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  • 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. Fire Dan Gladden's Avatar
      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.
    1. twinswon1991's Avatar
      twinswon1991 -
      Quote Originally Posted by savvyspy View Post
      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
    1. Thrylos's Avatar
      Thrylos -
      Quote Originally Posted by one_eyed_jack View Post
      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.
      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
    1. Nick Nelson's Avatar
      Nick Nelson -
      Quote Originally Posted by BD57 View Post
      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.

      Quote Originally Posted by savvyspy View Post
      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.
    1. Brock Beauchamp's Avatar
      Brock Beauchamp -
      Quote Originally Posted by savvyspy View Post
      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.
    1. JS's Avatar
      JS -
      [QUOTE=Brock Beauchamp;51493]
      Quote Originally Posted by savvyspy View Post
      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.
    1. Jim Crikket's Avatar
      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.
    1. SpiritofVodkaDave's Avatar
      SpiritofVodkaDave -
      As an Orthopedic surgeon, I agree with this thread.
    1. AMR's Avatar
      AMR -
      Quote Originally Posted by Jim Crikket View Post
      the Twins have been a bad team for too long
      It's been about 324 games now. We're spoiled.
    1. Shane Wahl's Avatar
      Shane Wahl -
      So what is exactly "overblown"? Is it too much to say that they appear to have made a number of very erroneous decisions the past two seasons? Maybe that isn't "outrage" but I think being frustrated is a pretty legitimate response to how medical issues have been dealt with.
    1. Fire Dan Gladden's Avatar
      Fire Dan Gladden -
      Quote Originally Posted by Jim Crikket View Post
      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.
      Can anybody tell me with any certaintity that there hasn't already been changes made and these things are still happening? Does anybody know if their has or hasn't been any changes to their medical staff in the last three years? I am not talking about team doctors, but the techs and specialists that are helping to make these decisions? It seems to me that, as usual, too many people are blasting the situation without any clear knowledge of what is going on.
    1. SeanS7921's Avatar
      SeanS7921 -
      This is correct, totally overblown.
    1. Brock Beauchamp's Avatar
      Brock Beauchamp -
      Quote Originally Posted by JS View Post
      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.
      At least with the Johan trade, you can fall back on the stats. I didn't like the players sent from the Mets in trade for Santana. I could back up my belief with graphs, charts, historical comparisons, etc. of each player. I could build a case, based on evidence, that it was not a good idea. I could compare that to the expected performance of Santana in 2008 and the comp picks the team would receive in return. I've watched baseball my entire life. I've spent the better part of my adult life pouring over the finer points of the game. I'm no baseball expert but I know something about the game.

      On the other hand, I've only seen a half dozen episodes of House and I didn't even like the show much. I'm not a doctor. In all likelihood, nobody here is a doctor or even involved enough in the medical profession to do anything except speculate wildly over half-truths and diagnoses not seen by anyone outside of the medical staff and the organization. Hell, we don't even know if anybody has been fired for these perceived issues with the medical staff. We know virtually nothing. In short, there are a hell of a lot of people going off half-cocked about a situation they don't even understand. They don't have the slightest clue how the medical profession works, how the system operates, and whether the Twins are doing anything right or wrong. They see a bunch of injured players and start to lay blame. Are they wrong? I don't know. That's not my point... The point is that they don't know, either.

      And in life, I've generally found that it's best to shut up when you don't know something.

      As fans, we get frustrated. That's expected. We want to see changes when things go badly. That's expected. But there's a big difference between stating "the Twins medical staff is incompetent and needs to be fired, along with the front office" and "damn, I wish this team didn't spend so much time on the DL... what is the problem here?". One is raising an issue and trying to determine if the organization is at fault while the other comes off as heavy-handed and supremely arrogant considering the complexity and nuances of the human body and sports injuries. After all, people spend eight ****ing years getting a degree just to be allowed to diagnose a person. Why don't some of the people in this thread stop to consider that they look like fools when they don their Internet White Coat & Clipboard and pretend that they have the slightest friggin' clue what they're talking about?
    1. jokin's Avatar
      jokin -
      Quote Originally Posted by Fire Dan Gladden View Post
      Quote Originally Posted by Jim Crikket View Post
      Overblown fan outrage? Say it ain't so, Rick.

      "1) 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. 2) 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.
      Can anybody tell me with any certainty that there hasn't already been changes made and these things are still happening? Does anybody know if their has or hasn't been any changes to their medical staff in the last three years? I am not talking about team doctors, but the techs and specialists that are helping to make these decisions? 3) It seems to me that, as usual, too many people are blasting the situation without any clear knowledge of what is going on.
      "1) 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."

      I sense a staff meeting is in order, the topic: "How to avoid the 'Phil Mackey Disaffecting His Readers Effect' when writing articles"

      "2) 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. "

      Let's see that's 6 possible answers, A/B/C/D/F/G....I'll vote for Box H- All of the Above.

      "3) It seems to me that, as usual, too many people are blasting the situation......"

      Despite a strong declarative opening statement from the new GM that the training/medical issues were a top priority, it seems demonstrably obvious to me by their repeated identical blunderings that the people in position to know and do something about the situation are first and foremost the prime suspects who don't, as of yet, have "any clear knowledge of what is going on."

      And yet, to question the situation at this level of knowledge by the common layman is deemed "overblown outrage". Particularly after two seasons of: a peculiar happening, followed by an incidental instance, right after an odd occurence, after multiple players are physically unready to perform at a major league level on opening day, one seemingly innocuous injury after another, from the ridiculous- "bilateral leg weakness" (how was this 2011 epic catastrophe not even casually mentioned in the article?)- to the sublime- the repeatedly aggravating- Will he? Won't he? DL-Dance.

