Rx for Staff

How do you manage staff members coming to you for healthcare advice? Top athletic trainers offer some tips.

By Jim Catalano

Jim Catalano is an Associate Editor at Training & Conditioning.

Training & Conditioning, 11.5, July/August 2001, http://www.momentummedia.com/articles/tc/tc1105/rxstaff.htm

As an athletic trainer, you devote hours each day to helping athletes maintain or regain peak physical condition. You’re probably also often called on to provide advice to department staffers, such as coaches and administrators. You may be glad to offer your services, especially when it doesn’t interfere with your main responsibility of caring for athletes.

However, easy access to the athletic training room may mean that you are seen as the first line of medical care by innumerable staffers who just drop by with questions or concerns. Athletic trainers report dealing with staffers complaining of everything from backaches to jogging-related injuries as well as questions about supplements and requests for calling in prescriptions—sometimes pushing the limits of what you’re able to do.

It’s not always easy walking that delicate line between helping colleagues and saying no when necessary. In this article, athletic trainers talk about the potential pitfalls of providing healthcare for staffers and approaches that can help you better manage the issue.

Setting Boundaries
Setting down some basic rules is essential to ensuring that you don’t become overwhelmed by staff healthcare requests. Most important is that you let them know the students are your primary responsibility. “Sometimes, coaches will want you to drop everything and help them,” says Mark Bohling, ATC/L, Head Athletic Trainer at Texas A&M University-Corpus Christi. “If I’m busy, I tell the coaches if they can’t wait, they should call the doctor’s office and make an appointment. My first priority is to care for the athletes.”

“Ann Landers likes to say that no one can take advantage of you without your permission,” says Brian Robinson ATC/L, MS, Head Athletic Trainer at Glenbrook South High School in Glenview, Ill. “There are times we must learn how to say ‘no,’ which has been the hardest thing for me to learn in all these years. I now tell people, ‘We are really busy right now and I want to be able to discuss and evaluate your problem when we will not be interrupted. I’d like to be able to give you my undivided attention. Can you come back at...?’”

Others take a stronger stance. “My approach is to continually remind the athletic director and Student Health Center that I am there for athletics only,” says Aimee Brunelle, ATC, Head Athletic Trainer at Jamestown (N.Y.) Community College. “Favors will be given, but with the staffer working around my schedule rather than mine changing to fit his or her schedule. Of course, it works for about a month, then someone forgets and the issue comes up again.”

Most athletic trainers, however, agree on the importance of clearly outlining what you can and can’t do for staff members. Coaches and other staff members become so accustomed to seeing you as having all the answers about athletic injuries that they sometimes forget your limitations.

“I am not a doctor, nor by any stretch of the imagination do I have all the answers,” says Michael Adams, LAT, Director of Sports Medicine at Pflugerville (Texas) High School. “But they sure expect me to. Since a big part of my job is referral to appropriate sources, I just tell them that they really need to see this or that doctor. Usually, since they are school faculty, they have to go to their primary care physician.”

“We’ll look at each coach that comes into the training room with a problem,” Bohling says. “If it’s nothing serious, they’ll usually wait to see the doctor when he comes to the training room for his weekly clinic. If they need to see the doctor in his office for something more serious or if they need x-rays or tests, we’ll help make the appointment for them.”

“Some may have psychological stress-related problems that manifest themselves physically,” Robinson says. “If they become more than I can handle, I will try to refer them on to someone who can give them more individual attention.”

Sometimes, insisting on referring the staff member to a doctor is all it takes to end the discussion, since he or she may have come to you simply looking for a way to avoid a trip to the doctor’s office. “Many times, the coaches just want us to call the doctor to get a prescription for them without them seeing the doctor,” Bohling says. “They don’t understand why the doctor isn’t willing to write the prescription without examining them. You try to tell the coaches that the doctor needs to examine them to diagnose the problem so that he or she doesn’t prescribe something that may be contraindicated, but they just want their medicine now.”

“I also request that they have a doctor’s note for any electrical modalities they need,” Adams says. “If they don’t have a note, I usually can call my team physician and get a note to accompany treatment. I did have one teacher try to get me to perform a treatment that her physical therapist did. When I refused, saying I had no documentation from her doctor, she said, ‘My therapist told me you can do it.’ I again said, ‘I need a note from your doctor, or no treatment.’ She has not been back since.”

