Article: Outrage Over Medical Staff is Overblown

[Nick Nelson]

You can view the page at http://www.twinsdaily.com/content.php?999-Outrage-Over-Medical-Staff-is-Overblown

[J-Dog Dungan]

Well said, sir!

[twinswon1991]

I respectfully disagree. The med staff was so bad that TR singled them out as a major area that needed improvement when he took the job. Since then, Baker, Pavano, and several minor leaguers have been harmed or ruined due to misdiagnosis.

 

The deal with Span and others is Ryan's inability to understand the DL rule which is something that won't improve until he is replaced.

[Highabove]

It's the continuing pattern which is the cause for concern.

Nick, are you in the Medical Profession ?

If so, I will give more weight to your comments.

[Mave]

I knew I would agree with the content of this article from simply by reading the title alone. I agree with both of your 'facts' listed above, and I know that other conversations on this site have cited other reasons why it is so hard for a medical staff to get it right 100% of the time. The past two years have been tough as a fan, with a significant amount of payroll and production sidelined for extended amounts of time.

 

I agree that when businesses are dealing with employees as expensive as professional athletes, that they will employ the best in the medical profession to ensure their investments are taken care of. It has simply been hard to watch a large portion of our productivity and payroll sidelined, especially when these are still young men who were coming off productive years on successful teams-- and we as a fan base were looking forward to years of success with a healthy, productive ans successful core.

 

Nonetheless, no two human bodies are alike, and not even the best of medical staff can be completely prepared to deal with the consequences of how demanding the game can be on even the fittest of athletes. The given track record of success, as mentioned above and then the contrast of the past two years has been tough. But how much of that is the ebb and flow of the game? How much of that is truly a reflection of the medical staff?

[one_eyed_jack]

It's the continuing pattern which is the cause for concern.

Nick, are you in the Medical Profession ?

If so, I will give more weight to your comments.

 

----Did you actually read what Nick wrote?

 

To be clear, I'm not saying that the Twins' medical staff compares well to the rest of the league. They might even be among the worst. But I don't believe we have the evidence to make that assessment. Judging a doctor's performance isn't like judging a pitcher, or hitter, or manager, or GM. Each situation is unique and there are lot more factors in play than some would assume.

 

These comments need not come from a medical expert to be given weight.

 

I read him to be pointing out that the constant railing on the medical staff is coming from people who have neither the knowledge nor expertise to make educated evaluations of their performance, which unlike judging a player, is infinitely more complex than just making conclusions based on outcomes.

[AMR]

Three Seasons ago, Rany Jazayerli wrote a screed about the Royals Medical staff. That staff was sacked in the offseason. I'd say the Twins' staff could have just as much complaint written about them, and I'd say it dates back to at least Rondell White's days with the team.

[Mave]

I read him to be pointing out that the constant railing on the medical staff is coming from people who have neither the knowledge nor expertise to make educated evaluations of their performance, which unlike judging a player, is infinitely more complex than just making conclusions based on outcomes.

 

Word.

[old nurse]

Every human body is a unique thing. If the medical profession were as straightforward as auto mechanics the complaints against the staff would have more validity. Are the players being honest with the medical staff? Are they doing what they are told to do? Is the medical staff equipped with all of the technology they need? Are the training/monitoring regimes up to date? There is a thing called differential diagnosis. Are the medical staff directed to go with the least severe differential first? All these questions have answers that are not available to the fan. When teams are winning, the fan doesn't care. When they lose, it becomes an excuse or a reason for the fan to blame someone for the losing.

[Mave]

Thank you, old nurse, I think that was perfectly put. Taken directly from Dr. Jazayerli's article:

 

"I have long hesitated to wade into a discussion about the team’s medical staff, because as a physician myself I’m paranoid that someone might use my credentials inappropriately in this discussion.So let me be clear: in advocating for Swartz’s dismissal, I am not speaking as some sort of expert witness. I do not have access to any of the players’ medical records, and am not basing my opinion on some sort of medical expertise. I am arguing as a fan, and using the evidence that is available to all fans – the results on the field."

 

After that, I felt a little uneasy as I continued reading the rest of that article, especially reading about Mike Aviles because of the point you raised above-- are the players being honest with the medical staff? This was a young man fresh off of a 4th place finish on the ROY ballot and 5 pretty darn respectable years in the Royal's farm system. Dr. J continues, "Mike Aviles, after hitting .325 as a rookie last year, hits just .194 with one homer in his first 32 games this season, before finally coming clean on May 14^th and admitting that his forearm was bothering him."

