WA News Feature Articles Treating Trends for Sport Injuries
Treating Trends for Sport Injuries
Written by Peter McClelland
Monday, 02 October 2017


29092017-Dr-Peter-Steele-Sports-Medicine-300x300Dr Peter SteeleMedical Forum asked sports physicians for their views on treatment trends in the specialties.

Dr Peter Steele: “For me, knees, shoulders and back pain are most common.

I am seeing a number of teenagers with overload injuries because they are playing club, school and sometimes representative teams. No one monitors the overall load. And active older people are coming in with injuries, which is a good thing in a way – at least they are still being active

Improved technology allows more specific diagnosis in most cases and being able to direct appropriate management quicker. However, I think people in general are becoming happier to give conservative treatment a try before surgery.

In regards to joint replacement and revision, I’m not directly involved but I try to flag to patients with degenerative change the possibility of joint replacement in the future and then balance the load and their expectations to get the most out of the joint as long as possible.

In terms of elite sportsmen heading to the US for treatment, the size of their population and the number of elite sportspeople and programs would suggest they have dealt with difficult cases more often and have experience we do not. If athletes or clubs are happy to fund it then it is up to them, and they may well bring back new information.”

Dr Arjun Rao: “For me, overuse injuries especially soft tissue (tendon) and joint (arthropathy) are 29092017-Rao-Arjun-Dr-Feb15Dr Arjun Raocommon and age is a factor.

In terms of new treatments, I have found biological therapy to be extremely beneficial.

Regarding pressure to refer for surgery, in certain instances eg ACL injury there is, even though the Frobell study demonstrates that the recreational athlete can respond well to conservative management.

I am seeing an increasing number of joint revisions – it goes with the territory of an ageing population. I’m seeing increased frequency due to accelerated/Grade iV OA in a younger population.

Joint replacement still remains end-stage management. Even in the knee, 80% are satisfied with the result.

Regarding elite sportsman going to the US, I think a lot of it is down to slick marketing and the US does it better than most. The technology is no different and in some instances inferior eg; treatment of chronic recalcitrant tendinopathy by autologous tenocytes – that’s available here but not in the US.”

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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