Outsourced rehab splits the medical record in half

Sending a player to an external clinic solves a capacity problem and creates an information problem nobody owns.

He goes to the specialist on Tuesdays. The club sees him the rest of the week. Two sets of notes, two clinical judgements, and one player trying to work out which set of instructions he is supposed to follow.

Outsourcing happens for sound reasons. A club cannot employ every specialism, surgery is always external, and some rehabilitation facilities have equipment no training ground can justify. For a smaller club, buying sessions at an external clinic is far cheaper than hiring another practitioner. It is a straightforward procurement decision and often the right one.

The friction is in the handover. External providers keep their own records under their own obligations, and what returns to the club is a summary, sometimes a phone call, occasionally a delay of several days. Meanwhile the club's own system expects a daily status, because the coach builds a session plan from it. Anyone who has worked in that gap knows the version that ends up on the whiteboard is a compressed guess.

It gets more tangled when the external opinion is commissioned by someone else entirely. A player unhappy with a club's assessment can seek his own, funded by his agent or an insurer, and now there are three files. In a contract year the incentives around those files diverge sharply, and the person holding the injury is also the person least equipped to referee a disagreement between professionals.

The commercial layer deserves a mention. Some clinics have partnership arrangements with clubs, discounted or free in exchange for association with the badge. The care is usually fine. The governance is not, because a supplier who is also a sponsor is a supplier nobody wants to criticise.

What I would require is dull and would fix most of it. A single shared record for each injury episode, controlled by the player, written to by every provider involved, portable when he transfers. The technology is trivial. The obstacle is that nobody wants to be the party responsible for the file.

Continuity of care is the thing that actually determines outcomes, and in this industry it is currently maintained by whoever happens to be conscientious that week.