Note: Concussions have received enormous media scrutiny in recent months. The post below describes a very public, but unfortunately not unusual, disagreement about letting an athlete continue to play after a concussion. I recently did an interview with Brenda Rindge of The Post and Courier about concussions in sports and protecting these athletes.

Texas Christian University team physician Dr. Samuel Haraldson recently issued a statement downplaying an argument between himself and TCU head football coach Gary Patterson about the treatment of an injured player. The statement comes after an article appeared in American Medical News, which is published by the American Medical Association. In the article, Haraldson describes evaluating TCU star running back Ed Wesley after a concussion that occurred during TCU’s September 24 game against SMU. The article quoted Haraldson claiming that he was “accosted” by Patterson several minutes after he had held Wesley out of the game. Haraldson now claims that the dispute, which was reportedly seen on television, arose from a lack of communication.

“He was knocked unconscious, and any loss of consciousness is automatically considered a concussion,” said Dr. Haraldson. “He had an unsteady gait and a few memory problems. Then five or six plays later, I literally was verbally accosted by the coach, screaming at me insanely at the top of his lungs that he doesn’t think [Wesley] has a concussion and what right do I have to hold him out,” Dr. Haraldson said, according to On the day after the game, ESPN Dallas reported that Patterson said, “As far as I’m concerned [Wesley] was fine 10 minutes after he was hurt.”
Now I obviously don’t know the exact circumstances, as I am not the physician for TCU, nor do I have direct knowledge of the discussion. That said, I think both the interview and the subsequent statement about the alleged controversy bring up important points about team physicians and player safety.

First and foremost, athlete safety is the most important consideration. Being a team doctor, especially for college and professional teams, brings a lot of notoriety, but there is also pressure on the physicians. In the current sports climate, getting scholarships, gaining media attention, and securing lucrative contracts and endorsement deals often affect decisions made regarding high-level athletes. More frequently though, winning is the main consideration. Coaches, players, and fans just want to win. The problem comes when trying to win the game conflicts with the decision to allow an athlete to play.

In this case, a physician decided to hold a player out due to a concussion. Due to increased research about the long-term effects of concussions and intense media scrutiny regarding these injuries, physicians and sports’ governing bodies are adopting stricter guidelines regarding return to play after concussions. In the past, doctors used to hold a player out for at least 15 minutes after a concussion to assess the injury and see if the symptoms completely resolved. Now most doctors are holding players out for the rest of the game for any degree of head injury. Fear of a catastrophic head injury due to a second blow to the head when the player has not fully recovered from the initial head injury has been the driving force.

In this case, the physician decided that the player could not return to the game after his head injury. It does seem as if there was a lack of communication between him and the coach. I’ve always felt that the physician must adequately communicate to the training staff and coaching staff the status of the player and his injury. The physician’s job is to decide if the player is capable of doing his or her job on the field and whether or not he or she can cause further injury. The physician must then adequately explain the decision to the player and coaching staff so that everyone involved agrees with the decision, whether it be to allow the player to return or not. Having said that, asking a player to return to the game in order to help the team win, when the player has not fully recovered from an injury, is not appropriate. The team physician has to be an advocate for the safety of the athlete.