For all future F1 docs

I’m constantly contacted by medical students and young doctors who wish to devote their lives and careers to Formula 1. They seek advice as to what the best path to follow to actualise that desire. Here in a nutshell is my answer.

First of all, I know almost no one in motorsports medicine for whom it is a full-time job.This includes some of the most well-known and important guys doing this. There are a number of reasons for this, including the weekend nature of the sport, the fact that to maintain any level of competency one needs constant clinical exposure, and the fact that very few (non corrupt) motorsport associations can afford to pay doctors a full-time salary for what is basically a hobby. A time-consuming, passionately engaging, and extremely serious and rewarding hobby to be sure, but a hobby nonetheless.

DO NOT ENTER THE FIELD OF MEDICINE BECAUSE YOU WANT TO BE A “F1 DOC”. Become a doctor because you want, need, cannot BUT, be a doctor. If what keeps you going, through the long grueling years of studying, through the 100 hour weeks, the emotional and physical hardships of training, is the ultimate goal of being in the front seat of the medical car, GET OUT NOW. Not just because of the extreme statistical unlikelihood that it will happen, but because the motivation needs to come from the day to day practice of medicine, not from what or where you want to be . . . years later.

In terms of the skill set you need to work in motorsports, pick the field of medicine you love. The one that fulfils you. The specialty that fits your personality. It doesnt matter if it’s dermatology, ob/gyn, anesthesia, emergency medicine, or endocrinology. Remember, you need to wake up every day and go to work. And if your first thought is “shit, another day in the clinic seeing diabetics” or some such negativity, you’re going to be miserable.

To be effective at a circuit, at a rally, drag strip, etc, you of course will need total mastery of the basics of trauma care. Taking and passing courses such as PHTLS, ATLS (or perhaps more usefully the European Trauma Course) is obligatory. And only then can you start to take these certificates and turn them into real, reflexively available, psychomotor skills. I know psychiatrists, dermatologists, etc, who are marvellous motosports docs – because they’ve taken the time to learn what they need.

Get involved with the sport you love early. Start hanging out at your local venue, whether it be a hill climb, rally, circuit … Get exposed to the work, the environment, the organisation. Start to meet and know the people, and to let them know you. It’s a pretty small world, and by the time you’re ready to get out there, you’ll have built up a circle of friends, mentors, and colleagues.

Work as much as you can. I remember when i first met Sid. I’d been a consultant anesthesiologist for years, but had been doing motorsports for only a few months. I remember he turned to me on the Sunday and said “you know old boy, in five or ten years, you’re going to have figured this thing out, and you might be pretty good”.  I was, of course, shocked. But, of course, he was right. It takes a long time to figure things out. In every way. Be patient, keep your eyes and ears open. Find a mentor, and engrave everything he or she says in your memory. And be safe, right from the get-go. It’s a dangerous environment, and mistakes get paid for in cash. Protect your ears from the beginning. Thresholds are such that ANY exposure will immediately start killing your sensory cells. They don’t grow back, and you won’t notice it until it’s too late. I’ve been extremely careful since the beginning, and I’m the only person I know in any position with fully intact, audiogram-proven, hearing. Everybody else is well on their way to becoming functionally deaf.

If your personality, your medical orientation, and your needs point you to a more “acute” specialty, then the obvious constitute fantastic preparation for prehospital trauma care. Emergency Medicine and Anesthesiology – nothing like them to give you the knowledge, technical skills and reflexes necessary for immediate, life-saving decision making. Then go on and learn the principles of mass casualty management.

Hope this helps. Post your questions to the comments, and I’ll get to them as I can.

Back at long last

Hey everybody!

It’s been forever and I’m thrilled to feel my fingers banging away at my keyboard. Tons of stuff to talk about, but I’ll split it into a few posts.

Leaving Belgium was a totally bittersweet experience. It’s essentially the only job I’ve had since finishing my training, and it occupied the vast majority of my adult life. On the other hand, it was me who decided to become an expat again.

Saying goodbye was deliciously moving, sad and hopeful at the same time. My co-workers were fantastic and lovely and heartbreakingly nice with me as I got ready to leave. I’ll never forget any of them, and of course I’m looking forward to seeing them and the hospital again.

As any of you who follow me on Facebook have seen, I’m completely enchanted with Abu Dhabi. I’ve been here for six weeks now, and am nowhere near coming down off my cloud.

Leaving aside the weather, the sun (feels like a reunion with a long lost friend), and the sea, what makes this place magic is the people.

On an average morning, from waking up until getting to the OR, I interact with people of at least five to ten different nationalities and cultures. And everyone is full of respect, usually smiling, and displaying an openness that is completely new for me. I’ve thought long and hard about the origins of this, and while I’m not sure I have AN answer, what I came up with surprised me. A lot.

Of course there’s the weather, and how it buoys the spirit. Of course there’s the pay – remember that most people, regardless of their job or station in life, are usually earning more than they would had they been home rather than here (Please don’t assail me with the horror stories. I know they exist, but I’m here and you’re not.) But there’s more.

For me, the explanation of the incredible vibe here is . . . Islam. Yep, that’s what I said. Islam.

You see, Islam is more than what we think of as a “religion”. It’s more than just a set of rules and practices and going to Masjid (the Mosque). Islam is about how to live. From waking up in the morning to waking up the next morning. (Sound familiar to any Orthodox Jews reading me?) The respect and openness that pervade and permeate life here are, for me, proof that this is not just talk. It is the essence of life here. I suspect that the number of devout people here is only slightly higher than in the west. But the principles really reach far into the fabric of day to day life here. And it is wonderful.

