Reliance Management in Healthcare for Professional and Elite Athletes: Ethics, Patient-Centered Care, and Governance

Professional and elite sport represents a high-pressure healthcare environment in which standard principles of patient-centered care, confidentiality, informed consent, shared decision-making, and clinical independence are tested by organizational and performance-related pressures. This narrative review examines reliance management in athlete-physician relationships. Reliance is conceptually distinguished from trust: whereas trust is an interpersonal attitude that can be betrayed, reliance denotes the broader dependence of the athlete-patient on the physician, the care process, and the surrounding governance system-a dependence that may persist even where trust is absent. Reliance management is conceptualized as the deliberate, multi-level design and maintenance of communicative, ethical, and governance conditions under which such reliance is well-placed. A structured, non-systematic literature search of PubMed, Scopus, Web of Science, SPORTDiscus, and Google Scholar, supplemented by backward citation tracking, informed a thematic synthesis organized around three dimensions: clinical ethics, patient-centered care, and governance. The synthesis distinguishes empirical findings, professional consensus guidance, ethical and legal analysis, and illustrative cases, and identifies domains in which evidence remains weak. An integrative conceptual model is proposed that links governance antecedents at the dyadic, clinical, organizational, and system levels to mechanisms of well-placed reliance and to outcomes that require empirical evaluation. Proposed safeguards-independent medical oversight, documented return-to-play pathways, formal data-sharing rules, second-opinion access, and contractual protection of physician autonomy-are intended to protect patient-centered care and patient safety; their effectiveness has, however, rarely been evaluated and should be the object of future intervention research.