Otolaryngologists Discuss Keys to Treating Top Athletes

For James Kearney, MD, an interaction with professional athletes began as it does for most people: with passion, but from a distance. In 1974, the Philadelphia Flyers, his hometown hockey team, won the Stanley Cup, sparking city-wide euphoria.

“One of my enduring childhood memories was going out in front of my house when the Flyers won the Stanley Cup … and cars were beeping, people were jubilant,” Dr. Kearney said. “It was the first championship in Philadelphia in a long, long time, and the entire city had rallied behind the Flyers, who are a gritty bunch of players that Philadelphia could really identify with. From then on, I was a hockey fan.”

Now, Dr. Kearney, chairman of otorhinolaryngology at Pennsylvania Hospital of the University of Pennsylvania Health System, treats members of the Flyers team for otolaryngology conditions. As a physician, his interaction with the world-class athletes is much different than the connection he had with them when he was young. In the exam room, he’s no longer at a distance. He’s close up.

When it comes to being a fan, though, Dr. Kearney stays relatively dispassionate. A friendly remark about a recent game might be OK, but autograph seeking is not. Otolaryngologists who treat professional athletes say that, while they are aware of the stakes that are involved, a crucial part of the job is treating professional athletes as they would other people—as patients first.

They also emphasize availability and, when necessary, discretion. “You can’t let the celebrity aspect of it overwhelm your willingness to take care of this individual as a human being who needed your help as a physician and not as somebody who is a public figure,” said Dr. Kearney, who also provided care for the Philadelphia Eagles football team for two decades until 2018. “You need to treat them as real human beings.”

Medical Conditions

In terms of the care provided, there is a lot of overlap between professional athletes and other patients, otolaryngologists say. While a hockey or basketball player might be more likely than an average patient to come in with a laceration or a facial bone fracture, otolaryngologists typically see conditions that are run-of-the-mill—from sinus infections to chronic tonsillitis to earwax build-up.

“Most of the injuries or problems I see in these patients are not something that is an injury or a condition unique to a professional athlete,” said Christopher Larsen, MD, associate professor of general otolaryngology at the University of Kansas, who provides care for the Kansas City Royals baseball team and Kansas City Chiefs football team. “It’s more common conditions that every human being gets; it just so happens that it’s occurring in a professional athlete.” For these conditions, athletes receive the same treatment as most other patients would, otolaryngologists say.

Dr. Larsen said he screens baseball players for oral cancer, provides antihistamines for allergies, chooses topical steroid spray or surgery for swollen turbinates, and performs routine sinus, nasal, and throat surgeries on players who fail maximal medical management.

Many football players, and some baseball players, struggle with snoring and obstructive sleep apnea (OSA), which interrupts sleep and can have a big effect on focus and performance, he said. But in his experience, professional athletes struggle just as much with adherence to and tolerance of continuous positive airway pressure (CPAP) for OSA as other patients do.

During spring training, some players on the Royals team develop nosebleeds because they are unaccustomed to the dryness of the Arizona desert air, he said.

Pro athletes frequently need custom-made protective masks so that they can continue to play while facial injuries heal, and at Detroit’s Henry Ford Health System, some of their faces are pre-scanned so that the 3D printing process for the masks can be started right away, said Lamont Jones, MD, MBA, vice chair of otolaryngology, head and neck surgery at the Henry Ford, who treats members of the Detroit Pistons basketball team, Detroit Lions football team, and Detroit Tigers baseball team.

Pressure to Perform

With players being paid millions of dollars to perform on the field, otolaryngologists acknowledge there can be at least implicit pressure to get players back on the field quickly, although not nearly as much as orthopedic surgeons face in treating injuries such as, say, Achilles tendon tears or knee injuries. But they say they have to stay mindful of their obligation to the health of the person in front of them.

