Florio Again Spot On

28 Dec

If you have followed for the past few months you will notice a big increase of posts on one journalists offerings: Mike Florio.  He has taken up the “professional” version of what we have been doing for the past 16 months here on The Concussion Blog.  Although Florio was not an initial proponent of the athletic trainer looking down from above, it seems that he has warmed to the idea.

What that move has done is begin the motion of putting independent neurologist on the sideline/stadium for the evaluation process.  Florio has outlined the basic premise as to why it makes the best sense, but in his most recent post he makes the strongest case yet;

Though Dr. Ellenbogen said he believes doctors aren’t going to be “bought and sold” to make team-friendly decisions based on the potential impact on their practices from an affiliation with NFL teams, his reference to the possibility that coaches can influence doctors should raise eyebrows.  Long suspected by many that coaches who peer over the team-hired doctors’ shoulders while the team-hired doctors are evaluating players for possible concussions tend to mudge any close questions toward diagnoses like “dirt on the face,” Ellenbogen’s acknowledgement of that very real human dynamic makes it even more important that independent neurologists be involved in the process.

One thing that Florio does not mention is that in some cases the physician practices actually pay the team for the privilege, for what that is worth.

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10 Responses to “Florio Again Spot On”

  1. Joe Bloggs December 28, 2011 at 11:05 #

    This is not complicated. All teams should have to cashier the current medical and training staffs to the man. All doctors that served on the NFL failed concussion committee should receive a permenent ban from treating NFL playes. All medical groups/hospitals that pay or have paid for sponsorship should be banned from offering NFL medical services for 5 years.

    All teams have major academic medical centers or research centers in the area in which the play. These centers should be paid by the league to administer medical care to the players and continue care in the system after retirement. New York has 9 major academic medical centers, New England has Harvard, Brown and Yale, St. Louis has Wash U., SF has Stanford and UCSF, and so on.

    Best care and life long care for the disabled. Many owners already support many medical centers philanthropically so use it for the benefit of the players.

  2. Dustin Fink December 28, 2011 at 17:49 #

    This is one of the best plans I have seen in a long while Joe!!! If they would only listen to us who aren’t “on the pay roll”…

  3. brokenbrilliant December 29, 2011 at 05:45 #

    Makes sense to me that the folks (owners) who are enriched by the pain and injury inflicted upon the players should assist with helping them live with the aftermath they have helped to create. I do believe the age of believing you can fly in the face of reason and basic cause and effect without any consequences is over. However, I do have one caveat — as a recovering multiple concussion survivor who has been through the wringer trying to find decent neurological help for the after-effects of my numerous mild TBIs — I am wary of the innate trust placed in neurologists, as well as the apparent assumption that they are above corruption. Many “neuros” are actually on the payroll of insurance companies, and you have to be extremely careful who you deal with, because their interests may lean them towards discrediting any claims you may have. If this is the case with insurance companies – and it is – then it can just as easily be the case with pro football teams.

    I have personally dealt with a couple of neurologists — one of them a high-ranking leader at a famous hospital, whose *specialty* is purportedly TBI, who treated me as a hostile, drug-seeking patient (I was neither), when I was just looking for someone with sufficient expertise to help me figure things out. They took me down a line of questioning that had more to do with my emotional well-being and my prior use of drugs and alcohol, than my actual medical history. Another neurologist I dealt with, as I was trying desperately to stop the neurologically induced chaos of my life, again treated me like I was a drug-seeking hostile agent who was trying to get one over on the insurance companies. I was none of the above, and had they deigned to treat me as the individual I was, they might have broadened their view about what’s possible for concussion/TBI survivors.

    Additionally, while it may be great to have independent neurologists consulting for NFL teams, the sad fact is that tons of neurologists know little to nothing about concussion and mild traumatic brain injury. It’s surprising and alarming, how many don’t get it. Even what they do know may be slanted by financial interests.

    If there’s going to be a bona fide doc on the sidelines diagnosing concussions, they need to not only show that they have NO financial ties to any insurance or commercial entity, but also that they have a clue about mild TBI — that hasn’t been gleaned from scanning CDC Heads Up materials for physicians while sipping an umbrella drink on the beach. Concussion can be as much of a blind spot with neurologists, as it is with the general public — maybe even more of one.

    Caveat emptor. For real.

    • Joe Bloggs December 29, 2011 at 06:00 #

      I only know about a half dozen neuros (surgeon, neurologist, psychologist) diagnose and m-TBI. It is important to select young doctors who have been recently trained and have no dog in the fight.

