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The NFL has a Concussion Problem

The NFL has a concussion problem. The league may not be able to fix it, but all experts should glean an important lesson from the crisis which could dismantle the entire sport.

The NFL’s concussion problem continues. On Sunday, December 10, 2017, Tom Savage, the quarterback for the Houston Texans, was hit in the offensive backfield was left twitching on the ground. He exited the game briefly but returned minutes later. Once back on the field, it was evident to officials that Savage was suffering the effects of a neurological injury. He was removed again and taken to the locker room for evaluation. A week later Savage did not return to the field for the Texan’s next game. Savage’s brief return to the field has renewed suspicions that the league is unable or unwilling to protect players from brain injuries.

For several years the NFL has been under scrutiny for brain injuries among players. In 2013 the NFL reached a $1 billion settlement with former players who suffered ill health attributable to brain injuries. The league has also changed several game rules in hopes of reducing head injuries. They have instituted stiff penalties and fines for high risk forms of tackling and hitting. The league has also created an independent scientific advisory board to identify and support leading research in concussions and brain injuries. They have announced $100 million in funding toward scientific research in brain related injuries. They have educated coaches and trainers to help identifying injuries.

One action the league has taken since 2013 is the introduction of neurological experts. Independent head-injury experts are now on the sidelines of each game with concussion assessment authority. This includes trained medical experts in the press boxes who help identify players who may have suffered a head injury. The neurological experts are authorized to remove players from the field, perform prolonged injury assessments, and withdraw players from games regardless of what the players, coaches, or team doctors may say.

Of course, neurologists on the sideline of a football game cannot eliminate head injuries on the field. They can, however, assist players when an injury occurs, and reduce the chance that an injury becomes worse. The most important treatment for concussion is rest, which is antithetical to NFL culture. It is unlikely therefore that players, coaches, or team staff, who are motivated to win games can consistently protect a players’ long-term health and the league’s best interest.

This of course is where the NFL’s independent neurologists have an important role. Given adequate authority and autonomy the neurologists can protect players from the catastrophe of wide spread debilitating brain injuries. Quickly diagnosing head injuries and prescribing treatment, which in most cases means the player’s removal from the field, may be bitter for the teams and the fans, but highly beneficial to the players and league.

Ergo, the mistake with Tom Savage was an important event for the NFL and an important lesson for all other experts more broadly.

One role that experts often play is the position of expert sentry. Sentries pass judgment and approve or deny entry. Due to their unique training or experience, experts are frequently put into this gatekeeping position where they are authorized and expected to guard an organization from unwanted people or things. Organizations have used expert sentries throughout history and in almost every industry. Corporate recruiters who make hiring decisions are expert sentries. Judges who approve or deny search warrants are expert sentries. Doctors who select patients for clinical trials are expert sentries. And of course, neurologists on the sideline of NFL games are expert sentries.

Of course, experts also wear other hats. NFL neurologists, for example, don’t just say to athletes, “Yes, you may play.” Or, “No, you may not.” They prescribe treatment. They council with other doctors and trainers. They do what they can to ensure the health and safety of the players. But in the narrow role of sentry their decisions are binary. They decided if someone is in or out, approved or denied.

As simple as a binary decision may appear to an outsider, there are often weighty factors which contribute to any sentry’s decision. Because of complexities and the lack of immediate information, it can be difficult for sentries to ensure their decisions are reliable and consistent. Sentries may occasionally deny admission to one person who should have been admitted, while granting admission to another person who should have been denied. Binary decisions carry the risk of false positives as well as false negatives, and both types of errors can be vexing for the best experts and their organizations.

For sentries, one type of error is almost always more desirable than the other. In the NFL, for example, when a neurologist decides that a player has a brain injury, when in fact the player does not, the diagnosis is a “false positive” and the player is unnecessarily removed from a game. In this case the health consequence of a false positive is benign. There is no risk of hurting a player by treating him unnecessarily for a concussion. Of course the false positive does carry other negative implications but not regarding the player’s health.

