but we're not going to keep everyone long, but I do think it's worthwhile to have this panel come up here. And first of all, this is more of a collective kind of situation. We're all in similar situations. So if anyone has anything they'd like to share or any questions for the panel, I definitely want to open it up. Thanks, David. We'll get everyone seated and then definitely. Yeah, thank you all. That was really, really interesting. Amy, we have an interesting problem, which is that we also are bound by HIPAA and privacy. So when we're, if we are, you know, God forbid faced with a crisis, how do we navigate the HIPAA issue? I mean, it's a challenge and there you are going to be hamstrung and not able to directly rebut certain things, but thinking about who can speak about your character, who can speak about the care that you give. So maybe, you know, a player comes out and says, you know, that you messed up his shoulder. Can you, are there other players that can come and speak on your behalf? Is there a piece that could be put into your local newspaper and op-ed, you know, speaking about the virtues of you as a physician. So just thinking about sort of creative ways that to push back without literally pushing back on the specific player or patient or whoever it is that's coming after you. So Amy, just a follow up. And when we're looking at things using now kind of looking at media or social media in a positive way, can you give us kind of some pearls on how we may be able to use things like, you know, Twitter, Instagram responsibly, and then maybe some of the pitfalls, things to avoid? Yeah, I mean, what I would think about is also using LinkedIn. LinkedIn is a great platform for thought leaders. And every person in this room is a thought leader in their area of expertise. And so whether you're posting an article you think is interesting, writing something yourself, I mean, that will help you get, you know, followers and help establish you and your voice. And then it can carry over to Twitter, where you can then, you know, tweet out those stories and look for stories, you know, stories in the news that you wanna push out or other ways you wanna be seen as a thought leader and an expert in your area. You know, Instagram as well with photos, I would just, you know, keep it professional and not make it personal. I wouldn't have family photos up there or pictures of you on vacation or having a margarita somewhere. I'd be really careful about what's out there because patients do look. I mean, I checked my doctor's Instagram accounts to see like what they're up to. So just make sure that it's, you know, passes sort of the smell test of what you want your patients to see. So this- Sorry, G. Yeah, David, please. No, this is it. We want this to be more of a discussion than a- I'm interested in both the legal and the medical answer to how we handle the athlete who has had multiple opinions that are in conflict and yet they choose us for the care. I'm just curious how people handle this situation, both from a medical and a legal side. So David, just to clarify. So is this, you have a player, he's got an injury, you give your opinion, he goes and sees two or three other people, they give a separate opinion, but then he comes back to you and wants you guys to do what the second opinion doctor said or- No, wants you to do what you did, what you said you would do, but your plan is in direct conflict with the other person's plan. Is that a dot? Maybe Charlene? Yeah, so like I said, really, really simply, documenting the conflicting opinions and notating that, you've had the fact of that discussion with the player, that is actually probative of the player's empowerment to choose you and the course of action that you've recommended. It's actually excellent. Like I said, you are an elite specialty and there are going to be conflicting opinions sometimes, especially when you're trying to be creative, when there's new technology or new medicine that you think might be helpful. If a player can perform with some intervention that might not be as established, the fact of that conversation is actually helpful and the fact of the tour is actually helpful. Don't take that personally, like the doctor said. So I would say the key is documenting that and that's probative of the person's empowerment and informed consent to go along with the treatment plan that you've recommended. Pat and Tim, would you like to weigh in? I'm sure you guys have experienced this at some point in time. Yeah, I think that's right and I think that I would go even beyond just the documentation of that second, those other opinions that are conflicting, but also I would say what my thought process is, why they may have got this other opinion and something like, while this is certainly a reasonable approach, I don't think it would be as helpful in this situation for these reasons. And so you've kind of thought all that out rather than just saying, they're wrong, I'm right. And we're always kind of weighing those clinical judgments. So if you give your thought process at the time, it'll really help as you go back and look at your records. That's a great point to emphasize is that contemporaneous record keeping, not just at the time when you're explaining what you did back then, what you were thinking, it's really persuasive for it to be preserved at the time when you're actually having the conversation or making the rationale for why you're making the recommendation that you're making. I feel like in honor of Freddy Foo, you should say, you want a second opinion? You asked Freddy Foo twice. Hey, Jay. Jay, one