Doctors have gotten much better at diagnosing and treating sports-related concussions, which is a good thing since Americans suffer up to 4 million sports-related concussions a year.
But we're not so good at is following their advice.
Student athletes and parents sometimes balk at doctors' recommendations to avoid play until concussion symptoms are gone, or to cut back on schoolwork. Both have been shown to speed recovery, and getting another hit on a vulnerable brain increases the risk of long-term problems.
Doctors shouldn't wimp out, according to a position paper released Wednesday by the American Academy of Neurology.
"Sometimes what will happen is that an athlete will come to you and they'll be a few days out from their concussion," says Dr. Matthew Kirschen, a pediatric neurologist at Children's Hospital of Philadelphia and lead author of the committee that wrote the position statement, which was published in Neurology.
"They'll be a few days out from their concussion, and they'll still be symptomatic. They'll still have deficits on their neurocognitive testing," Kirschen told Shots. "And they'll say, 'Yes but I really want to play. There's a big game Saturday. There will be a recruiter there.' And the parents say they're OK with them playing.
Other times, parents will worry about damaging a child's chance for an athletic scholarship, though the paper delicately hints that those scholarships might not be as generous as parents expect.
"The physician has to sit back and say, 'The risks are too great. You can't go back in,' " Kirschen says.
Educating parents, students and coaches on concussion treatment will help make that easier, the doctors conclude, and that's starting to happen, thanks to laws in all 50 states that require concussion education and removal from play.
But doctors are stuck, Kirschen says, if they can't talk with schools or coaches about a child's injury due to health privacy laws.
They would like patients and parents to sign waivers that would let doctors share that information. But those aren't in wide use now.
That's one ethical conundrum the neurologists wrestled with. Another is whether a patient's right to autonomy trumps the doctor's responsibility to protect the patient from harm.
They acknowledged patient autonomy as a fundamental right, Kirschen says, but "the ultimate priority needs to be protecting the health and well being of their athlete patients."