I have always had a huge passion for sport and in particular rugby, ever since I was a young boy. I played the game at school and university and went on to be a national-level referee for several years with the RFU.
I then took up a role as a match day doctor with a semi-professional team in my local area, and eventually was invited to join a full professional team as their doctor – predominantly for the academy sides, but I also gained a lot of first team experience when the senior doctor was unable to do some of the match day duties. This gave me invaluable experience in making tough decisions and dealing with complex trauma injuries.
I was invited to join Wasps RFC in the summer of 2016, after they relocated to Coventry. My role with Wasps is mostly with the Academy and the A-league side, which contain up-and-coming talent as well as players who are coming back from injury.
A regular game day, if we are playing away, usually means a meet at the club several hours before the game to do an equipment check and finalise team lists. I usually bring up any players coming back from injury or those who have any medical illnesses and discuss their overall health and plans for injuries and illness with the strength and conditioning staff, physio staff and coaches.
We then board the bus and travel to a hotel near the away stadium for a pre-match meal and for the players to have strapping and do pre-activation, which is a form of warm up. At the ground we meet the away team doctor for a medical briefing and induction, as well as the local paramedic service, who help us with emergencies pitch-side. We set up all our own trauma kit, from suture kits to spinal boards, and do final checks with our oxygen cylinders and equipment.
Concussion is our most common injury, but we are expected to deal with anything from a cardiac arrest to a broken leg or just a cut eyebrow!
During the game I work pitch-side with two physiotherapists, treating and assessing injured players. If there is a game which is covered on television, we also use video technology via an iPad, with a link to the TV broadcasters' feed, to help us identify any players who may have suffered a concussion and determine if they need to be removed. We also have the capability to remove a player temporarily for a head injury assessment (HIA), to give us more time to assess for concussion where there is diagnostic uncertainty on the field.
Concussion is our most common injury, but we are expected to deal with anything from a cardiac arrest to a broken leg or just a cut eyebrow! After the game we usually help treat and assess injured players or players who need hospital care, and then travel back with the team to the training base. On some away days, this can mean up to a 12 or 14-hour day for a game.
The right skills
GP skills come in very handy for sports medicine. I was fortunate enough to be asked to go to Russia last summer with the RFU England Counties U20 side as their team doctor. I was working with 25 players and eight management staff, and was responsible for all of their medical care.
There was a lot of GP work, such as dealing with diabetic patients, managing an outbreak of viral gastroenteritis amongst the squad in the hotel, skin rashes, depression, and ENT conditions – all bread-and-butter conditions that a GP sees regularly, but ones that might not be so familiar to a sports physician without much GP experience.
Extra qualifications are also essential to work in sports medicine. I do an annual two-day course on the management of polytrauma in the pre-hospital setting, such as managing a player with a broken neck who is lying face-down in the mud, or a cardiac arrest or an acute airway problem. The course is run by the RFU and is an essential requirement for any doctor or physio to work pitch-side in rugby.
As part of that course I also have to undertake a written exam and a trauma moulage scenario, which is assessed and graded. A pass is essential so that I can remain competent and be signed off to work in professional rugby. Apart from that, I have also completed suturing and minor surgical courses to maintain my suturing and tissue handling competencies, as well as joint injection courses.
I am also studying towards a masters in sports medicine and work as a specialty doctor in sports medicine at the University of Leicester Hospital. All these skills and experiences help me remain competent to work in professional rugby.
It can be difficult to juggle general practice and rugby work as I also have a young family, but I find I am quite organised with my time and the two actually complement each other quite well.
For any student interested in sports medicine, my advice would be to focus on being the best at your level. I was told these wise words myself when I was an FY2 doctor interested in sports medicine.
There is little to gain by trying to be a sports doctor for an international sports team when you're still a medical student, as there is so much to learn and do to become a competent FY1. Your focus should be on passing finals, then on being an exceptionally good FY1/2. This way you can develop good basic skills, such as management of acute medical and surgical conditions, during foundation training and your interest in sports medicine can become more prominent when you enter specialty training.
Dr Ralph Mitchell
Ralph is a GP partner in Hinckley, Leicestershire and is also a specialty doctor in sports and exercise medicine in Leicester. He is one of the team doctors for Wasps rugby team and the England U20s counties team. He has also worked as part of the medical team for the 2014 Glasgow Commonwealth Games.
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