The Team in the Care of the Athlete


The author would like to thank Bill Polian of ESPN and former General Manager/President of Indianapolis Colts, Carolina Panthers, and Buffalo Bills of the NFL; Dave Hammer, ATC, current Head Athletic Trainer Indianapolis Colts; Mark Bartelstein, owner and president of Priority Sports Agency Chicago, IL; Gordon Hayward, former Brownsburg, IN Bulldog, former Butler University Bulldog, former Utah Jazz, current Boston Celtic NBA basketball player; Robert (Bob) Anderson , MD, past president of AOFAS, PFATS; Jerry “hawk” Ray, NFL team physician, award winner, and orthopedic foot and ankle consultant to NFL and NBA; and lastly, thank you to one of our elite athlete patient’s parent, Luan Peszek! Thank you to my family and medical staff who supported me and proof read much of my work!

When we set out to be a team physician or to take care of the athlete with foot and ankle problems, it is a noble deed. However, it is important to remember, we are just one part of the TEAM that takes care of the athlete. We play a critical role both diagnostically and therapeutically, but we cannot misunderstand our role, misplace where we fit in the care, or in any way minimize the role so many others have in the care of the athlete.

From a distance, it can appear glamorous to be involved in the care of some of the greatest athletic specimens who have ever walked this earth. It can be incredibly rewarding to be a part of a great outcome and see the results literally played out on a field or court right before you and the world. There is so much at stake for the player and his/her team, owner, and administration. However, I always remember what my mentor for my Masters and PhD in Exercise and Sports Performance Physiology, David L. Costill, PhD, told me, “You will likely be remembered more for the mistakes you make than the successes you enjoy!” We are supposed to be successful, but when an outcome is not so great (and we all have them), increasingly the media and fans react harshly and unsympathetically.

Just like most facets of medicine, taking care of the athlete is a lot more about work, tireless and selfless service, and not so much about glamour! That’s okay. We still get plenty of moments when an athlete will say to us, “Thanks, Doc, for keeping my wheels a-turning, so I could do all I wanted to do!” That really is reward enough. Put all the marketing, recognition, fame, and fortune aside, and the personal involvement we get to have in the lives of these amazing athletes, more importantly, these amazing people and families, is why we chose this field to begin with.

I have thought a lot about all we present in this book regarding the science, studies, innovation, and analysis that we do, all so that individuals can have a better outcome and have a “normal” life (even when “normal” can mean trying to help an athlete get back to a level only experienced by less than 1% of the population). I thought it only appropriate that we take a little interlude and talk just a bit about HOW we care for and about the athlete. This is my feeble attempt to discuss our role and how consultants team physicians interact in the care of the athlete. I have chosen to go to those we actually serve and provide care for in this endeavor. The remainder of the chapter is taken from interviews I conducted with an athletic trainer, general manager, agent, professional player, colleague, and a generous parent. I have interjected stories and anecdotes that I personally have experience that support and give example to the points made by the kind folks I interviewed. So please understand some of what you read is a bit editorialized by me, and I think it will be obvious to you what are my examples and what are the key words enlightening our understanding from the contributors. I hope you enjoy it and can agree with much of it, or at least be challenged by their thoughts, concerns, and needs.

Bill Polian (Former NFL General Manager and Executive)

Competence: The doctor has to be good! He or she must be right most of the time! Specifically, these are athletes, and it’s not enough just to know about their foot and ankle condition from an orthopedic standpoint; we have to know the sports medicine context. In its unique demands and contexts, sport creates extreme demands on the same structures, causing them to be affected differently. The sports medicine physician and health care provider need experience and understanding of what goes on for that specific athlete, realizing that each athlete and position is different. I remember when a ballet dancer came to our clinic for a lateral ankle sprain. She was diagnosed appropriately, given appropriate guidance regarding the natural history, was explained the anatomy of the injury, and was sent to physical therapy where she was given a large bulky brace and told to come back in a month if it wasn’t better. She went home and was in tears. She had a performance in 3 weeks, which was before her next visit with her doctor to clear her to dance. She cried as she put on the brace the first and only time as she saw clearly she could not dance “in that thing!” Now, our approach is different. We get our dancers in with a physical therapist who is a former dancer, use a low-profile support for the ankle, start them on Barre work immediately, see them back every 1 to 2 weeks to ensure they are clear and safe to dance, and work directly with the therapist to follow their recovery.

