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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. Boom Boom's Avatar
      Boom Boom -
      On the Span situation... I'm not so much bothered by the medical staff.

      What bothers me is that it took so long to DL Span when there was no logical reason to keep him on the roster. If the Twins really thought he could be back in a couple days, and if they were in position to play meaningful games, I can see how you might hesitate to DL him. None of that has to do with the medical staff but rather with the coaches and Span himself.
    1. Brock Beauchamp's Avatar
      Brock Beauchamp -
      Quote Originally Posted by Boom Boom View Post
      On the Span situation... I'm not so much bothered by the medical staff.

      What bothers me is that it took so long to DL Span when there was no logical reason to keep him on the roster. If the Twins really thought he could be back in a couple days, and if they were in position to play meaningful games, I can see how you might hesitate to DL him. None of that has to do with the medical staff but rather with the coaches and Span himself.
      I have speculated that the Span situation was a front office decision. If you're planning to trade a guy in the offseason, avoiding the DL in favor of sitting him for 8-10 days looks better on paper. After he came back and was injured again (or still had the same injury), they couldn't avoid the DL any longer. Again, this is all just speculation but if you can avoid using the DL to shelve a player you want to trade in ~3 months, it makes sense to just bench him for a week and see what happens.
    1. Boom Boom's Avatar
      Boom Boom -
      Quote Originally Posted by Brock Beauchamp View Post
      Quote Originally Posted by Boom Boom View Post
      On the Span situation... I'm not so much bothered by the medical staff.

      What bothers me is that it took so long to DL Span when there was no logical reason to keep him on the roster. If the Twins really thought he could be back in a couple days, and if they were in position to play meaningful games, I can see how you might hesitate to DL him. None of that has to do with the medical staff but rather with the coaches and Span himself.
      I have speculated that the Span situation was a front office decision. If you're planning to trade a guy in the offseason, avoiding the DL in favor of sitting him for 8-10 days looks better on paper. After he came back and was injured again (or still had the same injury), they couldn't avoid the DL any longer. Again, this is all just speculation but if you can avoid using the DL to shelve a player you want to trade in ~3 months, it makes sense to just bench him for a week and see what happens.
      I really doubt that's the case. Teams aren't usually going to balk from a trade because of a clavicle injury caused by a collision. That's not usually the kind of injury that will chronically reappear.
    1. CDog's Avatar
      CDog -
      Quote Originally Posted by Highabove View Post
      Scott Baker
      On May 8th 2012, B.N. National Baseball editor Rob Neyer wrote about and quoted Baker following his TJ Surgery.

      While
      Scott Baker
      worked through elbow issues over the past two seasons, the Minnesota Twins right-hander heard the whispers both inside and outside Target Field.
      "I knew I wasn't crazy," Baker said Friday. "I knew there was some speculation that maybe I was babying it or taking it easy, but good grief. I did everything I possibly could to get better and to try to pitch with it. But that just wasn't going to happen."
      Baker battled pain in his elbow dating to 2010, and some urged him to try pitching through the pain. He was shut down for the season earlier this month and scheduled for surgery on his flexor pronator tendon. But once his arm was opened up, Dr. David Altchek made the decision that he needed Tommy John surgery to repair the ulnar collateral ligament.


      Of course you "forgot" this (from 1500 ESPN, but I'm fairly certain it was elsewhere, as well). Starting to feel like Groundhog Day. Bolding is mine. ...

      Manager Ron Gardenhire and pitching coach Rick Anderson wanted Baker to cut it loose, provided he was healthy enough to be on the mound.

      In retrospect, it's clear now why Baker was unable to ramp up into the 90's, but when asked if there were any hard feelings between he and the coaching staff Baker said, "None whatsoever."

      "Nobody knows what's going on," he added. "Nobody knows what's going on until you get in there. I didn't know, doctors don't know. The doctors don't know until they get in there. I mean, they can have an indication from an MRI, but what can you do until you get in there? ...

      "To be honest with you, you're not always completely forthright with the staff."
    1. Nick Nelson's Avatar
      Nick Nelson -
      In the Baker example, his elbow was checked by multiple specialists (including the guy that eventually did his surgery) and NOBODY knew what the deal was until they opened him up. This is what I'm talking about when I refer to the complexity of these situations and the mysteries of medicine.

