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"Sport Medicine Journal" No.6 - 2006
EDITORIAL


The role and configuration/organization/structure of medical team in modern rugby

Mihai Vioreanu
Lecturer in Orthopaedic Surgery
Royal College of Surgeons in Ireland


Introduction

As modern rugby developed and evolved to a professional sport, important successive changes occurred within the structure of managerial team’s various departments dealing with a rugby club. Following this new evolution, “new jobs” appeared while classical ones became increasingly specialized and compartmental.

Even from the beginning of this sport, the physician trade has been existing and clearly defined. In the British society, the very fact that rugby had been seen as nobility’s sport – most players being physicians, lawyers, architects from prestigious colleges – certainly facilitated a strong liaison between medicine and rugby.

It was common during a rugby match to have at least one physician player or otherwise certainly there were physicians among spectators ready to intervene if needed.
The hospitals in the large cities had rugby teams for physicians and students, traditions that’s carried on with pride even nowadays. Thus between medicine and rugby there’s been a strong relationship and maybe this was the reason medical “staff” in amateur rugby had not been rigorously structured and organized.
During the Romanian rugby’s “glorious” times, the Romanian national team benefited from an exemplary medical service under the coordination of Bucharest Sportive Medical Institute perhaps also due to the fact that in those times everything was “centralized” and “orderly” and the players spent a lot of time under surveillance in the training camps. This led to the development of the Romanian sportive (and rugby’s for that matter) medicine during those times.
The possibility of making studies and medical research on athletes (athletes which were at the institute’s disposal) facilitated this progress.

The continue movement of medicine and rugby

On international level we all are aware of the continuous changing from medicine - the evolution of medical research, the predisposition for specialization and over-specialization in all medical aspects and not least the economic and financier progress of medical industry (pharmaceutical, medical technique)
Sport medicine well developed in USA and Australia rising/ getting higher in popularity in Europe too. If at the beginning, the medical doctors were generalist doctors (in the large majority) step by step are formed the position of sport doctor specialized with a special training in this discipline.
These doctors had followed then course of over-super specialization in well known country and then they dedicated their carrier in this field of medicine, so later on are formed nationals and internationals associations with the exclusive interest in sport medicine.

Romania, from this point of view was quite advanced in Europe and on international level, being represented by the Sport Medicine Institute of Bucuresti. In rugby, with the professionalizing took place in the same time the specialization and over-specialization of the medical staff to assure high sportive performances.

The personal experience in rugby and the medicine in Romania

For 10 year period (1993 -2003) I know booth domains (rugby and medicine) from the inside, being player in Romanian team and in the same time student and then resident in medicine.
It was a period of time with many essential changing in booth domains, a period in witch we were confronted with to many changes maybe – from this entire disturbance and the explanation of results with lees satisfactions in booth domains. We all know the history of rugby in this period so I will not get any fur deer with the details.

From the point of view of medicine, lot of thing happened that not seems normal to me (in that moment I did not know what ,,normal’’ is):

- Doctors fight for wining a social status –in the same time being under a continuous denigration,
- Our teachers just discourage us to go on with this noble profession,
- Under a bombard with negative messages and with all the efforts to have a decent existence no one thing to the carrier,
- in this conditions sport medicine in Romania was under disappear, so with can not talk about overspecialization
Those doctors that dedicated there time for sport teams, in the large majority doing this from passion (they were ex-players, in a little number) or like a way to go out in a new world – and this don’t have an special interest for sport medicine.
All this period of time we have to deal with a very large of doctors at national rugby team (I will not give name because I am afraid it is possible to forget somebody) – from people that were interested about the traveling aspect to doctors that spend time with the athletes (with me personally- I was in training in sport medicine, I remember the specials meetings in witch I was learning haw to treat the various problems of health of my colleagues).
In those times the team doctors were under the direction and domination by the delegation leaders (,,Let him’’ or ,, What do you say doctor? Are you telling me? ….I have seen other cases like this’’)
In this conditions, observing the ,,managers’’ comportment (totally without respect) for the doctor, it is not strange that the players start to address having the same attitude to the team doctor – the relation doctor-patient seem to being lost, so the practice of medicine seems very hard in those conditions.(Extremely severe)
Some doctors abandon, other continue in the presented conditions and so the progress was very slow, and some times inexistent. The organization and the structure of a medical team in rugby, on national and club level was replaced with the finding of a doctor (was preferred from FRR or from club), a doctor that have a minimum budged and was teach how to practice theirs job. Expression that ,,we can get somebody else’’ was functioning in nearly all of the times.

