To what extent do clubs respect medical confidentiality?

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Tnhere was an interesting debate last season when Dani Carvajal joined his then team mate Gareth Bale in requesting that Real Madrid did not publish the details of their latest injuries. 

Reports at the time suggested that Dani had a calf injury and that Gareth's injury was said to be a hamstring muscle tear. 

Both players had every right to privacy. It's been reported that Dani did not want the details of his injury made public and, like Gareth Bale, the media respected their wishes.

Both players were said to be invoking medical confidentiality as their reasons.  Although that was a first for Dani, Gareth has invoked his right to medical confidentiality in the past.

The previous occasion was when he sustained an injury while playing for Wales against Croatia in 2019, in the same game that Real Madrid teammate Luka Modrić picked up a thigh injury. 

I commented at the time that Gareth's stance could well set a precedent for other clubs to follow.

Real Madrid, as do so many other clubs, take particular care to be as accurate as possible about the information released regarding players' injuries, but in most cases, this is limited to a brief statement giving the site and nature of the injury.

Usually, this reads as a vague statement about the player having suffered a muscular injury to the left leg for example but without detailing which muscle, or clarifying whether it's a muscle in the thigh, hamstring or calf etc.

Gareth is said to be citing the doctor-patient relationship over the release of medical information without consent, and this might well be an indication of things to come.  

Medical confidentiality applies in all walks of life but tends to be treated differently in professional sport as a whole, and not only in football.

It might be that Real Madrid, in their eagerness to keep their supporters informed about player injuries are providing too much information, although in practical terms it's debatable how much that information affects things going forward.

Media reports aren't going to influence opposing coaches' team selections and they're certainly not going to affect whether or not other clubs make approaches to sign certain players.

Clubs are going to base those decisions on accurate medical examinations as opposed to reading a single line saying that a certain player has a calf injury. 

They'll get their club medical people to decide on matters of that importance.

Perhaps Real Madrid needs to re-assess their release of injury information policy to include the consent of the players in these statements, such as is the practice at several other clubs in La Liga.

Medical reports from Real Sociedad in particular always carry the addendum that the information has been made available with the consent of the player and the medical services; although it is the consent from the player that is ultimately the most important aspect of this.

It might well be that Gareth Bale was so fed up with being publicly lambasted over his injuries that he simply did not relish another period of relentless media speculation over the reasons for his absence from Real Madrid's team.

He may well have been genuinely worried about whether his  injury constituted a threat to his career and for that reason wanted to keep his own counsel as opposed to having everyone analyse the chances of him making a return and suffering yet another recurrence.

How far we take this discussion is where the whole situation could potentially get out of hand. What happens if Dani, Gareth, or any of the other players decide that they don't want Carlo Ancelotti to know the exact details of their injuries?

There have been incidences in the past of players asking the club medical team not to divulge the full extent of their injuries to the coach (Malcolm and Scott, 2010). 

Another example is of players refusing club medical staff access to MRI reports etc. before they have had the chance to discuss these fully with independent specialists.  

As a physio, that's a situation I have found myself in on several occasions and it is not easy to deal with. It can be very difficult trying to rehab somebody accurately when they are not telling you the full story!

There is also the question of how much the coach needs to know about a player's medical status, this too has been debated at length and no doubt that debate will continue.

The issue of confidentiality in sport is not new.  Importantly, with media interest as it is today, we have to acknowledge that considerable pressure is placed on the clubs to publish information about players injuries, but without necessarily going into too much detail.

So, the question of to what extent clubs respect medical confidentiality is difficult to answer. Even if clubs stick to sharing just the basic information, there /will always be players who prefer not to have the details of their injuries discussed in public.

Cristiano Ronaldo, for example, managed his own return to fitness from the knee injury sustained in the Euro 96 final in Paris to such an extent that information released about his recovery process was virtually non-existent in terms of detail.

Even basic information relative to the extent and nature of the injury itself was controlled by Cristiano and readers may remember that I wondered then if this could be the shape of things to come.

Most players in general though, are happy to share information about their injury. Players normally love to talk about their injuries and often feel that the exchange of medical information that arises from discussing their conditions will help them in their recovery process through taking as many opinions as possible.

The medical room is often the place where players will openly discuss their injuries with each other, and these discussions frequently extend to include other members of the coaching and medical staff as well.

Therein lies the problem if we are talking about medical confidentiality. Are we limiting this to the one-to-one medical situations Gareth is said to be referring to, or are we talking about keeping injury matters 'in-house' amongst the medical team?

In addressing confidentiality, Giordano (2010) wrote that in team situations ''the complexity of such interpersonal strategies stems from the recognition that the requirements of sports medicine may exceed those of 'standard' medicine''.

Often, it's that complexity that leads to issues of confidentiality arising in the first place. How clubs adapt and address this could well be placed under increased scrutiny in future.

References:

Giordano S (2010) A new professional code in sports medicine. British Medical Journal. Available at: https://doi.org/10.1136/bmj.c4931 (Published 21 September 2010)

Malcolm D, Scott A (2013). Practical responses to confidentiality dilemmas in elite sports medicine. British Journal of Sports Medicine. Vol. 48 (19); 1410 – 1413.