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League acknowledges possible influence of coaches on doctors who evaluate concussions

Team personnel pull clumps of grass from Vick's facemask during their NFL football game against the Washington Redskins in Landover, Maryland

Team personnel pull clumps of grass from the facemask of Philadelphia Eagles quarterback Michael Vick (R) during the second half of their NFL football game against the Washington Redskins in Landover, Maryland, October 16, 2011. Also pictured is Philadelphia Eagles head coach Andy Reid (2nd L). REUTERS/Jonathan Ernst (UNITED STATES - Tags: SPORT FOOTBALL)


As the NFL continues to wrestle with the challenge of thoroughly yet efficiently ensuring that players who have suffered concussions are properly diagnosed as having concussions (and are in turn held out of games) and that players who have taken blows to the head but have not suffered concussions aren’t held out of action unreasonably and unnecessarily, the league isn’t content to stop with the recent adjustments that placed an independent, certified athletic trainer at booth level for the purposes of spotting players who need to be evaluated.

Buried in an excellent Associated Press item that focuses primarily on the notion that players remain willing to hide concussion are quotes from Dr. Richard Ellenbogen, the co-chairman of the league’s head, neck, and spine committee, regarding the league’s intention to continue improving the in-game concussion diagnosis process.

“If the real problem is the doctors are being influenced by the coaches, then we’ve got to fix that,” Ellenbogen said. “If the [players’ union] says, ‘We want independent neurologists,’ we’ll discuss that. . . . To be honest with you, we ain’t done. When our committee meets with the team physicians after the Super Bowl, everything’s on the table. You think this is the last rendition of what we do? Heck, no. We’re not done.”

Though Dr. Ellenbogen said he believes doctors aren’t going to be “bought and sold” to make team-friendly decisions based on the potential impact on their practices from an affiliation with NFL teams, his reference to the possibility that coaches can influence doctors should raise eyebrows. Long suspected by many that coaches who peer over the team-hired doctors’ shoulders while the team-hired doctors are evaluating players for possible concussions tend to mudge any close questions toward diagnoses like “dirt on the face,” Ellenbogen’s acknowledgement of that very real human dynamic makes it even more important that independent neurologists be involved in the process. Though, as Charley Casserly of CBS noted on Saturday, some teams believe that the use of independent voices undermines the credibility of a team’s medical staff in the eyes of the team’s players, the league crossed the bell-ringing Rubicon when turning to independent neurologists for the critical question of whether a player who has been diagnosed with a concussion can return to practice or to game action.

Now that the NFL has decided to use independent trainers to help flag the players who need to be evaluated for brain injuries, the use of independent neurologists to do the testing becomes, well, a no-brainer.