thing that, one thing I'd like to ask Tim about that affects not just AFL, but college, I've called a lot of my mentors in the NFL about certain cases. And your point that you made about curbside consults going down the drain, maybe within, can you expand on that a little bit more? Because I think that's a, if we don't have collegiality to call somebody that you know has a certain area of expertise more than you do, and you've got an elite athlete to take care of, whether it's college or professional, that's kind of scary if we can't communicate like that. Or is it gonna be more like, you're gonna say, well, Pat, I can tell you this, but I need to have a note, I need to see the player, I need, I mean, where do you see that going forward? Because I think it's a really big issue. I think it's a huge issue. And we just had our annual meeting for the NFLPS at the Combine, and it's a big, big deal. And I'll give you an example of someone who said I could talk about it, he knows, is Bob Anderson, who does so much foot and ankle work for a lot of the different groups, and just frankly says that's the first advice he got, was just, you can't take those calls. And if he takes a consultation, it's gotta be, I gotta see the player and do a formal consultation. So, how much, I mean, it's a real, real problem, but I think that only if we stand firm, and the only way that that's gonna change for us is if the players' union says, hey, no, we wanna just go ahead and get a second opinion, can you just call this doctor? And no, these are the reasons we can't. So, they've gotta be the ones that help support us and say, okay, well, we can help support you as well with your liability. But right now, the more I look into this, there's nobody else out there. We met with Roger Goodell. They would love to help us. What are they gonna do? Why should they? I wouldn't do anything about it. They don't wanna get involved with this game. It's us. We're gonna be standing there all alone at the end of the day. That's the bottom line, sadly. So, I think all these things we're talking about, doing good work and doing all the right documentation are all helpful, but you're gonna be alone at the end of the day. Tim, is there any discussion about skin in the game in the sense that I'll do your surgery, but I'll get 5% of your future contract? If I'm taking all the liability to do the operation, then I should have some benefit when you do well. Well, there's been, yeah, half-joking, absolutely. People have mentioned that. And it wouldn't be a reality with the way the union's set up but that concept is certainly something that we're frustrated with. I agree with you, Tim. I think the biggest impact we're gonna see next season is the second opinion because the agents are so programmed and they're pushed by the union to push for second opinions. And to this point, we've made it very easy because we have great relationships. Our trainers will call Bob or Jimmy Andrews or whoever, and those guys have been so gracious in the past, or Pat, and to look at an MRI very quickly over the phone and give an opinion that either supports or maybe you need to do this. And I think a lot of people are gonna shy away from that. And the timelines are so precious. So if they gotta fly up now to Green Bay to see Bob, I mean, you're gonna lose a week right there. And so it's gonna be, I think next season is gonna be very interesting with this and maybe it'll push the needle a little bit. Well, we're putting together a task force and this issue is not going away. And I think the only way it's gonna change is if we still have that united front that says players come back to their agents, the big agencies hear from them that, hey, the docs aren't, I'm having to go, I don't wanna just go fly out to Green Bay. And until they get that feedback, we're gonna just keep being treated the way we're being treated. On the college side, this is kind of more for Pat and Kevin, but definitely Tim, you can weigh in as well. With NIL and transfer portal, Kevin, you did a great job of kind of highlighting some of those challenges. Have you guys figured out some ways to kind of start to navigate that a little bit? I mean, has it gotten a little bit more easier? How do you decide who, if they end up going somewhere else, or is the university paying for that? How does that work? Yeah, no, we haven't figured that out yet. Historically, if we send an athlete out because of our recommendation, at least with the high-income sports, we pay for it. If it's coming from somewhere else and that's their preference, then that would usually go under their insurance. It's kind of been done in the past. But the problem is we just don't get a heads up now. Like the one guy I showed the next day, I operate on big, complex surgery. I was already worried about his outcomes. I guess I was probably relieved when he hit the transfer portal, because I was like, man, if it doesn't do well, at least he's not gonna be here. But I never got a call from the university. Nobody reached out. What's your rehab plan, how long? We actually played them the first game, and the kid stopped me in the parking lot as I was driving out to thank me. So I was like, all right, I'm glad you did well. But that was the first interaction I'd had since then. But no, we have not figured it out yet. It's a case-by-case basis. We try to not put financial burden on the student-athletes if we can avoid it. But we've got a system in place where it's much more expensive. They go outside of the university, and that certainly is not something that they're real excited about. I'll just