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This case study examines the relationship between the “culture of risk” and the negotiation of treatment between sport medicine clinicians and student-athletes at a large Canadian university. The evidence acknowledges that a “culture of risk” was reinforced under certain circumstances during negotiation, but was also tempered by the existence of a “culture of precaution” that worked to resist those influences. The dialectic between the cultures of risk and precaution reveals some of the tensions inherent in negotiations between clinicians and patient-athletes, and helps to complicate the notion of a “culture of risk.” Another aspect (one that has rarely if ever been examined) of the negotiation of treatment is also considered—the promotion of “sensible risks” by clinicians to injured athletes.

Background Return-to-play (RTP) decision-making is required for every injured athlete. However, these decisions often lead to conflict between sport medicine professionals, athletes, coaches and sport associations. This study explores differences in professionals’ opinion about which criteria should be used for RTP decisions, and who is best able to evaluate them. Methods We surveyed Canadian sport medicine physicians, physiotherapists, athletic therapists, chiropractors, massage therapists, athletes, coaches and representatives from three sport associations. The 10 min online survey asked respondents to rate criteria as mandatory to irrelevant on a five-point Likert scale, and to indicate which profession was best able to evaluate the criteria. Results In general, medical doctors, physiotherapists and athletic therapists were considered best able to assess factors related to risk of injury and complications from injury. Each clinician group (except sport massage therapists) generally believed their own profession has the best capacity to evaluate the criteria. Athletes, coaches and sport associations were considered to have the best capacity to assess factors related to competition (desire, psychological and financial impact and loss of competitive standing). There remained considerable heterogeneity both between and within stakeholder groups. Conclusions We found that differences in approach to RTP decisions were generally greater within versus between-stakeholder groups. If shared decision-making is to become the norm in clinical sport medicine, we need to begin a discussion on which discrepancies are due to lack of training (resolved through education) or scientific knowledge (resolved through research) or simply reflect the divergence of personal/societal values.

1. Introduction: The Social Science of Sports Medicine Dominic Malcolm and Parissa Safai Part I: Sports Medicine Conceived 2. The Role of Physiology and Cardiology in the Founding and Early Years of the American College of Sports Medicine Jack W. Berryman 3. From Voluntarism to Specialization: Sports Medicine and the British Association of Sport and Medicine Neil Carter 4. From Rehabilitation Patients to Rehabilitating Athletes: Searching for a History of Sports Medicine for Athletes with Disabilities Fred Mason Part II: Sports Medicine Organized 5. Women Professional Athletes' Injury Care: The Case of Women's Football Joseph A. Kotarba 6. Public Health, Elite Sport and "Risky Behaviours" at the Canada Winter Games Victoria Paraschak 7. The Benefits and Challenges of Complementary and Alternative Medicines for Health-Care in Sport Elizabeth C.J. Pike 8. Challenges to the Implementation of a Rationalized Model of Sports Medicine: An Analysis in the Canadian Context Nancy Theberge Part III: Sports Medicine Practices 9. Docile Bodies or Reflexive Users? On the Individualization of Medical Risk in Sports Lone Friis Thing 10. Sports Medicine, Client Control and the Limits of Professional Autonomy Ivan Waddington 11. Making Compromises in Sports Medicine: An Examination of the Health-Performance Nexus in British Olympic Sports Andrea Scott 12. Sports Physicians and Doping: Medical Ethics and Elite Performance John Hoberman Part IV: Sports and Medicine Contested 13. Doctors Without Degrees Michael Atkinson 14. Pre-Participation Screenings in Sports: A Review of Current Genetic/Non-Genetic Test Strategies Arno Muller 15. Sports Medicine Beyond Therapy: Genetic Doping and Enhancement Yoshitaka Kondo and Mike McNamee

People of South-Asian origin have an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, South Asians are among the least likely people to participate in these programs. Automatic referral increases CR use and may reduce access inequalities. This study qualitatively explored whether CR referral knowledge and access varied among South-Asian patients. Participants were South-Asian cardiac patients receiving treatment at hospitals in Ontario, Canada. Each hospital refers to CR via one of four methods: automatically through paper or electronically, through discussion with allied health professionals (liaison referral), or through referral at the physician's discretion. Data were collected via interviews and analyzed using interpretive-descriptive analysis. Four themes emerged: the importance of predischarge CR discussions with healthcare providers, limited knowledge of CR, ease of the referral process for facilitators of CR attendance, and participants' needs for personal autonomy regarding their decision to attend CR. Liaison referral was perceived to be the most suitable referral method for participants. It facilitated communication between patients and providers, ensuring improved understanding of CR. Automatic referral may not be as well suited to this population because of reduced patient-provider communication.