By Josh Bartholomew – Interview conducted for Hampton Radio with Paul Wilkinson
Since leaving Hampton in 2002, Dr Akbar de Medici has worked in a range of different roles, including as Head of Research and Development at Fulham FC and his current jobs at NFL London and the ISEH (Institute of Sport, Exercise and Health).
In the NFL especially, the pressure on medical staff has never been stronger, with recent studies suggesting that 99% of American footballers show signs of CTE (Chronic Traumatic Encephalopathy) at some point in their life after retiring.
Despite this, Dr de Medici praises the American medical system. “I’m trying to bring some of the practices that they have in the NFL to the UK,” he says. “If you watch a typical football game in the UK, you’ll see a physio and a doctor, and they’re the ones who run onto the pitch.
“In the NFL, there are around 35 doctors for each game. They are all specialists, and I don’t think we need to go to that extreme over here, but I think we could find a balance.
“The procedures they use in America, like the choice of hospital an injured player will go to, who treats them and where they’re going to get seen are much more meticulous in America than over here, which needs to change.”
Concussion itself is a topic which Dr de Medici is very knowledgeable about, having founded the Complex Concussion Clinic in London. This entails “working with all professional athletes that have serious concussion injuries. We see them in our clinic, look after them and ensure they follow the ‘Return to Play’ protocol correctly.
“The IOC release the guidelines for concussion, and they’re used from school sport all the way up to international level. I help the panel that decides on these guidelines.”
As mentioned earlier, Dr de Medici understands the reasons behind such a controlled medical procedure in America, compared to the care over here: “A lot of it is due to litigation. In America, you’re much more likely to get sued if something goes wrong, so the doctors are very careful: there’s much more support and structure to make sure everything is taken care of.”
With less pressure comes less care, says Dr de Medici. “I think player care is very important. This is quite controversial, but one thing we need to work on is pitch-side emergency care. I think the doctor that runs onto the pitch should be more experienced and skilled than they are at the moment.
“They’re very good at dealing with knees, hamstrings and smaller scale injuries, but they wouldn’t have the full range of skills if their player had a cardiac arrest.”
This was tragically highlighted in 2012, when footballer Fabrice Muamba suffered a cardiac arrest at White Hart Lane.
Medical staff were treating him on the pitch, but Muamba’s survival has been credited to a consultant cardiologist who was attending the game as a fan.
Medical staff currently hold a huge amount of responsibility, but it’s an interesting debate as to whether they should be neutral or not. “One of the key messages in a study by Harvard was that doctors shouldn’t be linked to their clubs,” he says.
“There should be an independent doctor, who’s completely neutral to the game, so there is no chance that they could be linked to a decision that could harm a player.
“That has been brought up, but it’s very challenging to put into place.”
As well as his role with the NFL,Dr de Medici also works with the FA and RFU. “Sometimes they contact me for assistance with more complex injuries to help them sort it out,” he comments.
Yet the greatest pressure on sporting doctors nowadays is from the clubs: “You get stress from all sorts of people: the club, the owner of the club, the player’s agent, the players themselves. It’s quite difficult sometimes to tell them that there’s nothing I can physically do to get the player back playing as quickly as they need to be. Often, they go elsewhere to get an opinion, but I don’t think that’s correct.”
Dr de Medici expands on the difficulty of potentially having to compromise medical ethics to satisfy a player’s needs, saying that “I always have to be thinking about how I’m dealing with a certain issue, and the potential repercussions.
“It can be difficult when you’re working with Ronaldo, say, or Messi, and you have to tell them that you can’t risk your career by taking very dangerous risks.”
These players become even more stressed with big events coming up: “I deal with a lot of sportsmen who need to return to action quickly as they’ve got the World Cup coming up, or the FA Cup Final in a few weeks.
“Often, you have to use less conventional, riskier methods to make sure that they’re back as quickly as possible. That can be incredibly challenging, but it’s not too hard. I love my job!”