• Outrage Over Medical Staff is Overblown

    Last week, Denard Span finally landed on the disabled list one day before rosters expanded and 18 days after initially suffering a shoulder injury back in early August. Not the medical staff's finest hour, probably, but the uproar I saw amongst casual fans and hardcores alike sort of left me dumbfounded.

    My Twitter timeline exploded with rants against the team doctors. Commenters here at Twins Daily vented in similar fashion. Clearly folks are fed up with the strange injury situations that continue to arise with this club. That's understandable. Still, I'm wondering if we haven't reached a point where people are jumping the gun a bit to crucify the medical staff for every mishap.

    Here's a fact: medicine is an inexact science.

    Here's another: the members of the Twins' medical staff are highly trained experts who have reached an elite level in their profession. Most of them have been around for more than the past two years, yet the implication seems to be that since the start of 2011 they've just forgotten how to properly diagnose injuries.

    The truth is that this staff made mistakes before 2011 as does every other staff in the league and they went largely unnoticed because the Twins weren't one of the worst teams in baseball. My sense is that the higher incidence of injuries in the past two years and the club's struggles overall are causing a lot of people to exaggerate the role of the medical staff in lingering ailments and goofy DL management. It wouldn't be a unique case.

    As an example, let's look at this latest situation with Span. The fact that it took the doctors so long to properly diagnose his sprained sternoclavicular joint is concerning, but the outfielder didn't make their jobs easier by backing out of an MRI due to claustrophobia. Additionally, we simply don't know whether the Twins would have shown the same patience and deference to Span if the games actually mattered and they were legitimately hurting themselves by tying up that 25th roster spot. They weren't.

    Sure, there have been examples where the team's medical staff has pretty clearly erred. Those extend back past 2011. Like I said, it's an inexact science. But frustration seems to have some people believing that we're dealing with a bunch of quacks who have completely lost the ability to competently do their jobs, all while the numerous execs running the organization have failed to notice or care.

    Pretty ridiculous notion born out of a scapegoat mentality, if you ask me.

    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.

    Maybe after this season ends the front office will clear out the entire medical staff and bring in new faces across the board. I'd say that's unlikely, and I doubt it would meaningfully resolve any of the real problems plaguing this organization.
    This article was originally published in blog: Outrage Over Medical Staff is Overblown started by Nick Nelson
    Comments 76 Comments
    1. J-Dog Dungan's Avatar
      J-Dog Dungan -
      Well said, sir!
    1. twinswon1991's Avatar
      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.
    1. Highabove's Avatar
      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.
    1. Mave's Avatar
      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?
    1. one_eyed_jack's Avatar
      one_eyed_jack -
      Quote Originally Posted by Highabove View Post
      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.
    1. AMR's Avatar
      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.
    1. Mave's Avatar
      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.
    1. old nurse's Avatar
      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.
    1. Mave's Avatar
      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 14th 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.
    1. OldManWinter's Avatar
      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.
    1. nicksaviking's Avatar
      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.
    1. NoCal's Avatar
      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.......
    1. clutterheart's Avatar
      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.
    1. Highabove's Avatar
      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.
    1. BD57's Avatar
      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"?
    1. JB_Iowa's Avatar
      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.
    1. savvyspy's Avatar
      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.
    1. Don't Feed the Greed Guy's Avatar
      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 [QUOTE][/
      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!
    1. one_eyed_jack's Avatar
      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.
    1. stringer bell's Avatar
      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.
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