      One of the biggest problems is that because of the behavior of the Department of Defense attempting to characterize war wounds as nothing more than a “ding” or PTSD has led to the believe these injuries are nothing more than a method to fleece the government for disability funds.

      In fact, the injuries are real and because of the negligence of Medcom in screening, tracking and treating these injuries it has created a rerun of Gulf War Syndrome on a geometric scale.

      Expect more obfuscation between the DoD and NHL (other sports leagues) to continue to minimize the severity and long-term consequences of the injury so to minimize their respective financial obligations.

  4. Michael Hopper December 29, 2011 at 14:41 #

    Joe, the problem with your suggestion above is this:

    –Washington University in St. Louis already IS the team physician group for the Rams.

    –Stanford already IS the team physician group for the 49ers.

    • Joe Bloggs December 29, 2011 at 22:11 #

      Not a problem. Fire them and move in other resources. I am surprised both hospitals would risk there reputations with second rate delivery. On the other hand, if these are physcian groups as opposed to the hospitals themselves these units may have been acquired due to the team affiliation delivering patients. So it goes.

  5. Michael Hopper December 29, 2011 at 22:53 #

    Wow. How’s that for lumping everybody together? I’ve met one of the team physicians for the Rams last year. He’s a primary care sports medicine physician with a specific concentration in sports concussions. All of the physicians in the WashU Orthopedics/Sports Medicine Department are faculty members at WashU’s medical school..

    Stanford and the 49ers are undergoing concussion research which required specific permission from the NFL for the researchers to have laptop computers on the sideline.

    There are teams out there working to do the right thing. Yes I realize there are plenty of problems in the NFL, but be careful putting every team in the same basket here…

    • Joe Bloggs December 30, 2011 at 05:52 #

      Perhaps, I did not understand your original comment. I thought your point was that Stanford and WashU were already providing services that were substandard. I have had experience with both hospitals in the real medical world and are world class.

      Let me be explicit, the management of traumatic brain by nearly the entire league since 1994 has been a politicized mess. The parties who played central parts in the mismanagement or followed policies, in the face of scientific evidence, should not be treating players.

      It is time to employ “death penalties.” You screw up and you are gone. If it goes for players, it should go for the medical and training staffs.

  6. Michael Hopper December 30, 2011 at 08:56 #

    “Let me be explicit, the management of traumatic brain by nearly the entire league since 1994 has been a politicized mess. ”

    Then maybe we should start AT THE TOP. If we put it into the hands of the NFL, things won’t get better if in fact the NFL has been screwing it up for 20 years…

    Look, I want changes to be made. But we need to remove those who are messing things up and not just start eliminating groups who are currently providing care simply because they are “currently involved.”

  7. BryanATC December 31, 2011 at 17:41 #

    Well let me give you an example of why the NCAA needs to evaluate it’s procedures as well.

    Watching the Miss St. / Wake Forest Bowl game yesterday, the game kicked off for the second half. WF returned the ball and Miss St. DB Wade Bonner (#7) assisted on the tackle on the WF sideline. At the end of the play Bonner lay on the sideline on his stomach pointed towards the field. For a few moments he didn’t move, then got up gingerly and attempted to run forward. He instead went directly sideways for 5 yards, nearly running over the side judge spotting the ball at the end of the return. The side judge obviously noticed he was not ok and held on to him and turned across the field and motioned for help.

    At this point the camera switches to the WF QB who is doing the college football routine of “Stare at the sideline blindly waiting for the coach to make up his mind about the play call”. Assumed it was taking so long because they were getting Bonner off the field. Wrong, just as WF walked to the line, the same side judge had to hold the game, run to the defensive safety spot where Bonner was lined up for the next play and make the Miss St. staff come get him. Good for the ref for following his responsibility and making him sit out.

    So what happens? You guessed it. Less than a minute later Bonner is back on the field playing. You’d think that the medical staff for Miss St. might take longer than that to do a proper evaluation other than “You, ok?”. A situation where a ref physically stops the game to go ensure a player is actually taken off to be evaluated wouldn’t throw up some flags?

    I understand they can’t see that play clear across the field, but that referee doing what he did (during a nationally televise bowl game none the less) had to indicate something at least.

    Don’t know what the solution is, but there are only 32 NFL teams, there are only so many Colt McCoy incidents that can statistically happen. How many NCAA games are there?

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