 

I don't know, the article just didn't sit well with me (for what it's worth). And I think that the blame on the Twins medical staff is, as mentioned above, a reactionary excuse to poor performance on the field and the production/payroll sitting on the shelf.

[OldManWinter]

People jump to conclusions over a whole lot of things we have no way of knowing. Without all of that missing information any conlusion we make is inaccurate.

 

I have had three rotator cuff surgeries, two in the last 18 months. The oldest of the last two has not healed to allow a full range of motion despite best efforts of surgeon and therapist.

 

They will not heal evenly because they are all different. No one can predict or guarantee any result. It is not an exact science, the result will vary.

 

We do not have enough information to make educated guesses about their competence.

 

Updated Today at 09:31 PM by OldManWinter

 

Comment repeated from the blog.

[nicksaviking]

Perhaps the medical staff has only made moderate mistakes, or perhaps just league average mistakes. If this is true, than Ryan, Gardenhire and anyone else making personel decisions based on the uncertain injuries are hangin the medical staff out to dry.

 

There is no rule that you need a firm diagnosis to place a player on the DL. Either the medical staff is not giving useful enough preliminary findings to the decision makers, or the decision makers are too indecisive to make a decision without a complete and accurate diagnosis.

 

Bottom line is, it didn't matter what was wrong with Span, SOMEONE should have had the foresight to have said, he's going on the DL seeing as he can't play now and this team is out of contention anyway.

[NoCal]

A couple of observations.

- Span came back and played a couple of games; the last play he made was a long throw from centerfield to third base, catching a runner advancing on a fly ball. Could he have aggravated the earlier injury? If so, is it not logical that he might be deemed disabled at that point, more so than with the earlier, perhaps less severe, injury?

- These players make lots of money. Most probably have personal trainers and other members of their entourage who contribute to keeping the player on the field. And an agent, who most definitely has a say on whether the player goes on the disabled list or not. The medical staff does not have total authority on these decisions.

- Looking over the Collateral Damage section of Baseball Prospectus: the Twins injury rate is not exceptional, as measured by players on the disabled list. Excellent organizations like Washington and Texas have had far more injuries. That's life. And probably outside of our ability to evaluate.......

[clutterheart]

In isolation, all incidents appear to be isolated. As a whole the pattern appears pretty damning for the medical staff.

 

I do not see other teams wait so long to put players on the DL. Quick google searches show me nothing of past players ripping the medical staff like Hardy and Osterbrook did. I so see many players who try and hide injuries, but other team's Dr's seem to figure it out.

 

Its a tough thing to measure because its so subjective, but in this case there does appear to be something fundamentally wrong with the way the team is diagnosing injuries, understanding the injury timeline and rehab.

[Highabove]

Pavano, Baker, Hardey, Kubel, Neshek and Mauer, have all criticized the way their injury's were handled.

That should set off some alarm bells.

[BD57]

I'm not so concerned about DL management. It's important, yes, but I can't see how it's really cost us the past two years.

 

My concern? We seem to have a lot of pitcher's arms blowing up & it seems we manage them all the same .... wait a while hoping to avoid surgery, doesn't work & now our guy's out for two years.

 

Obviously, surgery's a big deal. Obviously, we'd like to avoid it. BUT ... if there was a decent chance of avoiding surgery, wouldn't we be somewhere closer to 50/50 on "turns out surgery wasn't necessary"?

[JB_Iowa]

I was not one of the people screaming about the medical staff last week -- as I recall I made some comment about "art" and "science"; however, the medical issues and DL use are puzzling to me.

 

BUT more than that, I'm concerned that even in what will be another 90+ loss season, fault FOR ANYTHING doesn't seem to get assigned. Terry Ryan makes the token "I accept responsibility" statement -- but what does that mean? It looks like this organization just rolls merrily along.

 

We'll see at the end of the season but for now, all I see is stagnation. And that is not a good harbinger for next season.

[savvyspy]

I disagree. Scouting is an in exact science too yet the Twins are worse at it than almost every team. Pitching is an Inexact science yet the Twins are historically bad. This medical staff as botched almost every arm injury at every level of the organization. You DO NOT see this in other organizations. To chalk up continued failure of this team to address injuries and misuse of the DL process to basically chance makes no sense.

