Robert Saunders writes:

I was wondering what your thinking was on the issue of owners' obligations to assess medical problems of their players. Obviously, the most recent baseball death spurs the note, but it's not limited to deaths. Year after year, you read about players who are injured during the season but postpone surgery decisions to the off-season, considering surgery all off-season, then not going through with surgery until after the next season begins. If they had just had the surgery in the first place (or if they had done more comprehensive testing and diagnosis that would lead to a surgery), they might have been ready sooner. I know some surgeries are not 100% effective and may cause other complications, but conditioning exercises apparently are not 100% effective either (though they avoid surgical complications).

Oakland seems to be doing great things by working with the orthopedists in Birmingham to maintain arm mechanics and prevent arm injuries for their staff. I wonder if there will come a time when teams will go beyond the standard physical (e.g., take full body MRIs). Texas apparently did more than the usual once-over of R.A. Dickey--a Tennessee grad who seemed a sure bet for big $ as a high draft pick--when the Rangers discovered he was born without an elbow ligament and used the info against him in negotiations.

I guess that's part of the problem: players have no incentive to reveal health problems because they are hurt financially; and, owners' incentives to discover them are limited because they have to pay for the surgeries (directly or through insurance).

Still, it seems players and owners in all sports could make better judgments about the timing of surgeries and being more aggressive in discovering problems. And they could take a more active interest in policing their players, whether for illegal drugs (Mets) or legal drugs (the ephedra cases), given the investment they're making in the players. But, I guess that's where the Union's opposition and the owners' plantation mentality (players are essentially replaceable) come into play.

Some teams are doing more. Oakland is mentioned above. A good friend from college who is a radiologist has spent time the last two years at the Phillies camp performing ultra-sounds on pitchers elbows and shoulders. His group is developing ways of using ultra-sound to do less invasive surgery to remove bone spurs and fix rotator cuffs. On the other hand, I've heard that the Yankees have a poor conditioning program for their pitchers, which may be one reason Andy Pettitte spends his winters working out with Roger Clemens. And surgery is a tough thing to agree to. I assume players get more than one opinion, and I would hope that these opinions give them probabilities of success. When there are other choices, surgery should be a last resort, since so much can go wrong on the table, even in minor, simple surgeries.

The ultimate responsibility for health lies with the player. It's up to him to make sure that he's not increasing an injury by playing hurt, but also that he's not getting railroaded by a team doctor who might not have his best interest at heart. In the best of all worlds, it would be a cooperative process, but I'm afraid we're a long way from that with most teams.