Another big reason to send staffers to a physician is that, often, those who ask for help aren’t always forthcoming or knowledgeable about their own conditions. “When dealing with these chronic and previous injuries or illnesses, it’s very easy to simply listen to the staff members’ problems and then treat them based on the information they give me,” says Dave Hammons, ATC/R, Head Athletic Trainer at Westminster College. “But I have found that in most cases, the information they give me isn’t accurate or they aren’t giving me the entire story. So we end up treating something we don’t need to be caring for, and may end up missing something we should be treating. So, now, when dealing with chronic and pre-existing injuries or illnesses, I ask for medical records and diagnostic reports as well as any x-rays they may have. Coaches especially seem to keep their x-rays from ‘old’ injuries—sometimes, I think x-rays are like trophies to them.”

There are times, too, when you will simply have to draw the line and tell staff members that you can’t help them if they won’t take your directions. “The one thing that does get aggravating is when their problems become mine,” Hammons says. “Especially when the problem is pre-existing or chronic. I make every attempt to let them know that this is their problem and I will help them as much as possible but if they don’t follow through with my recommendations, then they are on their own.”

Another place to draw the line is when staffers start recommending your services to all sorts of people outside of your institution. “We have been noticing more and more staffers bringing their children, wives, husbands, sisters, brothers, and even friends to the athletic training room for advice,” Hammons says. “Generally speaking, I will consult with them and that is all. Treatment is out of the question because of liability concerns and also due to staffing restrictions. I usually just refer them to their primary care physician.”

Overall, athletic trainers recommend handling staffers on a case-by-case basis, keeping in mind the potential benefits down the road. “I really think that the way to handle these cases is individually,” Adams says. “I see it as a way to educate some teachers who do not know what an athletic trainer is or does. Then, when a student might be a little late for their class, with a note from me, they will be a little more understanding.”

A Matter of Policy
Opinions vary widely on whether or not a written policy on treating staffers is necessary. Many athletic training programs don’t have a written policy, mainly because it hasn’t become an issue for them or it wouldn’t be appropriate in the school’s environment. “A written policy sounds like a good idea, but I have not run into a situation where it would have been helpful,” Robinson says. “To date, all faculty and staff have been very grateful for our assistance and are aware of our limitations in both expertise and time.”

“I think a formal policy would not be worthwhile at a small college, where there is a small-town attitude that you help your neighbors,” adds Brunelle. “A policy would not be adhered to, as I am always asked to do a ‘favor’ for whomever may be doing the asking.”

However, some athletic trainers strongly recommend implementing a written policy that outlines your school’s expectations and your responsibilities toward dealing with staffers, especially to limit exposure. The athletic training program at Lake Forest (Ill.) High School has such a policy (see “One School’s Solution,” on page 42). “It spells out what the athletic trainers will do for staffers, and when,” explains Jeffrey Dooley, MS, ATC/L, Athletic Trainer at Lake Forest. “It’s especially important for workman’s compensations injuries, for liability reasons.”

Seattle Pacific University also has a written policy. “We have a policy that basically precludes ATCs from providing any care to a non-athlete,” says Bob Grams, ATC, Head Athletic Trainer at Seattle Pacific. “Fortunately or unfortunately, it is really hard to actually follow the letter of the policy in many instances. But there is much less protection for an ATC when he or she does anything outside his or her job description; for example, the university’s insurance company may have no obligations in the case of non-athletes. Intercollegiate athletes are many times the only client named in an ATC’s job description.”

“Of course, there are liability concerns with staffers,” Hammons adds. “However, if they are injured, we treat them like a regular student-athlete patient. Even then, I think we tend to be more conservative and perhaps cautious, especially if it is related to workman’s compensation. I’ve never been implicated in a legal suit regarding liability, but I think a good preventive measure is to provide the same service to all.”

If you don’t have a written policy, it’s still a good idea to go over this issue with assistant athletic trainers to make sure everyone is on the same page regarding staff healthcare. “I discuss this issue with my two full-time assistants, informing them that I do not mind if they work with staff members as long as it does not take away from the student-athletes,” Robinson says.

A Proactive Approach
Another way to manage staff healthcare issues is by providing information on preventive medicine. Many athletic trainers start by putting up posters or leaving out informational brochures in the athletic training room. Others follow up by giving talks to staff members. “Generally, we provide preventive information to the athletic department during staff meetings, and it works well,” Hammons says. “We are in the process of offering presentations and workshops to the entire college faculty about repetitive stress injuries and illnesses and musculoskeletal injuries. It is foreseeable that we may even begin a campus-wide ergonomics type of program.”

Earl Osborne, MEd, ATC/L, Athletic Trainer at Angleton (Texas) High School, meets with his athletic director and superintendent of schools at the beginning of each school year. “We discuss safety issues for the athletes and then, for the coaches, we talk about sun protection and staying hydrated,” he says. “I also print a monthly ‘Wellness Letter’ that goes to all employees of the school district. It covers many different topics: diet, how to treat a cold, proper exercise, menu ideas, glucosamine and chondroitin supplements, chronic diarrhea linked to gallbladder problems. I will also put articles in a teacher’s box if I find something that pertains to him or her.”