False negatives in the NFL (falsely judging a player to be fit for play when he is actually seriously injured) can have catastrophic consequences for the players, the teams, and the league. Long-term health problems and premature death are just a few problems connected with concussion. The lopsided difference between a false positive and a false negative should lead to a diagnosis bias in favor of false positives. NFL neurologists should be expected to err on the side of caution and remove players from games on the suspicion of concussion, even if one does not exist, and should not allow players to return to games unless they are certain the player is fully healthy. This is why Tom Savage’s return to the game in Houston is so alarming. The decision was in error and the diagnosis bias was insufficient.

All experts who serve as sentries are subject to error, both false positives and false negative. And, as important as it is for sentries to make the right decision, it is even more important that sentries make the better of the wrong decisions. It is better to remove a healthy NFL player from the field than to allow an injured player to compete. It is better to wrongly ground an airplane than to wrongly put an airplane in the sky. It is better for a court of law to wrongly acquit than wrongly convict. Both decisions are wrong, but one error is more egregious than the other. One decision is the right-wrong and other is the wrong-wrong.

Taking a page from the NFL playbook, experts need to know when they are playing the role of sentry and what their binary decisions can be. They need to understand and abide the decision bias, and avoid above all else, making the wrong-wrong decision. The players need expert sentries to protect them from themselves. And, the league needs expert sentries to ensure the long-term viability of the entire sport.

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The Danger of Speaking Outside Your Expertise

You worked hard to become an expert. Think hard before you throw it away.

Whether you are a doctor, a lawyer, a lawn care professional, or any other expert, you should glean some important lessons from the NFL Anthem protests and the fallout that surrounds them. Missing in national conflict and heated rhetoric are some critically important lessons about what can happen when experts in one field opine publicly about subjects outside their expertise. Experts of all stripes should pay attention. This is one way for things to go bad–very bad.

The NFL is filled with experts. The league has some of the most gifted, talented, and disciplined athletes in the world. They are well-paid and given global visibility. Many people are highly interested in what they do and say. Consequently, players are frequently asked about subjects beyond the sport. They are asked about entertainment, fashion, culture, politics, and so on. Many players use their unique platform to speak for causes they support or on subjects they strongly favor. And, of course, in America they are well within their rights to express themselves on any subject they wish.

The NFL Anthem protests are, in part, about police brutality, oppressed minorities, and freedom of speech. They are also about Black Lives Matter and Blue Lives Matter. They are about respecting the flag, and disrespecting the flag; respecting the troops, and disrespecting the troops. The conflict began while Barrack Obama served as our first black president and then escalated sharply when President Trump called for the public termination of kneeling players.

As important as all these subjects may be, another urgent message is being missed. Few people are absorbing some of the truths concealed in the controversy. Here are my top three lessons for experts from the NFL Anthem protests.

Lesson One: Communications are fraught with misunderstanding and difficulty.

Following President Trump’s rebuke of players who kneel during the National Anthem, Eric Reid, a strong safety on the San Francisco 49ers, who frequently knelt beside Colin Kaepernick, wrote an op-ed for the NY Times. In the article, Reid said, “It baffles me that our protest is still being misconstrued as disrespectful to the country, the flag and military personnel.”

Undoubtedly many experts, inside the NFL and outside, feel the same way. How can kneeling, which is a symbol of reverence and respect in many settings, be interpreted as disrespectful during the National Anthem? Well, frankly, it can be. That fact should not baffle anyone. I will gladly take Reid at his word that he means no disrespect. I accept that. The point here is not about what Reid meant or what Kaepernick meant. The point is that people will draw their own conclusions and you, as the expert sending a message, cannot control these conclusions. You cannot control the deductions nor the interpretations. People will listen to your words, observe your behavior, and determine for themselves what you mean. It should not be lost on anyone in the United States of America, fan, player, or otherwise, that if you do not stand and quietly face the flag during the playing of the National Anthem there will be some, not all, but many, who will conclude that you do not value the flag nor the nation for which it stands.

So, I point all experts to the invaluable advice of the Finnish Professor, Osmo Wiio, who published his Laws of Communication in 1978. He said, “If a message can be interpreted in several ways, it will be interpreted in a manner that maximizes the damage.” Experts should know that everything they say and everything they do will be interpreted through the observer’s pessimistic, critical, and over-sensitive lens. In most cases, people who listen to you will draw the wrong conclusions and they will continue to draw the wrong conclusions until you make it impossible for them to draw any conclusion except the right one.

