The Australian Football League (AFL) recently announced it’s “considering appointing independent doctors in any respect AFL games to help club medical staff in identifying and assessing players for potential head injuries.”
The announcement got here after recommendations of a coronial inquiry into the death of former AFL player Shane Tuck, who died by suicide in 2020.
A post-mortem examination of Tuck’s brain found a sophisticated case of Chronic Traumatic Encephalopathy (CTE), a neurodegenerative disease linked with repetitive head trauma.
CTE is a type of dementia which is more regularly diagnosed in individuals with exposure to repeated head trauma, like athletes involved sports.
The governing bodies of those sports, including the multiple football codes in Australia, have been striving for several years to guarantee players, parents and the general public that their games are protected to play.
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Why are independent doctors needed?
One of probably the most significant concerns about concussion (otherwise generally known as a light Traumatic Brain Injury or mTBI) is the potential for an athlete to incur serious neurological damage in the event that they suffer recurrent brain injuries inside a brief time period.
This is why many contact sport organisations across the globe and in Australia have developed exclusion protocols for concussed players, to forestall their brain from receiving more trauma while it continues to be recovering.
In Australia, mandatory exclusion periods vary between different sports. The AFL recently announced it could adopt the Australian Institute of Sport’s (AIS) suggestion for 21 days of exclusion from games and training for non-elite or “community” athletes.
The rules are different for players within the elite AFL and AFLW competitions, who’re only required to take a seat out for 12 days post-injury.
The first step on this exclusion process is determining whether or not a player has sustained a brain injury. Currently, this decision is made by a club doctor – a licensed medical doctor who’s employed by an AFL or AFLW team.
Concerns have been raised concerning the impartiality of club doctors, and the potential for his or her decisions to be knowingly or unknowingly influenced by a desire to see their club succeed.
The subsequent suggestion is, if independent doctors are employed by the AFL or AFLW, somewhat than the clubs, they might be higher capable of make a diagnosis without being influenced by coaching staff or other players.
With pressure comes risk
Being embedded in a high-performance sporting environment can influence people, including doctors, to adopt a win-at-all-costs attitude.
If the AFL and AFLW resolve to adopt independent concussion doctors, not only will it relieve club doctors of a few of their responsibilities regarding players’ brain health, it is going to also remove one other key decision-making group from the method – coaches.
Some coaches are vocal opponents of removing coaching staff and club doctors from decisions about brain injuries. In the National Rugby League (NRL), where independent doctors have been employed since 2022, coaches Ricky Stuart and Wayne Bennett argue it is an indication the governing bodies don’t trust coaching staff or club doctors.
However, the code argues it just isn’t a problem of trust, somewhat it’s about ensuring decisions on player welfare are made dispassionately by those that have specific training in the world.
It has been argued from performance, legal, and moral perspectives that look after athletes must be central to the practice of sport across all codes.
Indeed, some coaches have been major public advocates for this and there is no such thing as a suggestion that coaches or clubs don’t look after the health of their players.
However, the pressures of elite sport and the backgrounds and training of many coaches, particularly those that are former players, can create an environment where player health is seen as an affordable sacrifice for high-performance and competitive success.
Removing doctors from this environment is meant to assist them make more impartial decisions about concussions.
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Are independent doctors the best move?
The introduction of independent doctors is a step-change for the AFL somewhat than a fundamental shift.
The AFL’s approach to managing brain injuries is precisely that – it ‘manages’ brain injuries since the league, together with the individuals who manage other high-contact games, know that any significant reduction to the incidence of brain trauma would require fundamental changes to the way in which their sports are played.
Ultimately, the introduction of independent doctors is an exercise in tinkering, which may have no tangible impact on reducing the variety of brain injuries sustained by elite players.
It also stays to be seen how the AFL might seek to introduce the same system of concussion watchers for the lots of of 1000’s of recreational footballers across Australia, who play the identical games as their skilled counterparts with far fewer eyes watching them.
It can also be necessary to notice that emerging evidence tells us the chance of developing a long-term neurodegenerative disease like CTE is most strongly related with repeated micro-concussions, which can’t be diagnosed by a health care provider, independent or otherwise.
If the AFL and AFLW adopt independent doctors, it is going to be a positive move toward further prioritising player welfare, but it is going to not fix the concussion problem.