FIFA must do better with concussions
I'm not a doctor. In fact, medical stuff tends to creep me out. Not the graphic side of it like rashes, fractures, blood or insides -- I can handle all that. What I've always found unsettling is the uncertainty of so much of what doctors do.
They observe ... and that observation may be incorrect. They judge, based on that observation, as well as their own experience and what they know from the textbooks ... and that, too, maybe incorrect.
And, finally, they diagnose ... but that too, may turn out incorrect because they're asked to play percentages and likelihoods.
Writing in The New Yorker years ago, Atul Gawande described with heart-wrenching accuracy how much of a trauma doctor's job was about figuring percentages and probabilities. I thought back to that as I watched Alvaro Pereira laid out cold on the pitch in Sao Paulo and the Uruguayan team doctor, Alberto Pan, hunched over him.
It's worth bearing this in mind when criticizing what happened in that Uruguay-England game Thursday. Forty-four seconds elapsed between the moment when Pan leaned over the prone Pereira and the instant when he appeared to signal to the bench for a substitution. That's when Pereira got annoyed and announced his intention to return to the game. Shortly thereafter, he was back on.
Pan submitted a statement after the match in which he confirmed for the record that he had completed a full neurological examination of Pereira and determined that the player was able to continue.
Here, you either put your trust in doctors or you don't. You either accept that Pan gave Pereira the same "full neurological examination" that he would give any other patient in any other circumstances, or you don't.
Many people are skeptical, starting with FIFPro, the players' union. It issued a statement calling on FIFA to review its own concussion protocols, and suggested reviewing the Laws of the Game so that a concussed player can be temporarily substituted while he is properly and thoroughly diagnosed.
ESPN's Taylor Twellman, whose own career was cut short by head injury, pointed out that the dangers of "second-impact" syndrome -- in short, suffering a blow to the head while concussed -- can be fatal.
“The Laws of the Game may be sacred to some, but they are not sacred enough that they should come before the safety of the players.”
Dr. Pan may well be satisfied with his neurological examination. And maybe he's right. To much of the world, however, it looked like something different. It looked as if a player overruled a medical professional. Pereira himself said he was "dizzy" and at "that moment [with] your adrenaline flowing in your body, maybe [I acted] without thinking."
Which is precisely why players are paid to play and doctors are paid to protect players from serious bodily injury.
There's an easy way around this, and it follows FIFPro's suggestion. FIFA has doctors and medical officers at every ground, and in fact, part of their job is to even determine when it gets so hot and humid that teams can have water breaks.
To avoid the appearance of a conflict of interest, it seems only logical that these ought to be the folks who determine when a player in Pereira's condition gets the all-clear to return to the pitch, not the team doctor. And if it means allowing an extra, temporary substitution, so be it.
The Laws of the Game may be sacred to some, but they are not sacred enough that they should come before the safety of the players.
Pan was put in a horrible position on Thursday. If, in giving the all-clear, he was able to act entirely according to his conscience, to the hippocratic oath he took and to his years of experience as a medical professional, he is a strong, principled and courageous man.
But frankly, I doubt that every single team doctor is that strong and courageous. And it takes only one doctor to be swayed by team allegiance and the desire for victory for a player to be put in a life-threatening situation.
That's why it's time to have a clear protocol administered by independent medical professionals.
Gabriele Marcotti is a columnist for ESPN FC, The Times and Corriere dello Sport. Follow him on Twitter @Marcotti.