What a World Series MVP taught me about practicing medicine

Summer, 1998
Three Rivers Stadium
Pittsburgh, Pennsylvania

It was a typical Saturday morning on call. We’d finished rounds and I’d taken the sign-out from the resident who’d worked the night before. I headed to the library, planning to do some board prep before the inevitable beeper call to the ER or ICU. I was a PGY-4 neurosurgery resident, with many previous weekends on duty to my credit. No reason to think this one would be any different.

When the pager beeped I read the message and was very surprised.

The operator connected me to my chairman, Dr. Joe Maroon. He wasn’t the attending physician that day, so when I saw his name on my pager I swallowed hard.

Am I in some kind of trouble?

“Good morning Lee,” he said, “You like baseball, right?”

Dr. Maroon was the team doctor for the Pittsburgh Pirates, and he’d been asked to see a player from the visiting team whose neck was hurting. In a moment of great kindness (one of dozens he’s extended to me over the years), Dr. Maroon thought I might want to go with him to the stadium and meet the players.

What Dr. Maroon didn’t know was that the other team’s manager was my all-time baseball hero, a former World Series MVP. I had every one of his baseball cards, and even his jersey when I was a kid. We entered the locker room in Three Rivers and there stood my boyhood idol, wearing only his jock strap.

It wasn’t the way I’d envisioned meeting him, but hey, dreams and reality seldom match up, right?

Then we met him, the Reds’ general manager, several trainers, and the injured outfielder. Dr. Maroon examined the young man, and began to discuss the problem with the manger and the others.

The player turned to me and asked if I wanted him to show me around the locker room. I said, “Don’t you want to discuss your injury with Dr. Maroon?”

“Nah,” he said, “I’ve got no say in whether I play or not. I just do what they tell me.”

Over the next half hour, I listened as my chairman and my baseball hero argued about the player’s future.

The conversation went something like this.

Dr. M: “He shouldn’t play until his pain is better.”

Team personnel: “We could rest him tonight, but we have to have him for Atlanta.”

And so forth.

It became clear to me that the team’s concerns were not chiefly, or even significantly related to the player’s long-term health. It was a business discussion, a team decision, a money problem. They needed to win, and the player’s health was only one small variable in their equation.

Fast-forward almost twenty years to my office. My patient waits in an exam room while I discuss her neck pain with her insurer. I’m trying to get her approved for an MRI scan, and I’m doing a so-called peer-to-peer review on the phone. Except my, uhm, peer is not a neurosurgeon. Not an orthopedic spine surgeon. In fact, he’s not any kind of surgeon. He’s a nuclear medicine specialist, retired.

We battle for a while, and ultimately he denies my request. He ignores all the reasons why I, a board-certified neurosurgeon, think that this particular patient should not have to go through eight weeks of physical therapy before the MRI. She’s weak, she’s dropping things, she’s got muscle atrophy.

He says the evidence-based guidelines do not support early imaging here. I can appeal it if I want; a decision would take sixty to ninety days.

Meanwhile, the patient waits, rubbing her neck and wondering if she gets to play her normal life again, or if she has to sit out, getting weaker, waiting for a test that may never be approved or an operation that could restore her to normal health.

She thinks to herself, “I’ve got no say in whether I play or not. I just do what they tell me.”

W. Lee Warren is a neurosurgeon who blogs at his self-titled site, W. Lee Warren, MD.  He is the author of A Peek Under the Hood: A Brain Surgeon Looks at Life, Called Out: A Brain Surgeon Goes to War, and the upcoming book, No Place to Hide: A Brain Surgeon’s Long Journey Home from the Iraq War

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  • Suzi Q 38

    This appears to be a frustrating way to practice medicine.
    I have PPO insurance, so while I battle occasionally with my insurer, they seem to respond by giving me what my doctor and/or I think I need.
    I have had my doctor tell me that his request was denied.
    When this happens, I ask for the name of phone number who denied it and place a phone call that lasts quite some time. I describe my troubling nerve symptoms. Then I tell h/her that what I have read in the medical literature (articles from Up to Date) that these sensations, pain, and numbness could be permanent and the result of waiting could be paralysis.
    I take their name and number and then ask for h/her manager. I do the same with the manager.
    I tell them I will appeal their decision to deny me care when I have dutifully paid my premiums for over 20 years.
    I also tell them that if I have to get a lawyer to send them a letter, I will.
    Sad to pull the “lawyer card,” but sometimes that is the only “language” insurance companies know.

  • http://www.drleewarren.com W. Lee Warren, MD

    It wasn’t the outfielder; it was the manager. He was the MVP in 1986. Thanks for the comment.

    • K L

      Sorry about that. Speed reading missed that detail, so I read the article again. By the way, after spending time with one of those “peers” on the phone (who I always imagine is making these decisions while sitting on a beach), they told me that the trend is for making it easier for specialists to get approval for expensive testing. I have found that to be true.

      • http://www.drleewarren.com W. Lee Warren, MD

        Not true here. Everything is getting harder. Even things like epidural injections, etc. are being denied as ‘unnecessary’ unless your patient ha gone through the flow chart. Thanks for the comments.

    • Patient Kit

      I was initially mystified too about which player you were talking about because I misread as (regular season) MVP. But now that I notice you are talking World Series MVP, I realize you must be talking about Ray Knight, who was a NY Met in 1986. I hate health insurance companies but love baseball. I prefer my surgeons to have the personality and skill of Mariano Rivera. ;-)

      • http://www.drleewarren.com W. Lee Warren, MD

        Right you are. Glad you enjoyed the article. You might like my website, http://www.wleewarrenmd.com
        Have a great day.

  • Dzydvl

    I couldn’t agree more with the comments I’m reading. In my case I seem to be more informed than I should with my own care. I be sure to research everything, and I’m informed on the various medications that may or may no be used, but this seems to scare DR’s especially if it involves any sort of pain situation. I may not have MD after my name, or be a board certified surgeon, but I have one thing going for me that they don’t. I can tell them what is going on with MY body, I can detail what I’m feeling at any given time. They can’t say the same thing. this is what frustrates me even more about insurance. How is it they can come in a decide what’s the best treatment for me, when they haven’t even met me, or my DR for that matter.
    At some point the madness has to stop. I just hope it happens before our health care system is completely destroyed by the politicians.

  • 1775concord

    As a neurosurgeon, my patient-concern ways made me an enemy of insurance companies (and also substandard care hospitals). One line I used (didn’t always work): Please let me have your name. I need to note your rejection of care for my patient in case he gets worse and wants to sue for malpractice.
    We tried, in the 1990s and early 2000s, to get a law passed that would have made the companies responsible in the event of bad outcomes caused by them, but were unsuccessful.