Dealing with coaches can require a special tact, but many athletic trainers have found that taking the initiative is particularly effective. “I think it is crucial to take a proactive approach with staff members, especially coaches, when dealing with preventive medicine,” Hammons says. “Staff members within the athletic department make everything run efficiently. If they are unable to do their job, it ends up hurting everyone involved, including the athletic trainers. And coaches don’t always think about their personal health as much as their players’. I’ve seen a few coaches become affected by heat exhaustion that required treatment and work loss. So we also provide sun protection and OTC medications to these individuals.”

“Coaches tend to see themselves as when they were athletes—bulletproof,” Adams agrees. Two of the main areas he talks to all coaches about are avoiding overexposure to the sun and maintaining proper hydration. “I recommend all coaches wear sunscreen and hats during all practices,” he says. “I also keep high-degree sunscreen and lip protector in the kits, in case any coach needs them.

“Water consumption is also stressed with all coaches during our beginning-of-the-year in-service,” Adams continues. “I also teach all the coaches in our district CPR and first aid during each summer, and we go over proper hydration principles at that time.”

Many hard-driving coaches can also be prone to other diseases. “I have a coach who has high blood pressure—some of his uncles and his father passed away early from heart disease and heart attacks,” says Adams, who has high blood pressure himself. “I used a little of my budget to buy a good electronic blood pressure monitor with different size cuffs. I kept after the coach to take his blood pressure and after seeing it high so many times, I finally convinced him to go to the doctor. He did, was put on medication, and now he says he feels great.

“So, now some of my other coaches are taking a better look at their health,” Adams continues. “Some have gone to the physician and been given high blood pressure meds, and now every coach in our varsity football office takes his blood pressure at least once a week. I also do some blood pressure readings weekly for a few teachers in the building.”

Ultimately, it’s worth being persistent with coaches. “Sometimes, it may seem that when you warn a coach about something that it goes in one ear and out the other,” Bohling says. “But I think it eventually sinks in if you continue to warn the coach and give him or her examples of the potential risks.”

Getting coaches and other staffers to take better care of themselves will not only benefit them, it will help you by keeping them from dropping by the athletic training room for impromptu medical consultations or treatments. And, by having a policy in place—whether it’s written or not—you’ll be able to set ground rules that enable you to attend to fellow staffers when and how it suits your department best.

One School’s Solution

The athletic department at Lake Forest (Ill.) High School drafted a formal, written policy for how staff can and cannot utilize the school’s athletic trainers for personal injuries. The policy, reprinted in its entirety below, gives some idea of how simple such a document can be and some of the important points to consider.

Policy for Consultations, Recommendations, and Treatment of Faculty/Staff By The Lake Forest High School Athletic Trainers

Purpose of this Policy: The following policy and procedure is intended to provide guidelines for treatment of Lake Forest High School (LFHS) faculty and staff, including coaches, by the LFHS Athletic Training Staff.

Reporting On-The-Job Injuries
1. It is the staff member’s responsibility to report any injury incurred during the course of their employment at LFHS on the appropriate forms within 24 hours to their immediate supervisor. In the case of coaching staff, this report must be made to the Athletic Director, Ms. Jill Bruder, who can provide the coach with the appropriate report forms.

2. In case of an acute injury requiring immediate medical attention, the athletic trainers may provide basic care and refer the staff member for follow-up treatment as appropriate. Reporting the injury to the athletic trainers does not relieve the staff member of reporting the injury to their supervisor as stated above.

Treatment By The Athletic Trainers
1. Faculty/staff with athletic-related injuries or conditions, or with injuries or conditions which interfere with their athletic activities, may be evaluated and treated by the athletic trainers, or may receive consultations and treatment recommendations, only with written authorization of the athletic director.

2. If at the initial consultation/evaluation the athletic trainers determine that ongoing treatment is necessary, physician prescription will be required for that treatment to be provided at LFHS.

3. Faculty/staff will be treated by the athletic trainers only when they are not busy treating LFHS student athletes. Students will have priority for use of the athletic training room and equipment, and the athletic trainers’ time.

4. Faculty/staff shall sign in on the Daily Treatment Record, and all treatments rendered by the athletic trainers shall be recorded. By utilizing the services of the athletic trainers the faculty/staff member understands and agrees that all treatment records and evaluation and rehabilitation notes are available to the athletic director and school administration.

Faculty/Staff Member Name_________________
Faculty/Staff Member Signature_________________