[Don't Feed the Greed Guy]

Hey all,

 

I am hesitant to weigh in on medical matters. File it under the old axiom: "He who is his own doctor has a fool for a patient." Two things might sway my argument toward changes in the medical staff--and they may be the only factors that might steer Twins managment too:

 

1) Concern from the medical/sports medicine community, like Dr. Jazayerli's assessment of the Kansas City situation (see above).

 

2) Documented concern from present/former players. "Highabove" writes

[/

Pavano, Baker, Hardey, Kubel and Mauer, have all criticized the way their injury's were handled.

That should set off some alarm bells.

QUOTE]

There needs to be some documentation/confirmation here, but those are the two points that would get my attention: 1) documented concern from the medical/sports medincine community, and 2) documented concern from present and former players.

 

Until then, medical diagnosis is a rather complex matter, especially when players are funtioning under a whole host of countervailing influences, such as protecting their playing time, long-term value, and their competitive desire to be on the field every day. How do you sort all that out from the bleachers? It's one thing to be a Monday Morning Quarterback, I don't want to be a Monday Morning Quack.

 

Let's see what happens this offseason. My hunch is that there will be some turnover in the training room.

 

Enjoy the Labor Day!

[one_eyed_jack]

It would be interesting to see some actual quotes from these players. Were they openly critical about the medical staff? Or were they just expressing frustration about not being able to get back on the field sooner, which is being interpreted as a critique of the medical staff?

 

Either way, I don't know that it conclusively proves anything. The players are the recipients of the treatment, so they know a lot more that anyone here about what the medical staff actually does. But they don't have the expertise, so even if they are critical of the medical staff, it doesn't mean those criticisms are valid. Players have different goals than doctors, so some tension there is inevitable.

[stringer bell]

I think it is impossible for laymen to judge what the doctors are doing. What seems to be beyond doubt is that the players, the team and the medical staff are not all on the same page. The players want to protect their careers, first and foremost, but they also want to play. They don't report small injuries and aches and pains because they don't want to get benched and they don't want to be considered malingerers. The most common scenario is an injury goes unreported until the player's performance suffers. The team wants their valuable assets to perform, but they want them long term. The medical staff wants to do what is right for the player, but they are employed by the team.

 

 

The three components need to communicate and get on the same page.

[Fire Dan Gladden]

The same people that are leaping to conclusions about the medical staff are leaping to conclusions about how these situations are handled on other teams. Nobody here can tell me how the Mets handle theirs or the Mariners or virtually any other team. Until somebody comes up with an exhaustive study on what is reported, whether or not they end up on the DL, and follow up, the "it doesn;t happen anywhere else" argment needs to stop.

 

I too am concerned about how the DL is used, but considering the team has had a huge rash of injuries and DL usage over the last 2+ years, with lttle in the way of help from the minors, I can understand their trepidation.

 

Also, players can can be as much to blame here as the doctors. If they aren'y up front about the injury, or the severety, it can be harder to diagnose.

 

Finally, all the players complaining about the Twins med staff are ex-players, except for Pavano, who will not pitch another game for this team. Could easily be sour grapes. Easy to blame somebody who will not respond in the public environment.

[twinswon1991]

I disagree. Scouting is an in exact science too yet the Twins are worse at it than almost every team. Pitching is an Inexact science yet the Twins are historically bad. This medical staff as botched almost every arm injury at every level of the organization. You DO NOT see this in other organizations. To chalk up continued failure of this team to address injuries and misuse of the DL process to basically chance makes no sense.

 

x100

[Thrylos]

It's the continuing pattern which is the cause for concern.

Nick, are you in the Medical Profession ?

If so, I will give more weight to your comments.

 

----Did you actually read what Nick wrote?

 

To be clear, I'm not saying that the Twins' medical staff compares well to the rest of the league. They might even be among the worst. But I don't believe we have the evidence to make that assessment. Judging a doctor's performance isn't like judging a pitcher, or hitter, or manager, or GM. Each situation is unique and there are lot more factors in play than some would assume.

 

These comments need not come from a medical expert to be given weight.

 

I read him to be pointing out that the constant railing on the medical staff is coming from people who have neither the knowledge nor expertise to make educated evaluations of their performance, which unlike judging a player, is infinitely more complex than just making conclusions based on outcomes.

 

This sentence is actually pretty incorrect... Medical performance has always been judged based on outcomes, and in probably 2-3 years (some pilots are up and running now - google: ACO), most doctors will be "paid for performance" (where "performance" is mostly outcomes.)