Honesty: How bad is it? What is the prognosis? How quickly can the team count on the player? What does the future hold? We can’t just be optimistic. We need to explain the worst-case scenario and the realistic outline on how to plan for this week, next week, and the weeks to come! These are the questions the team asks and wants to know about. The need for prognosis and timetable is critical both at the recreational, collegiate, and professional levels. Not only are we setting practical expectations for the athlete and the team, but by giving an honest prognosis, we are giving the staff and administration time to logistically change their program if necessary. The next man or woman up needs clarity so he or she has time to prepare, while the coaching staff and management need time for roster adjustments, if needed. The list goes on and on, which is why honesty is essential to building a strong “team” and reliable approach. There was a time when one of our physicians had to tell a player that his spine condition would not allow him (the player) to safely continue to play his collision sport. Mr. Polian mentioned how impressed and thankful he was with how the physician handled the honesty of the situation but with empathy and compassion ( Fig. 32.1 ).

Fig. 32.1, Bill Polian.

Neutrality: We can’t just be a fan. Though we love cheering for our teams or players, we must remain objective when treating athletes. We have to be able to keep a level of detachment from the desire to see our patients “get back quickly” and do what is best for their long-term good. Essentially, we should have passion for the athlete, not for the score. We are physicians, surgeons, and health care professionals, not coaches, owners, or even just fans. Our professionalism and skills are tools that allow us to perform in the best interest of the athlete. Usually everyone can tell when our interests are divided, which sets us up for failure. A distrust can form between us and the patient/athlete if they feel we have our own agenda. They need to know that our number-one priority is their well-being and not the name on the front of their jersey or the boost in our name or recognition

Empathy: Can you understand the significance to the athlete? Can you see the situation as they see it? It is easy to just see a problem when dealing with any medical issue, leading to the mind set of “that part is broken, and it’s my job to fix it.” Though that mindset is technically not wrong, the situation is so much more involved and delicate than that. When athletes end up in our offices, they have just experienced something that has the potential to change the trajectory of their entire career path and possibly their long-term health. They will be worried about the next step, stressed about wanting to return to play, and they may even be scared. Not only is it our job to treat their physical needs, but we must also treat the needs/fears/concerns that x-rays and magnetic resonance imaging (MRI) do not show. To do that, we must empathize with them. We need to be able to understand what this means for the athlete and the additional stresses/concerns/worries that come along with injuries. They are not just a fractured foot or a sprained ankle, so we should not see ourselves as just a technician there to fix an injured part. We need to remember that every injured foot, ankle, or toe is attached to a real human being.

Selfless : It not about the “doc,” it’s about the athlete. The proliferation of interest in the health of competitors and players, and its impact on play and entertainment, is astounding! Getting your name in the paper for treating a well-known athlete can seem almost dreamy, but it can turn into a nightmare when “things go a bit wrong.” Again, this is another area where reminding ourselves of the importance of our professional relationship is critical. The athlete came to us for medical care, the team is counting on us to give the highest quality of care. Marketing of ourselves, at a minimum, plants a seed of self-interest but can lead to a deterioration of the entire patient–physician relationship.

Communication: Check your pride at the door. Communication is not about which “team member” gets all the glory; it’s about upholding the highest ideals of collaboration and treatment. So, get the language right and do it in a way that works. Speak a common language and develop a communication method that works for all involved. If communication is lacking the first few times, do not just give up, but work at understanding a common language for whomever you’re communicating. Be creative; analogies can help the non-athlete a great deal. For example, an osteochondral lesion (OCL) of the talus can be analogous to a pot-hole in the road. We all (especially those of us in the Midwest!) have experienced the bumpy ride our vehicle takes over an uneven surface or pot-hole. An athlete or parent can understand better how an OCL might cause pain or inflammation from this perspective. Talk to others on the team and see what will help them understand better. Do not fall victim to communicating in a silo (speaking in a way only a medical professional can understand). Poor communication only leads to confusion and less than ideal outcomes. Additionally, encourage the athlete to ask questions, not only so they feel integral in his or her own care, but so you may truly understand the issue at hand. This is especially important when delivering the “your career is over” message. First, we need to make sure this is the best decision for all involved and we are doing right by everyone. Then, we must make sure our message is delivered in a clear and compassionate way. Again, we must remain neutral from an allegiance standpoint and focus on the well-being of the athlete.

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