The Jalen Hurts blood clot saga initially started out relatively benign, but then turned into a more serious pulmonary embolism issue. The fallout included some erroneous reporting along with rampant criticism and questioning of the medical care such as these examples…
The following are some of my thoughts from a medical doctor’s perspective. Some of it is directly relevant to Jalen Hurts’ situation, while some of it is more indirectly related and general regarding medical care.
Updated Jalen Hurts’ blood clot timeline:
October 4 vs Rams: Cleated in the calf during game.
October 8: Calf pain noted.
October 9: Eagles fly to London.
October 10: Superficial blood clot discovered on ultrasound while in London. No blood thinners indicated or given at this time.
October 11 vs Jaguars: Played in game with no issue. That same night, the Eagles fly back to USA from London.
October 14: Practiced in full. Ultrasound after practice revealed “movement” in the clot. Ruled out for the next game on October 18.
October 17: Hurts put on IR.
October 19: Erroneous report via Tom Pelissero claiming that doctors told Hurts not to sleep. Later retracted.
October 19: Eagles release statement that Hurts has deep vein thrombosis (DVT) and bilateral pulmonary embolisms (PE).
October 25: NFL and NFLPA announce they will investigate Hurts’ management.
Abbreviations:
SVT = superficial vein thrombosis (clot in superficial veins of body)
DVT = deep vein thrombosis (clot in the deep veins of the body)
PE = pulmonary embolism (clot in the blood vessels of lung)
Every Decision in Medicine and Life Involves Odds
With every patient encounter, the doctor is mentally estimating the odds of each possible outcome, even the very rare ones. For every back pain that has a life-threatening cause, there are probably a million that are a simple strain. For every sinus pain that ends up being a brain tumor, there are probably a million that are a simple infection. For every leg pain that ends up being a SVT and subsequent PE, there are probably a million that do not. With a US population of 340 million and a global population of 8 billion, even extremely rare things will still happen regularly.
It’s like an NFL game where analytics may state a 99.9% chance of winning with a 21 point lead with 3 minutes left, but every once in a while, the unlikely is still going to occur.
There is Still Much Unknown about the Human Body
The more you study medicine and learn about the human body, the more you realize that there is a vast amount we still don’t know. When it comes to blood clots, there is a lot we don’t know about the odds and risks of various activities.
Bad Outcomes Are Going to Happen
Doctors cannot prevent every bad outcome from happening. In fact, bad outcomes happen all the time. Everyone is going to have some kind of negative health event in their life, and everyone is going to die of something at some point.
Doctors can do their best, but they can only do so much. Just because a bad outcome happened doesn’t necessarily mean that the medical care was faulty.
Risks of Activities with a Clot are Largely Unknown
With Jalen Hurts’ initial SVT, it’s not certain what the odds are that it would progress to something worse like a DVT or PE. It’s also not certain what the risk levels are with playing football or flying.
With a DVT, it is generally recommended to avoid flying if a patient is not anticoagulated. That’s because prolonged stasis in a seated position can increase the risk of a blood clot. And more consequentially, if the DVT breaks off and turns into a dangerous PE, there is no hospital in the air. With a SVT, there is no definitive consensus on the safety of flying.
As I stated in my initial analysis of Hurts, there are likely thousands to millions of people over the years living life, playing sports, and flying around with SVTs that nobody ever finds out about. That is in fact true for DVTs as well. There are studies that have found around 3% of people on a >4-hour plane flight will develop a DVT - almost all small and clinically unimportant. Nobody is routinely getting screened for blood clots before or after flights.
With NFL charter plane travel and the less-restrictive seating rules, players can get up, walk around, lie down, and stretch out frequently throughout a flight. So there may be negligible additional risk to flying with a DVT or SVT compared to being on the ground.
The Cost to the Patient of Trying to Prevent Every Bad Outcome
You do not want doctors to try to prevent every bad outcome, as that comes with a cost to each individual patient by way of excessive tests, “unnecessary” procedures, hospital stays, anxiety, time, energy, and money. All these things can actually lead to WORSE outcomes for patients.
If doctors were told to prevent every bad outcome for an NFL player, no player would ever be cleared to play in a game. It’s a balance, and there needs to be an acceptance that there is a risk/reward to every medical and patient decision.
For example, there are negatives to staying in hospitals. There are a lot more pathogens floating around. It’s more difficult to get rest due to uncomfortable beds, wires hooked up to the body, staff checking in regularly, random beeps and sounds, and doctor exams at ungodly hours. Staying in the comfort of home has a lot of advantages.
There Are Limited Resources in the Real World
From a societal standpoint, if doctors are expected to prevent every bad outcome, not only will the cost of healthcare rise exponentially, but EVEN MORE people will have bad outcomes because of the misallocation of resources.
There are not an infinite number of hospital beds, imaging machines, nurses, doctors, and healthcare personnel. Tough choices need to be made, otherwise resources will run out very quickly. The reality is a lot of this has already happened.
The Patient Has the Ultimate Authority
Doctors can give patients all the information and odds of their health situation, but in the end, the patient is the one who has the right to make the ultimate decision that fits their life. Doctors should not be imposing their values and philosophies on patients.
In Hurts’ situation, if he was given a choice between taking on a tiny risk to play in an NFL game and fly home with a clot versus staying in a foreign hospital, he (along with many of us) might choose to continue with normal life. Patients make these kinds of decisions all the time, and it is their right to make them.
Should Jalen Hurts Have Had Another Ultrasound Before the Flight Home?
Maybe. This might be the biggest current controversy of his medical care. He had just had an ultrasound the day before the flight, and presumably there were no worsening symptoms like leg swelling or respiratory symptoms. So the likelihood of a significant progression of the SVT at that time was probably very low.
Typically, a follow-up ultrasound would be advised in 2-3 days or in 7-10 days depending on the location of the SVT. To be extra safe (and to avoid criticism), an ultrasound immediately before flying home could have been performed. I would expect that in the future, the NFL with its vast resources will mandate ultrasounds immediately before flights for players with any kind of blood clots.
Doctors are Human and Can Make Mistakes
Doctors are only human, and when seeing thousands of patients per year, occasional errors will happen. Whether the medical staff made any errors with Hurts is debatable. Should an error cost a doctor their job or lead to a malpractice lawsuit like many are calling for in the case of Jalen Hurts?
The Impact of Unrealistic Expectations
Mental burnout can occur in any profession if the expectations are unrealistic. Doctors and healthcare workers can do their best with the information they have, but bad outcomes are still going to happen sometimes.
Unrealistic expectations can lead to hypercriticism and malpractice lawsuits that add stress and cost to doctors and the healthcare system. Imagine the effect if Jared Goff could get sued for throwing an interception, Dan Campbell could get sued for a failed 4th-down, or the entire Lions organization could get sued for having a bad season. Players, coaches, and teams would need to carry malpractice insurance, the costs would get passed on to fans somehow (think ticket prices are expensive now?), a lot more players/coaches would choose early retirements… and the on-the-field outcome probably wouldn’t even change and might actually get worse.
For my initial story and analysis of Jalen Hurts’ blood clot…
Jalen Hurts Blood Clot Analysis
Big health news out of Philadelphia has thrown the Eagles' season into turmoil. After initially playing through a superficial blood clot last week, QB Jalen Hurts now faces a potential multi-week, or even multi-month, absence due to progression of the clot. Here is my breakdown of the timeline, the diagnosis, and what this means for his immediate future.