MEDICINE OUTSIDE THE BOX
( continued from page 9 ) sick or injured . Relationships are built , trust is gained . Regardless of their status as a pro athlete , this is at its core the definition of the patient-physician relationship .
They say team work makes the dream work . Eleven men on the pitch comprise a championship caliber team , one that has won the United Soccer League ( USL ) championship twice in its short history . As a team physician to this caliber , I am reminded daily of the team that we have working behind the scenes to make this happen . We are in constant communication among the three of us physicians regarding our best medical advice to the team . We are also in constant communication with the two athletic trainers who are our backbone caregivers for the team . Clear communication amongst all from the medical side - which then funnels through to the coaching staff - is tantamount in providing the best evidence-based care to our team .
by MARK PUCKETT , MD , CAQSM
Sometime in 2014 I received a call to talk about working with a new soccer team that would be forming in the city . Professional soccer was growing , and Louisville was possibly getting an expansion team . Who knew what might happen down the road , but it would be a fun opportunity to practice full scope sports medicine as a part of a comprehensive program .
Fast forward : now in their eighth season , Louisville City FC remains a major part of my medical practice with Baptist Health Sports Medicine . Over those seasons I have learned many lessons - some more easily than others - from this unique setting of practice .
Be thankful . The busyness of medical practice with its varied demands can distract from what led most of us to this career . We can lose sight of the fact that people come to us seeking help , and we have been blessed to have some wisdom to share . I am reminded that I have the privilege of sitting on the sideline of a world class team , using what I have learned to help them meet their goals . We can celebrate the victory , the return of a player to the field after a long injury recovery or feel the relief of the final whistle when the pressure is on .
Remember your patient is a person . Many patients in the sports medicine world benefit from being told to slow down and take a break . Overtraining is common in our field . However , we treat athletes who depend on their athletic ability for their livelihood . Their injuries affect playing time , a commitment to the good of the team and possibly long-term contract opportunities . This must be considered with treatment decisions . As a middle-aged doctor I can be content to let my own injuries heal with patient conservative measures , but conservative treatment is not always better . For a player with a fifth metatarsal fracture , for example , treatment with surgical fixation instead of patient immobilization could mean game eligibility weeks earlier . Further , that player also has a family - maybe a partner , or even young children in the stands . He is not a machine or just a persona ; he has a life , and perhaps a career , outside of sports in the future .
You are always part of a team . I remember applying for an internship at a local hospital as an undergraduate pre-med student . I walked in with the assumption that I would be placed with different doctors in different specialties to learn , shadow and help with menial tasks . Instead , I was assigned to help fold laundry , clean patient rooms and manage the OR schedule . I learned a valuable lesson that winter : a lot of parts have to fit together for medicine to work . We only have success in the context of a team . Our fantastic athletic trainers help optimize training while managing workloads to prevent injury , identify issues early before they become limiting , and prepare for the worst emergencies on field . Our coaches and team administrators take injury prevention seriously and truly care for the long-term good of each athlete . Our athlete-patient trains hard and intently seeks to be wise with his body to improve and recover well .
Hope for the best but prepare for the worst . Practicing medicine on a playing field brings some unique demands . This season alone I have been in matches with ice on the field and others with a dangerous heat index . Cold exposure is generally a lesser concern , but heat illness can be deadly . Sudden cardiac death in sports is a topic none of us want to learn about first hand . Soccer shots can fly up to 80 mph , a lot of force without protective gear , making trauma a real threat . A simple laceration can be stitched at halftime , but only if you ’ re fast enough .
History and physical exam always matter . A player once complained of ongoing knee pain despite a benign appearing exam and normal MRI . He continued to describe a sharp , pinpoint pain near the joint line with certain positions of flexion and loading the joint , but his meniscus had been cleared multiple times . It was not until we got in the gym and recreated the motion with my hand on his knee that we discovered a simple plica band , easily managed with conservative methods .
I am confident I have received much more than I have given through my practice of medicine on the field . The smile of thanks , the look of hope that the injury can heal , and the high five after a goal are rewards that will outlive any RVU or patient satisfaction survey .