Until 2003 on Australian World Cup when the doctor of the team (that participate to all prepares periods) has been replace with an French charming doctor, preferred by the coach (they spoke the same language) – witch enjoyed very much in a 4 week vacation and a quality tourism with the Romanian team, some times being irritate by the athletes injuries during competition.

My personal experience in rugby and medicine in Ireland

In a country were the rugby is culture, education, symbol of success/achievement/ victory and succeed I have the chance to know the booth domains (rugby and medicine) from inside.
In the medicine domain, were everybody talk about sport, being a rugby player it is something normal (team spirit, education etc.), and if you are a good player and win with the hospital team, the medical carrier open in front of you.
In rugby, if you are a doctor, again it is normal and prefer- ,,it is not longer necessary to have a doctor to assist the game’’ (many times I should get involved in case of accidents like player-doctor, even if I was from the adversary team).
On the professional level (provincial and national), few time ago I have the honor to manage the Ireland U21, like doctor. In this professional world everything is different – very well organized and delimited, every participant is responsible and have his own position very well defined.

The structure of medical staff IRFU

1. IRFU Medical Chief Officer – medic working for IRFU witch coordinate the all activity of medical staff:

- regularly conference and meetings with the educative purpose
- regularly informing about the novelty in the domain,
- the anti drug policy ,
- sending doctors for different teams,
- the coordination of all medical department,
- the relation with IRFU,
- recruiting of available and interested doctors

2. Specialized doctors in sport medicine:

- that spend loot of time with the team (one doctor or two for each team: U19, U 21, Ireland A etc)
- that follow the official trips of the sport teams
- they report to the IRFU Medical Officer
- take care (under the medical coordination of Medical Chief Officer) about the nutrition, rehabilitation/recovery and diagnosing the problems of every day living of athletes.

3. Consulting persons in the specialty domain, IRFU attached

- General surgery, Orthopedic, Radiology etc.
- this are specialized with the practice in hospital and extremely busy with the practice in their domain of specialization
- it is a great honor for them and they are invited on the games, dinner after the game, invited in different tour, they are a part of IRFU policy
- they are not paid by IRFU
When the sport doctor has a problem directly, or by the Medical Chief Officer establish the connection with the ,,Consulting’’ attached for solving the problem (in a urgent manner).

4. Physical therapist

- this are from the basis medical staff in this structure
- this are those that know better the players and spend the most time with them
- they keep direct touch with the sport doctor from this team – doctors that are not always in training camp with the team
- they keep in touch with the athletes before and after the convocation to the team,
- they have access to the medicines and the administration after the consulting (by telephone) with the sport doctor.

I will like to expose here an example that happened to me lately like sport doctor for Ireland U21: before the convocation (3 day in week-end?) each player receive a text message on telephone and he is oblige to answer be informing the doctor about his medical condition, if he have health problems and the nature of this.
If the answer should have been yes, the sport doctor contact personal the player for establish exactly the magnitude of the problem. When the player meets the technical and managerial staff they know exactly the state of health of the players in the squad. The problems that necessitate a medical consult have been reported by telephone and in a 2 hours evening visit I consult the cases with more problems. In a medical report I informed the technical and managerial staff about the status of health of each player that have happen an accident and the treatment followed in the resting period.

Although any system have this own deficiency for me this system seem to be extremely well organized and structured, were every one have this position well established and do this work with responsibility and without pressing from the non-specialists. All this have deep roots in the culture, traditions and respect, and we have all this characteristics in Romanian rugby, but we must cultivate them, we must to precious them and promote them with any occasion.



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