The team physician makes daily decisions on the safe return of a student-athlete to practice or competition, during and following recovery from an injury or illness.

Anyone who works closely with collegiate athletics knows that these medical decisions may have far-reaching effects on athletes and their teams. Can a linebacker return to play in the second half of a football game after suffering a concussion in the first half? When can a soccer player with infectious mono return to conditioning and subsequently competitive soccer? Should a wrestler being treated for a five-day-old herpes lesion be allowed to cover it and compete? When can a basketball player with an elbow ligament injury return to play? Can a swimmer with an eye infection and vision loss swim in this weekend's meet?

The answers to these questions can be complex, and many factors must be figured into the decision. The student-athlete, coaches, parents and administrators all have interests in these decisions, but the team physician is most qualified to make the final determination. The NCAA Sports Medicine Handbook states, "The team physician has the final responsibility to determine when a student-athlete is removed or withheld from participation due to an injury or illness or pregnancy."

Many of these decisions are made simple in that the student is unable to participate due to the injury or illness. Others are based on weighing the risks and benefits of an early return to competition.

Often, the decisions are based on solid research or medical knowledge, but many times the decision is based on limited conclusive research or possibly only the best clinical judgment of the team physician. In any case, the health and safety of the student-athlete must be the primary concern. The importance of the athlete's participation in the eyes of the athlete, coach, or parent must be secondary.

Recently, following input from its Committee on Competitive Safeguards and Medical Aspects of Sports, the NCAA has added new language to all championships handbooks. The new language makes it clear that the team physician or a tournament physician has the authority to make these decisions.

Obviously, the decision to medically disqualify a student-athlete from an NCAA championship can be controversial and contentious.

"The student-athlete's team physician can determine whether an individual with an injury, an illness or other medical condition (for example, skin infection, pregnancy) should continue to participate or is disqualified," the handbooks now state. "In the absence of a team physician, the NCAA tournament physician, as designated by the host school, has the unchallengeable authority to examine the student-athlete and make a decision of continued participation or medical disqualification. The chair of the governing sports committee (or a designated representative) should be responsible for administrative enforcement of the medical judgment if it involves disqualification."

It is the absolute responsibility of the team physician or NCAA tournament physician to make a decision based on the best medical evidence available. Ultimately, however, the welfare of the student-athlete and other competitors must be the primary concern guiding the final decision.

Michael Krauss is head team physician at Purdue University and a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.