      Silly and absurd characterization from the author about legitimate concerns that have yet to be properly addressed. This doesn't mean "fire everybody", but it sure as heck means complete evaluation and overhaul of procedures and the institution of accountability standards for everyone in the organization-, from the superstar on the field, to the top surgeon, to the masseuse on down to the towel boy.
    1. Montecore's Avatar
      Montecore -
      The bad track record is evidence enough thar the medical staff needs to be shown the door. It's the same with Gardenhire. He doesn't deserve the benefit of the doubt.
    1. TheLeviathan's Avatar
      TheLeviathan -
      The only thing overblown is the thesis of this blog post. Nick did the same thing on the forum a few days ago and it's no less wrong now. This blog pins the argument into two absurd corners - either as staunch defenders of the organization out of medical ignorance or overly critical hyperventilators. Personally, I think the sane response to this issue is largely in-between.

      This is a team that has been carrying 13 pitchers and one of the 12 position players (Butera) is a borderline major-leaguer with limited ability to contribute. When you spend 18 days with one of your other 11 position players in limbo - you're greatly impairing your team. Yes, this team is awful so the cost of this one position this year is minimal. However, bad practice is still bad practice no matter what the quality of the team is. Having a poor season is not an excuse to run your operation ineffectively. It's not "overblowing" anything to be critical of this.

      I don't claim to know exactly what the problem is, but by comparison to other teams in the league it's clear the Twins are not utilizing the DL as effectively as others. It's also clear that their ability to assess and treat injuries is not at the same level as the other teams. There also appears to be an issue with player-medical staff communication. (Not laying fault either direction, probably both are guilty) I don't lump TJS into this because that could jsut be a fluke thing but it certainly adds to the frustrations, warranted or not. Again, I don't claim to know why the problems above are happening. That's for someone with more direct supervision of the team to assess and correct, but it's within my rights as a fan to question and be frustrated with what is now a two year trend.

      It's not "overblowing" anything to be frustrated with the way the team is handling (or lack there of) injuries. It's one of many other things that the team needs to look at improving if they are going to return to contention.
    1. joeboo_22's Avatar
      joeboo_22 -
      Is it the medical staff or is it the front office and gardy? The medical staff I'm sure gives an honest opinion on most cases, though they have seemed to botch a few. Pavano's arm, Kubel's foot last year, Mauer's knee, etc. But over the last year I've seen way too many day-to-day's turn into weeks, and then months. Which makes me think its more the front office then the doctors.

      Lets say its something like this.

      Dr. well its not great, blah blah blah, could use surgery

      TR: well can he pitch through the pain?

      Dr. yeah, the damage is done, if he can pitch through the pain he'll be fine.

      TR: so and so is day to day with arm problems

      Guy tries to pitch through it, struggles, they try rehab, that doesn't work, and then 8-12 weeks later they decide on surgery. Well was the Dr. wrong?

      So I think it might not be 100% medical staff, I think it might be more the front office. I don't care what the Dr. is telling me, if my centerfielder can't take BP 9 days after the injury I'm going to DL him.
    1. Highabove's Avatar
      Highabove -
      Quote Originally Posted by one_eyed_jack View Post
      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.
      Coments by Players who have had issues with their treatment have been documented in the Print and Broadcast Media
      I will give you one regarding J.J. Hardy. Hardy speaking with 1500's Phil Mackey


      • "In spring training I started to feel it and got a little bit nervous, going, 'Oh (expletive), here we go again.' But the trainers worked on it, got rid of it in about a week, and I haven't dealt with it since." Hardy added that the treatment he received from Orioles' trainers was different than what had been tried in Minnesota, but he added, "I don't want to get into that too much and make people look bad, but yeah. It definitely was a little bit different."
    1. Nick Nelson's Avatar
      Nick Nelson -
      Quote Originally Posted by TheLeviathan View Post
      The only thing overblown is the thesis of this blog post. Nick did the same thing on the forum a few days ago and it's no less wrong now. This blog pins the argument into two absurd corners - either as staunch defenders of the organization out of medical ignorance or overly critical hyperventilators. Personally, I think the sane response to this issue is largely in-between.
      Pretty sure my stance was directly in the middle of those two extremes. I'm not pinning anyone in any corner, I'm responding to the (very real) reaction I saw after the Span news dropped last week.

      Quote Originally Posted by The Leviathan View Post
      It's not "overblowing" anything to be frustrated with the way the team is handling (or lack there of) injuries. It's one of many other things that the team needs to look at improving if they are going to return to contention.
      I'm not responding to the frustration over funky injury situations – that's well warranted. I'm frustrated with them too. What I'm responding to is the tendency to immediately blame the medical staff in every situation that pops up without considering the number of variables in play. I see people calling for the entire medical staff to be cleared out... do those people really believe that every single doctor, trainer and med tech under the organization's employ is incompetent? Seems pretty far-fetched. This is a complicated issue and the kind of blanket critiques often being thrown out there simply don't fit.
    1. TheLeviathan's Avatar
      TheLeviathan -
      Quote Originally Posted by Nick Nelson View Post
      This is a complicated issue and the kind of blanket critiques often being thrown out there simply don't fit.
      I'm only seeing the "fire em all" rhetoric from a select few - you used this same "overblown" response to me the other day when I expressed frustration with the handling of the DL. Now apparently that is "well warranted" - I'm not sure you're even clear what you think is being overblown.

      This article (and you can see it in the responses here) makes people think you're painting them into one of those corners.
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