The Similarities Between Medicine and Baseball

As an avid baseball fan, I have watched the transition of baseball over the past three decades. Growing up in the 80s, I remember baseball greats such as Nolan Ryan, Dwight Gooden and Roger Clemens. These players were work horses and would not be taken out of a game until their arm fell off. It was unusual if they were taken out of a game before the 8^th or 9^th inning. In those days, pitch count was not even discussed. At age 42, Nolan Ryan threw 164 pitches in a game in 1989. [[{"type":"media","view_mode":"media_crop","fid":"25354","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5704520165454","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2311","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"line-height: 1.538em; height: 118px; width: 100px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

During the 1990s and 2000s, baseball teams placed more scrutiny on pitch counts and limited pitchers to around 100 pitches per game. The restrictions created a need for specialty/relief pitchers, as many starting pitchers would not be able to finish a game or even pitch into the 7^th, 8^th or 9^th innings. It is not uncommon today that a starting pitcher may only pitch until the 5^th or 6^th inning before being taken out. This, in turn, created the sub-specialization of baseball. The specialty players were also introduced for position players when managers wanted to substitute a slow player on the base path or as a defensive switch in the outfield at the end of a game. 

The changes in medicine mirror the changes in baseball. Growing up, I remember my family physician would see everyone in my family including my mom, dad and sisters. He would see a wide range of ailments including an upper respiratory infection, broken bones, rash…you name it. He would follow my mom for her diabetes and my dad for his hypertension. It was very rare for my family doc to send me or my family members to a specialist.  When I would see him, I was impressed with his memory about me. He would ask me about my personal life, such as the sports I played, as well as how my cough was doing.

Today’s healthcare is much different than it was. Last week, my mother-in-law had a doctor’s appointment for a general checkup. She used to see a physician at her practice but now the practice has a policy that patients with Medicare must see a nurse practitioner. The evaluation with the nurse practitioner was for about 30 minutes, but not much came out of it other than three referrals for specialists to evaluate her knee pain, back pain and thyroid. My mother-in-law is a healthy senior so I cannot imagine how many referrals are given to sicker individuals. 

The primary care physician is similar to a starting pitcher in baseball. Decades ago, the primary care physician would do the bulk of patient evaluation, management and treatment, similar to how starting pitchers would pitch almost the entire game. Now, specialists are playing a greater role in healthcare, just as relief pitchers are pitching more innings in a baseball game.

Although many innovations have occurred in medicine for diagnosis and treatment of diseases, I feel that the primary care physician must play a more vital role in health care to reduce the fragmentation that currently exists between medical providers. Hopefully, information technology advances will also help reduce the fragmentation of healthcare. It will be interesting to see if the pendulum will swing back in the next decade with a greater role of primary care physicians given the Accountable Care Act and the emphasis on cost sharing.