The bearded, hundred-million-dollar face of the Red Sox franchise played through much of the 2013 season with an injury he wishes you never heard about. And the thing is, maybe you shouldn't have.
On Opening Day, Dustin Pedroia slid headfirst into first base in the ninth inning of an 8-2 victory at Yankee Stadium. The pain in his left hand was sharp and immediate and an MRI soon revealed that second baseman had a tear of the ulnar collateral ligament (UCL) of his left thumb, a condition also known as Gamekeeper's Thumb1.
Neither Pedroia nor the Red Sox initially acknowledged the thumb injury until late May, when the news was leaked to the press. While the details surrounding the second baseman's injury—and his insistence to play through the pain—were intriguing if not outright endearing to fans, Pedroia was not pleased that the information was made public.
"People shouldn't know if you're 100 percent or not. It is what it is, and it's my responsibility to perform well," Pedroia told the Boston Herald this summer. "My mindset is if I'm nicked up, I have to find other ways to perform. That's the way I think about it. Maybe I'm crazy."
He's not crazy. Professional athletes often have their privacy trampled on in the name of public discourse and the team press release. As a sports fan, I've never once stopped to think that this is strange or unfair. Yet as a physician, I'm familiar with the Health Insurance Portability and Accountability Act (HIPAA), and recognize the importance of the safeguards surrounding patient privacy. But professional teams often create their own HIPAA exemptions through the use of contractual waivers that allow team doctors and trainers to release private medical information to coaches, front office personnel, and owners. The waiver often allows the team to make certain injury information public, which makes many of us uncomfortable.2 Was Pedroia saying he didn't want others to know about his thumb because it was a purely private matter, or because he didn't want opposing pitchers to perceive a chink in his armor? Either way, it appears that the Red Sox were respecting his wishes and not disclosing an injury when perhaps they could have. So how does a team decide what information should be released?
Pedroia's comment underlines how unique his, or any professional athlete's, medical disclosures really are. Which led me to wonder: Does the privacy waiver that allows medical information to be released to the public exploit professional athletes, or is it a necessary part of the game?
Any lawyer will tell you that a celebrity has less of a claim to privacy than the rest of us—just ask A-Rod—but that doesn't really apply to newsworthy medical conditions. Plenty of rich and famous people pass through the hospital where I work, but none of my colleagues would suggest that these people deserve a lower standard of confidentiality—in fact, to the contrary, these patients' electronic medical records are more intensely monitored, and a nurse or physician can be fired for peeping in if they are not directly involved in the patient's care.
Perhaps the issue is the close relationship between injury and job performance. Professional sports are essentially an entertainment industry that fuels merchandise sales, cable deals, websites, fantasy leagues, and—importantly—point spreads. Are we, as fans and customers of this industry, owed information regarding any issues—health-related or otherwise—that could impair the performance of our favorite player or our fantasy team? What about ones we've wagered on? Maybe. At the very least, those are billion-dollar cottage industries predicated on us getting it, so we'll continue to get it.
But when I consider how confidentiality actually plays out in the real world, this assumption gets flung into the ocean. If I take care of a Goldman Sachs executive with migraines—migraines that may, on occasion, impair performance—am I obligated to tell the company about it? And is Goldman then obliged to release this information to its clients? The answer to both is a resounding "NO" because the employee was never faced with signing a waiver. (The SEC does require disclosure, however, in extreme cases where a CEO cannot perform his or her duties for an extended period. How this is handled is often a contentious topic.)
The disconnect between that and this might just be that ailments in professional sports, being mostly orthopedic in nature, are perceived as less sensitive topics for discussion. It certainly feels like less of a violation to talk about a quad strain than it does to discuss a heart problem. While both can impair performance, the former somehow seems less private, a mere technical issue related to the hazards of the job, whereas the latter feels more ominous and confidential. Should that distinction even matter, though?
Then there's the fact that not everything is so benign as a high ankle sprain, or Gamekeeper's Thumb. The Red Sox were clearly trying to protect Pedroia but other players have not been so fortunate. A member of the Philadelphia Eagles once discovered he had a potentially fatal disease after reading about it in a newspaper (he sued the team and won) and players sometimes file grievances against their employer for the way an illness is contracted or handled. So it's not safe to assume that a team always acts in the best interest of its players. As Magary wrote on Thursday, "There is sometimes a fundamental disconnect between what is good for a football team and what is good for a player." Three teammates on the Tampa Bay Buccaneers roster have been infected with Methicillin-resistant Staphylococcus aureas (MRSA) this year. If a fourth becomes infected, can he prevent the team from telling the world that he now harbors a potentially lethal infectious disease?
Fans, fantasy owners, and gamblers are understandably curious who will be on the field on a given day. But while it might make us proud to know that Dustin Pedroia is playing through an injury, it's important to reread his quote and remember that he doesn't necessarily share our satisfaction. Players may be embarrassed or even angry that their injury or infection is no longer a private matter between player and physician or player and team. It's not unreasonable to wonder if the weekly injury report—which was created decades before HIPAA—is an unnecessary airing of confidential medical information.
As a doctor who values patient privacy, I'm troubled by the conflict between commerce and personal rights that often influences the disclosure of athletes' illnesses. Public figures like Dustin Pedroia have a diminished right to privacy in the eyes of the law, but there isn't a truly credible reason for that to extend to medical confidentiality. And yet, here we are.
1The odd condition was initially described in the mid 1950's when an orthopedic surgeon reported chronic laxity of the UCL of the thumb in twenty-four Scottish gamekeepers. The injury occurred as these men, who were responsible for ensuring that there was sufficient game on the countryside for hunting, sacrificed wounded rabbits by breaking their necks between the ground and their thumbs, eventually causing a deformity of the hand ligament. (Scottish thumbs were clearly not the victims here). Today the injury is more frequently seen in skiers and volleyball players, but ballplayers who recklessly slide headfirst on a baseball diamond remain a high-risk population.
2Here's some further reading on the waivers.
Matt McCarthy is an Infectious Disease Fellow at New York-Presbyterian Hospital. You can follow him on Twitter here.