The entire NFL roster may kneel during the National Anthem. That is their prerogative. But they should not be surprised when people take offense. People will continue to interpret a message in the way that does the most harm. It is an undeniable law of communication.

Lesson two: Experts hurt themselves, and others, when they stray from their expertise.

As an expert, you have a sphere of excellence, a mastered subject or skill. Above all other domains, this is your turf, your home court. On that home court, you are recognized for your expertise. You have worked for years or decades to perfect your skills. This is where you are at your best. When you stray from your acquired position of strength, you become vulnerable—more so than many experts believe. Being strong in one field does not necessarily make you strong in another. To the contrary, having a strength in one area may actually make you weak in another. Experts who wander from their fortress of experience, skill, and knowledge are subject to doubt, disbelief, suspicion, insult, ridicule, and attack. Your opponent knows when you are weak and will waste no time exploiting your vulnerability.

It is easy for experts to think that their dominance in one field makes their opinions in another field more valuable. But the opposite is true. Experts should expect that their recognized excellence in one field will not automatically produce influence in another field. When a heart surgeon tries to give advice about home decorating, or when a plumber talks about tax law, the expert surgeon and the expert plumber is often dismissed. Waxing philosophical on a subject which is clearly outside your expertise makes you look like an arrogant know-it-all and it detracts from your true expertise.

Experts of all stripes should retain their stronghold. Why work for years developing a knowledge or skill only to set it aside? Experts who frame every question and every message into their domain will serve themselves, their colleagues, and their audience with maximum effectiveness. Stick with your own field of expertise.

Lesson three: Terminations happen behind closed doors.

President Trump obtained national attention in 2004 when he starred in the reality television show “The Apprentice.” Each episode included an abrupt, calloused, and public termination of the show’s contestants. With finger and thumb extended in the shape of a pistol, Donald Trump pointed at candidates and barked, “You’re fired!” This public termination may be exactly what the President had in mind when he asked NFL owners to terminate players who kneel during the Anthem.

Ironically, when the President called upon the owners to terminate players, he failed to acknowledge that the owners had already done what the president suggested. Their approach may not have been televised, but Colin Kaepernick, the instigator of the kneeling protest, was already out of his job. The message was already delivered to the league that players may protest if they wish, but if they did they shouldn’t expect to stay on the team roster. Eric Reid acknowledged as much in his NY Times op-ed when he said, “[Kaepernick’s] unemployment has nothing to do with his performance on the field. … I am aware that my involvement in this movement means that my career may face the same outcome.”

At least Reid recognizes that he is walking through a minefield when confronting subjects outside his home court of expertise. But not all experts are as aware of the dangers that surround them. As an expert, every time you step outside your field of expertise, you assume risk. There is a high likelihood that someone will be offended, confused, challenged, or alienated by your actions. Maybe the cause you endorse outside your expertise warrants the risk. Eric Reid believed his protest was worth the potential ramifications. It should be clear that risks do exist and that they are rarely as apparent as the risk of protesting the Anthem.

When you stray from your expertise and make even veiled or benign comments about public policy, social norms, or any controversial topics, you assume risk. When you criticize a leader, or take up a cause, no matter how noble it may be, you place yourself at the mercy of your audience. You no longer control your destiny as an expert. You are forfeiting your hard-earned expertise to the cause you now espouse. Is that what you want to do? Maybe it is, but don’t pretend that your causes and your expertise are separate. They are not.

People who sit in positions of power rarely act like President Trump. The President may find pleasure in saying, “You’re fired!” but very few other people do. Instead, if you alienate enough people, your influence as an expert will simply melt away. You will have less control and less influence. You will be left as an empty shell. Not because you lack expertise, but because enough people don’t want to hear about your social agendas.

The consequences of the NFL Anthem protests can teach every expert the importance of being cautious. You’ve worked for years to develop your skills. You’ve risen through the ranks and distinguished yourself. Now that you have reached the apex of your expertise, do you really want to throw it away over a social cause, or worse yet, a pet peeve? If so, great. Good for you! But don’t believe that you can have it both ways. You cannot stand on a soap box today and expect people to pretend it did not happen tomorrow. Treat your expertise carefully because it did not come easily.