maybe chime in there. From the Atlantic Coast Conference, where I chair the Health and Safety Committee, we meet monthly, and one of the topics that came up was just what Kevin said, that we're seeing the same problem. And we proposed that, conference-wide, there was transparency and sharing information, but that really had, we determined, had to go to the A5, because if we just had it in our conference, it wasn't really gonna be as helpful, right? But if there was some, at the anonymous five level, if they said, look, we're gonna have sharing of information like we do in the NFL, right, that there's a, I mean, there doesn't necessarily have to be a centralized medical record, but we should be able to have athletes, when they enter the portal, sign medical releases that allow us to then give health information between schools for continued care. I think it would really be instrumental in assuring that these athletes are bridging care effectively, but it would have to come collaboratively, and right now, I can promise you, that's one thing that is not happening. We have a question. Yeah, really great discussion here. It's becoming more prevalent for athletes to have outside experts that they work with, whether for treatment or ancillary services, so I'm wondering what discussions are being had to mitigate the legality issues that come up with that. So prime example, an athlete may undergo surgical repair with you as a team physician. They're working with the team medical staff, but then they also have their own experts on the outside where they're also doing rehab, a bit probably illegally, but certainly factors into the whole legal complex of it, right, so just wondering some opinions on that. I can tell you, that's where the documentation is critical. It happens all the time that somebody post-op, I think they're doing well, and I see a Twitter video of them out doing QB clinics, and they're not even cleared to run yet, so I just make sure that I, personally, I put that in, athletes running, not cleared yet, so that two months down the road, when the repair fails, I have some protection. That's sort of how my approach. That's the best, yeah. Grab a screenshot, you know, download that video and save it. You just have to document it. I didn't do anything wrong. You did something wrong. What I did didn't cause that, and even if it did, it didn't cause the damage that you say it did. The you did nothing wrong is really persuasive. I don't care where you are. It's non-compliance, and in particular, if it's, you've had the discussion, this is what we're doing, they've agreed to it, it's, you know, it's a departure from what we have begun to do, so it's like that departure leads wherever it leads at your doing. Hey, Mark. Hey, this is a great discussion, guys. Kevin brings up, obviously, a good point, you know, talking about his player that went the next day, that he had no idea about, and, you know, we're talking about communication with the player, the player, the player, but the other element here, right, is communication with the team, and how good would it have been if Kevin had, like, a heads up from, you know, somebody in the AD's office saying that, and Charlene, Amy, what sorts of advice would you give people to try to develop that rapport on the GM or the coaching side of things? I work with a coach who's not very good at communicating, and maybe there are others who have that same kind of problem. Well, I'm just gonna say, you should have friends before you need to have friends, and whether it is reporters or others, you know, and getting to know people and building relationships, both in your club and outside of your club, is critical, because you want to be able to call on people at a moment's notice, so having that open door that you can, you know, if it's not your coach, maybe somebody else's coach, where you have that trust built and you can have those conversations. I would echo that, that it takes a time. I mean, that's one thing that just doesn't happen overnight, but, you know, as far as at the university, I know everyone up and down the hall in the Athletic Administration, I know the people in Compliant, like, I've just been around, and I make it a point to be around and, you know, be helpful to those people as well, because, you know, when they need something for their kid and you help them, then suddenly they know who you are, and when you need the information that they know you need, they're apt to maybe tap you on the shoulder and let you know that that's happening. So it's relationships. You know, just Louisiana being my home state at the moment, the Louisiana State Medical Society is a really effective and persuasive lobby here. There are a lot of the physicians affiliated with the schools in that organization, and that's part of the reason that I think this jurisdiction has favorable tort reform where medical malpractice is concerned, and that might be a good forum, wherever you are, to start leaning and making this an agenda topic of conversation, because it's, you know, it's consistent with good medical care. It's consistent with these really big institutions for the state, the big landmark state schools. I think that might be an effective avenue as well. Well, that was great. I wanna thank the panel and all the speakers today. I think it was a really, you know, jam-packed program. We got a lot out of it. Tomorrow, we're gonna kick back off again at 8 a.m., so it's gonna be another really, really solid day. So appreciate everyone's time, and we'll see you tomorrow morning.

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