“As physicians, the key to remember is the patient is your first priority and then, as long as you remember that, you do what’s best for the patient and counsel them appropriately,” Dr. Larsen said. “Should they choose to do something outside of your guidelines or your recommendation, it’s only going to potentially be fraught with complications or problems…. What I know for a fact working with the Kansas City Royals is that it’s a team approach. The athletic trainers, physical therapists, physicians, and surgeons really work together as a team, and there’s constant communication, because at the end of the day, the investment is in the player and their future. Bringing them back too soon, or rushing them back to the field, is not always going to be in their best long-term interest.”

Sometimes, there can be conflicts of interest for a physician. “Somebody else is paying [the athletes] a lot of money to perform, and every time they are injured, they are not performing,” Dr. Kearney said. “And that is an issue for the team; it can be a competitive issue, it can be a financial issue. So there can be some conflicts of interest that come in particularly for physicians who are being
compensated by the team…. There can be a conflict in that they are being paid by the team that wants the athlete back on the field, but your obligation to the athlete is to provide what is best for them.”

While most otolaryngologists downplay the pressures they feel taking care of these athletes, they say there is a certain amount of pressure performing surgery on a player. “You treat every patient the same, and to say differently I don’t think is right,” Dr. Larsen said. “The flip side to that is, sure, you’re a little extra amped up that morning.”

Dr. Jones said surgeries are the most difficult scenarios he faces when treating pro athletes or celebrities. “In general, we want good outcomes, and sometimes if you have a high-profile player, it’s not that you would do anything differently, but the potential for, let’s say, good or bad publicity just magnifies itself,” he said. “In the era of social media, it’s easy for a routine or non-routine outcome to really be publicized.”

Privacy

The goal of a good outcome remains the same regardless of the public profile of the patient, but physicians say their centers do take steps to shield players from unwanted attention. Henry Ford  employs a concierge who coordinates care among physicians, the player, and the team, Dr. Jones said. Sometimes, he said, players are able to enter at a different location than the general public. Sometimes, he goes to see them rather than having them come to the medical center. “It depends on the person,” Dr. Jones said. “Some players are escorted; they may come in through a back entrance. For some of the players, I’ve actually gone to the sports arenas to evaluate them.”

Dr. Kearney said professional athletes coming to see him are typically not forced to stay in the main waiting area. “They are susceptible to their illnesses becoming public spectacle,” he said. “So if they’re coming into your office to be seen, if you keep them waiting out in your waiting area, it can be awkward for the athlete. People will wind up coming up to them, asking [them] to sign autographs or asking questions about why they’re seeing the doctor, things that people would not normally do to another patient. … I have always tried to go out of my way to help to preserve these athletes’ privacy.”

Professionalism and Availability

With time, otolaryngologists said it gets easier to regard the dynamic with a pro athlete as a typical physician–patient relationship, without worrying that inclinations as a fan will get in the way. Any references to their performance, they say, should be only for the purpose of rapport, much as they might converse with any other patient.

After a seven-foot-tall basketball player had a nasal bone fracture, Dr. Jones kidded him that he might have avoided the injury if only he had stood up tall and hadn’t had to bend down all that distance to pick the basketball up off the court. And, after a high draft pick in football had an unfavorable outing in his Eagles debut and got booed on his home field, Dr. Kearney good-naturedly told him, “Welcome to Philly.”

In the end, though, it’s professionalism that should guide the way, they say.

An indispensable ingredient in taking care of pro athletes is being available when they need care, they say. Usually, they can treat the player when needed. But if not, they find someone who can. “The nice thing about being in a large group practice is that we have redundancy,” said Dr. Jones at Henry Ford. “So, if for some reason I’m not available, there’s usually somebody available who can address the issue.”

“When I was in medical school, an otolaryngologist told me the three keys to success are availability, affability, and ability—in that order,” Dr. Larsen said. “And at the end of the day, even before I was associated with the Royals or any professional sports players, I would try to always be available for my patients and try to see as many people as I possibly could in a day while taking good care of them. And I think applying that philosophy … goes a long way with patients.”

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Thomas Collins is a freelance medical writer based in Florida.