as a return-to-play decision could adversely affect that team's chances of winning. "It is of paramount importance," the academy states, "for physicians to affirm clearly that their primary responsibility is to protect the health and well-being of their patients, regardless of financial interests or employment considerations."
"With nearly four million sports-related concussions in the U.S. each year, it is imperative doctors are educated and protect these athletes who may have sustained a concussion," said lead author Dr. Matthew P. Kirschen, a neurologist with the Children's Hospital of Philadelphia and a member of the American Academy of Neurology, in a statement.
To further aid physicians in their treatment of youth-sports concussions, the academy recommends including training about concussions into neurology residency training, further implementation of baseline cognitive testing, and the development of a national concussion registry. The latter two "would facilitate monitoring concussion rates and outcomes as various strategies for prevention," the paper suggests.
In an accompanying editorial, Dr. Ellen Deibert, a physician from WellSpan Adult Neurology in York, Pa., writes that the position paper is a "refreshing reminder" of the issues surrounding sports-related concussions and "the need for continued education and research on this topic."
That last point is one this blog has hammered home for years: Though we've learned a great deal about concussions over the past few years, there's still much to be discovered. There's certainly no harm in adapting new guidelines based on the latest research, but retaining flexibility is key when creating such recommendations.
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