By Jonathan M. Marron and Paul C. McLean
One of us is a sports fan, childhood cancer doctor, and bioethicist. The other is a former sportswriter drawn to medical ethics since the cure of his only child. If sports and ethics have something in common, it’s the value of a level playing field. Fairness matters. There’s a coin toss: heads or tails. Fairness, not favoritism.
We view the doctor-patient relationship through slightly different lenses, but it’s precious either way. It’s a relationship — above all else — built on trust. And that relationship, a cornerstone of healthcare, is suddenly like an already vulnerable person facing an uncertain prognosis. If the doctor-patient relationship is to survive the novel coronavirus (COVID-19) pandemic, it will require a unified team, trust, and a level playing field, regardless of how much money or influence you have.
What does sports have to do with this?
An early inflection point in public awareness about COVID-19 was when professional basketball player Rudy Gobert tested positive for coronavirus. This quickly led to cancelling the remainder of the basketball season and was a sign to many that this was more than just “another flu.” Shortly after, it was reported that professional basketball players, many symptom-free, were tested. At a time when many are hearing from their doctors that almost no tests are available, it can only inspire distrust to see how easy it can be for those with means.
There are many troubling aspects of the player testing. They’re among the least likely to fall victim to the most severe effects of COVID-19; they are strong, young, healthy, and wealthy enough to afford it when their league cancelled the rest of the season. This is not the case for many patients with symptoms and known exposures coming to clinics and emergency departments. Clinicians cannot test many of these patients because of a severe shortage of testing kits. The argument that testing of professional athletes was performed through private companies (and therefore doesn’t represent them having preferential access) doesn’t hold water either, since neither clinicians nor the public can readily access testing, even through these companies.
The government’s mishandling of this crisis is worthy of blame for the shortage in testing supplies, but who has access to testing is a very different question.
One reason social distancing has become vital to the effort to slow and limit the spread of COVID-19 is because testing has been so lacking. So how can testing be readily available to certain celebrities? Why have they been privileged in this way? How could someone of lesser privilege and access NOT see this as proof that their lives don’t matter as much and that the system doesn’t care about them?
These inequities could have ramifications far after COVID-19 is eradicated, as those who couldn’t get tested (but saw those with money and influence do so easily) will not soon forget. Memory of this mistreatment will follow them into their relationship with the healthcare system, perhaps for years to come. We run the risk of this being yet another item on the list of times we have failed our most vulnerable, leading to further systemic — but understandable — distrust in the medical system.
One of us is from Chicago originally, the other from Los Angeles. Now we’re both in Boston. All big-time sports towns, and all with world-class medical institutions in the process of becoming overwhelmed by COVID-19.
It’s worth remembering that NBA legend Magic Johnson profoundly changed public attitudes about HIV when he was diagnosed and retired in 1991. Perhaps the news of Rudy Gobert and then Kevin Durant testing positive for COVID-19 may be seen in a similar light someday: for having helped the public take the coronavirus pandemic seriously.
But as public concern has grown, availability and accessibility of testing has not followed suit. In response to questions about inequitable access to COVID-19 testing, President Trump said: “Perhaps that’s been the story of life.” This may be among the only truths he has uttered regarding coronavirus, but just because this has too often been the “American Way” doesn’t mean that it should persist now under the most dire of circumstances. We MUST do better.
No pro basketball team has been more successful over the last decade than the Golden State Warriors, a team that laudably choose not to arrange special coronavirus tests for its players. “We’re not better than anybody, not worse,” said the team’s director of basketball operations, Bob Myers. “Just a basketball team.”
Maybe fairness and equity will always be more aspirational than real. But at some point, games will return and coronavirus will be gone, survived by its impact on doctors, patients, and (mis)trust.
And the doctor-patient relationship?
It’s a coin toss.
Jonathan M. Marron MD MPH is a pediatric oncologist, researcher, and bioethicist at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and the Harvard Medical School Center for Bioethics. @JonMarronMD
Paul C. McLean is an author, parent, and Ethics Associate at Boston Children’s Hospital. @PaulCMcLean