Thursday, December 25, 2014

Major League Baseball and the second opinion

An update is expected on Roy Halladay's condition today, following Tuesday's visit with Dr. Lewis Yocum in California.

Major League Baseball and the second opinion

Roy Halladay should have learned from last year that any kind of discomfort should be disclosed. (Michael Perez/AP)
Roy Halladay should have learned from last year that any kind of discomfort should be disclosed. (Michael Perez/AP)

The Phillies expect to have some information about the particulars and the severity of Roy Halladay’s shoulder injury sometime today. The ace right-hander admitted to feeling discomfort in his shoulder after Sunday’s start against the Miami Marlins, and spent yesterday visiting with Dr. Lewis Yocum in California.

Phillies team physician and Sports Doc panelist Michael Ciccotti, M.D., says he doesn’t take it personally when a player asks to get a second opinion on an injury. In fact, he encourages the practice, and does everything in his power to ensure the player receives the best possible opinion.

“After an injury, the physician thoroughly evaluates the player—as with any patient,” says Dr. Ciccotti. “We ask how the injury happened, where they feel pain, when does it hurt. You gather a history, and do a full examination.”

Next is obtaining appropriate imaging. Many MLB stadiums—Citizens Bank Park included—have x-ray equipment onsite. If needed, the physician will discuss the need for an MRI with the injured player. “Once you have the results, you can develop a possible or tentative diagnosis,” he summarizes. “Then you discuss treatments and recovery periods.”

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In Major League Baseball, the utilization of second opinions is so common that Dr. Ciccotti has a list of physicians across the country who are available for such inquiries. Many MLB team physicians, including Dr. Ciccotti, appear on this list.

“These doctors have the appropriate medical and orthopedic background with elite athletes to allow them to give a meaningful second opinion,” says Dr. Ciccotti.

Typically, the player or his agent will request the second opinion. “I’m very open to second opinions,” says Dr. Ciccotti. “I know these physicians will give very meaningful, helpful input. By communicating and openly discussing the options with the players, I can ensure that they are going to someone who is truly an expert in the particular issue or problem.”

From there, Dr. Ciccotti works in conjunction with the agent to arrange the appointment. He is also available to give injury background to the physician offering the second opinion. “Not to sway their evaluation,” he clarifies, “but just to give them all the pertinent information.”

After the examination, the physician offering the second opinion will inform the player that he’s going to share his observations with Dr. Ciccotti. “With the Phillies, the players are very willing,” adds Dr. Ciccotti. “They know I have their best interests at heart, and that I will be involved with their ongoing care.”

This open discussion regularly yields the ultimate decision on treatment—operative or non-operative. The final decision is left to the player.

“Sometimes they decide immediately, sometimes they take a few days. But once we’re all in agreement, the treatment can begin.”

Dr. Ciccotti stresses there’s no ego involved in the second opinion process. His focus is on ensuring that the player receives the most qualified, through opinion available in order to yield the optimal approach to his particular injury.

“I’m very confident in our ability to take care of any of these injuries right here in Philadelphia,” he clarifies. “But I realize that professional athletes are different than they were 30 years ago. Back then, they were drafted into an organization and for the most part stayed there for their entire careers. With players moving from one team to another, they have injury histories and established relationships with other doctors. I respect and encourage that; but I also encourage the athletes to include me in the decision-making process.”

“There’s a very open line of communication,” he summarizes. “It’s about doing what’s best for the player, and if a second opinion is best, I’m happy to guide them in the right direction.”


Read more Sports Doc for Sports Medicine and Fitness.

Robert Senior Event coverage, Sports Doc contributor
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Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Martin J. Kelley, PT, DPT, OCS Advanced Clinician at Penn Therapy and Fitness, Good Shepherd Penn Partners
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Health Producer,
Tracey Romero Sports Medicine Editor,
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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