      Anyway, I'm glad that the post has generated some interesting discussion. Certainly there are some strong and legitimate points being made against this team's process when it comes to injuries. I was never denying that. All I'm asking people to do is think about the situation in context, and maybe look at the big picture before throwing out blanket accusations.
    1. BHtwins's Avatar
      BHtwins -
      Rocket, its not that I dont care or dont want to. I dont have time, or rather I'm not going to take the time for a wasted argument to prove something I know exists. Same with the agent thing. It exists and there is enough ancillary evidence to know whats going on. Again, I'm not trying to sway your opinion one way or the other because clearly it doesnt matter.

      People here spend all this wasted energy to prove a negative and I'm not going to do it. I'm not trying to get discovered by ESPN.com for my leet writing ability and I dont care if you dont think my opinion is valid or not. If you don't....then skip it. Theres enough garbage and good stuff here and everywhere on the internet to fit your view and validate your opinion.

      Thats not why I posted it in the first place. I posted to argue the point that A) It hasnt been 2 years. B) Its not just Twins fans.
      If you dont believe that...then skip it. Dont care.

      (This is pure opinion) I have no earthly idea whether the Twins med staff is good or bad or just has had a string of bad luck. I do have enough life experience to know that doctors are not infallible. So my suspicion is that there probably arent a lot different then any other middling MLB franchises medical staff. If results matter though ( and they should) then their track record sucks lately and that isnt opinion thats cold hard fact.
    1. StormJH1's Avatar
      StormJH1 -
      Nick, the gist of your article seems to be that Twins fans think the medical staff are "bad doctors". That is not what the criticism is. I think there's a cultural problem throughout the organization and when we say "medical staff", what we really mean is the interplay between the physicians, the players themselves, Gardenhire, and the front office as to how injuries are appropriately handled.

      I'd imagine that any highly-trained physician is predisposed to diagnose and fix problems as expediently as possible. With a Scott Baker situation, there's a gray area where you just don't how bad the damage is until they cut into his arm. Ultimately, the decision as to whether or not they can go in is Baker's, so maybe HE resisted, at his own expense.

      Reusse believed on the radio that Span's DL immediately before the 40-man roster expansion was meant as a punishment for not properly reporting his issues. I think the physicians and management are often at the mercy of the players to accurately report their symptoms. But I also think that the Twins as a whole perpetuated a culture of encouraging guys to play hurt, and celebrating the guys like Redmond, Punto, Cuddyer, Pavano, etc. who played hurt, even if they did so with terrible results. And to go along with that, the most prominent player on the team (Mauer) had several injury-plagued seasons where he was basically given free reign to let Gardenhire know on very short notice that he wasn't able to go that night. So is it right to punish guys like Span who essentially are doing exactly what it seems the Twins expect them to do, which is to play as much and complain as little as possible?
    1. OldManWinter's Avatar
      OldManWinter -
      Remember the difference between facts and opinions.

      Players, agents, doctors, or therapists remarks are all basically opinions ... especially discussing success of surgical procedures and recovery times.

      It is way too easy to try and convert all of this secondhand information into fact in our minds and the basis for our argument.

      But, we really don't know much more than we have had lots of injuries and not all healed.

      Suspicious people form one conclusion, accepting people another.
    1. one_eyed_jack's Avatar
      one_eyed_jack -
      Quote Originally Posted by thrylos98 View Post
      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
      ---Nice try, but what you're raising here is completely irrelevant..

      Most of the criticisms of the Twins medical staffs here have been based solely on end results of treatment. That is not how ACO pay-for-performance standards work. At all. They don't say "well, the patient died, so the doctor must have done a crappy job." Medical professionals have never been judged that way, and it would be completely senseless to do so. ACO's are looking at trends in how improved practices can lead to better outcomes. It's about best practices, not end results. Sometimes doctors do all that is humanly possible, but the outcome is not the one everyone was hoping for.
    1. Fire Dan Gladden's Avatar
      Fire Dan Gladden -
      As usual, people are trying to make 1+1=7. Take any of the aforementioned injury situations. What do we have:

      -What appears to be questionable decisions made from the Twins organization regarding DL decisions
      -Veiled comments from frustrated ex-players that their injuries were not handled appropriately by the Twins organization
      -No real public responses from the Twins on either item

      Let's see what we don't know:
      -How many doctors were in on the diagnosis?
      -How did the player respond to the initial diagnosis?
      -Did the players follow the directions of the doctors, or go on their own?
      -Were there any setbacks during the healing process?

