MEDICAL MATTERS Tom O'DowdIn the normal medical consultation there is usually just the doctor and the patient with, maybe, a relative. On the football pitch when the coach nods towards a fallen player saying "you'd better have a look at him", the doctor is on show.
There are the other players using the break to catch their breath, the sweating referee hoping you won't take too long in case he seizes up, the coach hoping you won't put his best player off, the family hoping they are not destined for hours in casualty, and the crowd hardly noticing.
Then there is confidentiality. In the usual consultation everything is under lock and key. "What was it doc - his collar bone?" You cannot say it's confidential between me and him as there is an audience getting increasingly interested if the injury involves longer attention. The coach wants to know as he will need to get him back on or if taken off, back into training.
The health of football players is a complex mix of good training regimes supervised by good coaching. Amateur coaches and managers put in enormous effort to keep the show on the road and keeping a team together involves motivation and loyalty as much as fitness, especially if the results are poor.
The health on the pitch is heavily dependent on the referee. They must establish their authority early and yet allow the game to flow in an entertaining manner which gets the best out of both sides. As we become more competitive as a nation, referees are often the butt of the failure and bitterness that occur a long way from the pitch. One thing evident to many of us amateur medics is that the more authority and skill the referee has, the easier our job on the sidelines.
It is not easy to get medical training for coaches or doctors who look after football players, which is surprising as training regimes, sports facilities, nutrition and coaching have all improved and are producing bigger and faster players who are capable of doing considerable damage to each other. For many clubs it is difficult to get trained help for contact sports on a regular basis.
Recently Prof John O'Byrne and Dr Noel McCaffrey ran a splendidly practical course for team doctors in Cappagh Hospital. There were doctors there from all over the island who look after GAA, rugby and soccer teams and some who look after two or three of these games. The doctors were there to gain new clinical skills, but also out of fear of letting an athlete down. We learned about head and neck injuries, suturing wounds and dealing with a collapsed patient.
Most of us were GPs who, at some time or other, had answered the call of "Quick, is there a doctor here" at a match and found ourselves gradually roped in. Rural doctors are often a vital part of the, mainly GAA, scene and carry an amazing array of equipment for almost every eventuality. Some of the bigger, mainly city, clubs can afford to have a rota of doctors who are available in the vicinity or at the match. Some doctors have a natural affinity for acute medicine and are only waiting for the call to go up. However, the difficulties clubs have in getting medical personnel indicate that such doctors are in a minority.
Sports medicine has grown in Ireland and courses up to Masters level are available. There is a need for more training for amateur coaches and doctors in the emergency care of sports injuries, first aid and perhaps cardio-respiratory resuscitation.
None of this is new of course. The first sports doctor was Herodicus who, in the fifth century BC, treated injured Athenians with what we now call physiotherapy and nutrition. His most famous student was Hippocrates who wrote about the value of exercise in the prevention of disease. Difficult to remember such a fine lineage as you run onto the pitch to administer magic spray to yet another injured shin.
Dr Tom O'Dowd is professor of general practice at Trinity College Dublin and a practising GP.