Elite athletes all over the world endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations.
For many athletes, coaches, clinicians and managers, the integrated and performance-focused approach to elite athlete health and coaching is still a difficult concept. Clinicians are focused on the medical ‘evidence’ and the physical health of the athlete and often want to have the ‘final say’ on these matters. They then tend to overlook the potential performance and psychological consequences when making decisions in isolation and when athlete preferences are excluded from the consultation. The reality check of a specific goal or ‘preference’ is demanded by the athlete–coach team and it might be argued that clinicians choosing to ignore this element only practise ‘safe medicine’. They might find it difficult to survive in the elite sport setting. Coaches and athletes are sometimes so performance focused that the health consequences of decisions in the heat of the moment are not taken into account.
It is therefore important to have a critical look at the organisation of medical support services to elite athletes, the process of decision-making in the elite sport environment and the best way to continuously manage athlete health. Athletes cannot do this in isolation and need the support of a well organised and integrated health and coaching team working in harmony towards common goals in a new Integrated Performance Health Management and Coaching model.