      I could take this on and on, but you catch my drift.

      Even if we make an assumption the Twins doctors erred in their work, we don't know who they were or if they are still employed with the team, or if changes have been already made in any capacity. All we have to go on is what is publicly reported or unnamed sources providing 2nd or 3rd hand knowledge. Yet many fans here use this as an excuse to call for personnel changes. Typical.

      Let me say this again... We do not know anything about the situation.
    1. USAFChief's Avatar
      USAFChief -
      Quote Originally Posted by Fire Dan Gladden View Post
      I could take this on and on, but you catch my drift.

      Even if we make an assumption the Twins doctors erred in their work, we don't know who they were or if they are still employed with the team, or if changes have been already made in any capacity. All we have to go on is what is publicly reported or unnamed sources providing 2nd or 3rd hand knowledge. Yet many fans here use this as an excuse to call for personnel changes. Typical.

      Let me say this again... We do not know anything about the situation.
      We know more than you imply.

      The Director, Medical Services is Dr John Stuebs. He has been with the Twins since 1986.

      Other Twins orthopedic physicians include Dan Buss (since 1990), Dianne Dahm, and Pierce McCarthy.

      Internal Medicine team physicians: Dr. Vijay Eyunni, Dr. Tom Jetzer, Dr. Amy Stromwell

      Training staff is headed by Dr Rick Aberman. Trainers include Rick McWane and Perry Castellano.

      All this information is publicly available. You can find it, for example, at MLB.com.

      I took the time to look up how long Stuebs and Buss have been with the Twins, but didn't check the others. At the very least, the top of the medical staff has been with the Twins for a long, long time.
    1. TheLeviathan's Avatar
      TheLeviathan -
      I think the Twins and a few key "leaders" on the team being publically frontal about player "toughness" has been a major component of this problem that has often been overlooked. Hard to establish good, honest communication when you call people out to the press for being soft.
    1. Fire Dan Gladden's Avatar
      Fire Dan Gladden -
      You have a list of names posted from the team media guide at the beginning of the year. You don't know what if any changes have been made since then. You don't know what level of authority they have (you can assume, but don't know for sure). You don't know how many 2nd or 3rd opinions were given from outside the organization. You don't know how the chain of command works within the medical portion of the organization.

      I am not saying the medical staff is without fault. I am saying that everybody who wants to replace them doesn't know if they are replacing the "guilty" party. They are taking partial comments, a little fact, and a lot of opion and making broad stroke demands.

      I repeat, we do not know anything about the situation.
    1. USAFChief's Avatar
      USAFChief -
      Quote Originally Posted by Fire Dan Gladden View Post

      I repeat, we do not know anything about the situation.
      No, YOU don't know anything about the situation. WE have learned some things.

      Sticking one's fingers in one's ears and singing "la la la" doesn't mean information wasn't presented.
    1. Brock Beauchamp's Avatar
      Brock Beauchamp -
      Quote Originally Posted by USAFChief View Post
      Quote Originally Posted by Fire Dan Gladden View Post

      I repeat, we do not know anything about the situation.
      No, YOU don't know anything about the situation. WE have learned some things.

      Sticking one's fingers in one's ears and singing "la la la" doesn't mean information wasn't presented.
      Outside of a few names, that information doesn't tell us much of anything. We know the names of people, we still have no information regarding internal policy, who makes certain decisions (training or medical), or who "calls the shots". We don't even know if that information is current.

      Personally, I think it's in the best interest of the organization that JR make some sort of public announcement this offseason. At least let us know they're doing something, even if it isn't a full disclosure of all internal operations regarding the medical and training staff.
    1. Nick Nelson's Avatar
      Nick Nelson -
      Quote Originally Posted by USAFChief View Post
      No, YOU don't know anything about the situation. WE have learned some things.
      Such as? Looking up the names of the people on the team's medical staff doesn't really illuminate anything.

      I guess the quotes from former players are somewhat damning, but I have hard time believing it doesn't happen in other organizations. My understanding is that friction between doctors & players/coaches is fairly common. And even if it's not, I haven't seen one post on this thread where anyone's been able to legitimately pinpoint a consistent source of blame for these medical mishaps.
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