 

As far as the Twins' situation goes, there are a lot of issues, including the doctors; but players and especially management have to take some of the blame for the waiting for Godot to go to the DL... Missdiagnosis, is another story

[Nick Nelson]

My concern? We seem to have a lot of pitcher's arms blowing up & it seems we manage them all the same .... wait a while hoping to avoid surgery, doesn't work & now our guy's out for two years.

 

Obviously, surgery's a big deal. Obviously, we'd like to avoid it. BUT ... if there was a decent chance of avoiding surgery, wouldn't we be somewhere closer to 50/50 on "turns out surgery wasn't necessary"?

 

This is a common gripe, but I would suggest that it's less unusual than you think. Elbow injuries are extraordinarily common across the league and surgery is always considered a last resort. Most teams will prescribe rest & rehab before TJ, not just the Twins.

 

This medical staff as botched almost every arm injury at every level of the organization. You DO NOT see this in other organizations.

 

Please elaborate, keeping in mind the points mentioned above.

[Brock Beauchamp]

I disagree. Scouting is an in exact science too yet the Twins are worse at it than almost every team. Pitching is an Inexact science yet the Twins are historically bad. This medical staff as botched almost every arm injury at every level of the organization. You DO NOT see this in other organizations. To chalk up continued failure of this team to address injuries and misuse of the DL process to basically chance makes no sense.

 

The Royals have sent a half dozen of their prospects to have TJS in the past year.

 

I don't believe the medical staff is doing a good job. That's not my point nor do I believe it to be Nick's point. It's easy to sit on your couch and "diagnose" maladies, especially when using the rearview mirror. It's even easier when you don't have the slightest clue what you're talking about (is anyone here qualified enough to make even the smallest statement about the medical treatment of athletes?).

 

No one is arguing that the medical staff is doing a good job. From the outside, it looks pretty bad to a layman. But remember that last word, layman.

 

People need to stop pretending that they have the slightest clue what is going on behind closed doors and they need to stop pretending that they have the medical knowledge to properly understand if someone is doing a bad job in the first place. I want to see the medical situation "fixed" as much as anyone but I'm also smart (and honest) enough to know that I don't have the slightest friggin' clue what I'm talking about.

[JS]

People need to stop pretending that they have the slightest clue what is going on behind closed doors and they need to stop pretending that they have the medical knowledge to properly understand if someone is doing a bad job in the first place. I want to see the medical situation "fixed" as much as anyone but I'm also smart (and honest) enough to know that I don't have the slightest friggin' clue what I'm talking about.

 

This completely sums up my issues with far too many commenters on this site. People come in to threads spitting vitriol about how much they screwed up this injury situation or this trade or this draft. For me, this goes all the way back to the Johan trade, since that was around when I started getting into Twins blogs (Gleeman). So many were up in arms because we didn't trade him for Ellsbury and Lester and whoever else, never minding the fact that the Red Sox never offered that package. Yes, the return on Johan was very underwhelming, but for all we know, it was the best offer available. Yes, the injury situation is very frustrating, but for all we know, we've been snakebit and any other team with the same players would've suffered the same fate.

[Jim Crikket]

Overblown fan outrage? Say it ain't so, Rick.

 

Face it, the success of Twins Daily is, at least to a degree, the direct result of overblown outrage on the part of Twins fans these days about one issue or another.

 

JB_Iowa's comments are pretty on the money. I admit I have no clue whether medical/training staff are doing a good job in a tough situation or are botching things. Similarly, I don't know whether successive 90+ loss seasons are due to bad managing, coaching, scouting, general managing, overly frugal ownership or just poor player performances.

 

As a fan, I do know the Twins have been a bad team for too long and the results on the field, in much of the farm system, and in the training room have not been good. It also just seems far too simplistic to say it was all Bill Smith's fault and since he was reassigned, the Twins have installed a culture of accountability.

 

I'm not giving up on Terry Ryan because I don't think you can fix everything in one year. That said, although I'm not an expert on running a ballclub, I would like to see some evidence on the part of those in charge of the Twins (who certainly should be experts) that they are actively identifying areas that need improvement and are holding those in charge of those areas accountable.

[DaveW]

As an Orthopedic surgeon, I agree with this thread.

[AMR]

the Twins have been a bad team for too long

It's been about 324 games now. We're spoiled.