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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