Major League Baseball and the second opinion

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.”

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.”

This article originally appeared on the Sports Doc blog of Philly.com Health. Read more about Sports Medicine and Fitness