One sees it in little ways, constantly. “Inch’allah” – if it pleases God. Used after EVERY evocation of a future event. See you tomorrow, inch’allah. I’m having curtains installed tomorrow, inch’allah. What a lovely way to constantly remind ourselves that much as we’d like to think so, we dont really control what happens to us. Or “al hamdillulah” – thank God. Of course, we use that too, all the time, but here it’s deeper, more heartfelt. And used every time anything good is evoked. So much so that when you’re asked – how are you?, you can simply answer “hamdilullah”. There are other expressions, all of them delicious and almost moving. It’s constant, and it’s refreshing, and I’m sure it’s part of what makes this place so wonderful.

I’m ordinarily a seriously grumpy guy, and I find myself in conversation, sometimes deep conversation, with the most unexpected people. Taxi drivers for example, or the salesman where I rewarded myself with a briefcase (full disclosure, Longchamp, brown, beautiful). Malek is his name. A Syrian (right there you think, holy crap, is your family ok? And you realise it doesnt matter what side they’re on, what matters is the drama behind that). Malek is an archeologist, and we both wound up teared up at the tragedy of the richness of his country being torn apart. Or the staff in the hotel I stayed at until my apartment was ready. They’re all like cousins now. I stop back regularly just to catch up. THAT IS JUST NOT THE ME I WAS.

I’m not going to talk about my job now, for reasons that will become clear in the next weeks. Suffice to say that men are men, with their jealousies, insecurities, and pettinesses. So I’ve a bit of a bump in this marvelously smooth road laid out in front of me. Still less than anything Malek has confronted. More on this later.

I’m thrilled to be writing again. Thrilled with my new life. And blessed to have so many fascinating, curious intelligent people willing to read my words.

Next post imminently.

What the fuck is wrong with CVC, FOM, Bernie, the lot of them?

Wrote this last summer. Still applicable. These guys are going to run our sport into the ground, then get on their helicopters, land on their yachts, and sail away rich and happy. This sport is being run by immature greedy corrupt capricious adolescents. I’m sick of it. We all work so hard in our daily lives to do our jobs right, to do right by those who use our services – why can’t these idiots have a tenth of that conscientiousness? Anyway, here goes:

What is wrong with this picture?

I’m going to venture out of my usual terrain, and allow myself to talk about the sport of Formula 1 in general. This is brought on by a tweet this morning by the CEA, the (fabulous) crew of fire marshals at Monza (and Imola). The tweet shows the start of restoration on the tarmac at Parabolica. It jarred me to realise that even Monza has raised the spectre of no longer being able to host the Italian Grand Prix.

This summer has been oddly and uncomfortably full of ruminations and reflections as to what’s wrong with F1. Commissions have been formed . . . and disbanded. Those asking the question itself are accused of negativity. And meanwhile, a spine tingling championship is underway, with team orders given and followed, team orders given and disobeyed, and drivers battling as much with their minds as with their cars. And the cars – brand new, beautiful machines with power trains that are stunning in their sophistication. Is there anything REALLY wrong at all?

Let’s imagine something, to help me illustrate my answer to that question.

I’ve just built a bottling factory. Modern, efficient, state-of-the-art. And you, well you have a soft drink you need bottled. A very popular soft drink indeed. People all over the world want to drink it. And you want to use MY factory to bottle it!

When the time comes to do the deal, you tell me “there’s just one thing Gary. Our business model is a bit . . . unconventional. You see, normally I’d pay to use your factory. But since my beverage is SO popular, YOU’RE gonna have to pay ME for the privilege of hosting my drink”.

I guess you see the concerned look on my face. My factory cost money to build. It costs money to maintain. Everybody ELSE rents my factory when they want to use it. I seek reassurances.

“Don’t worry a bit, Gary, you can run guided tours and have people pay to see your factory working. And you can serve them lunch!”

I guess you see what I’m getting at. I’ll have to charge $100 for a tour, and get 100,000 people over the weekend. No way that’s gonna happen. A guaranteed loss. Every time. Damn.

Right now, as we all know, for $15 million or so, a circuit can buy the privilege of hosting an F1 race. And all it has to do to recoup that is to sell tickets and hotdogs. A lot of VERY expensive tickets and hotdogs. Not one cent of the TV revenues generated by that race, and not 1 metre of signage around the circuit can be used to generate revenue for the circuit itself.

It’s not FOM who makes F1 tickets astronomically expensive. It’s the circuits. Do the math. You need to make up several million dollars with three days of tickets, food, and beer. No wonder it’s only races with government support that avoid the year to year threat of bankruptcy.

So here we are with the backbone of the season, with virtually every European F1 circuit, either under severe financial threat . . . or gone. Spa, Monza, Silverstone, Hockenheim, Nurburgring, etc. This is insane.

Why do these circuits not do what any normal owners of crucial and rare resources would do? Form a cartel.

Why do the owner/operators of the “classic” circuits of the season not band together to put an end to the bizarro world of F1 circuit use. You want to use our infrastructure? It will cost you this much, plus a percent of global TV revenues (averaged over a season, to avoid late season races, with their bigger box offices, earning more just by their place in the calendar), plus some portion of the signage at our circuit.

Sure Bernie will bluster. He’ll threaten to go elsewhere. And to some extent he will go elsewhere- he’s been “going elsewhere” for years now. But remember a few things:

  • F1 homologated circuits are not a dime a dozen. They are rare birds indeed, and the lag time from project to race is YEARS.
  • Google earth is littered with abandoned Tilke-domes, each having cost $200-400 million. Think Istanbul, Korea, India. (What will archeologists in 500 years think these things were?) Only governments awash in petro- (or narco!) dollars will keep building these white elephants, and even that will ultimately peter out. Even the most corrupt autocrats have better ways to waste $400 million!
  • Even if FOM moves strategically away from Europe, it’s wrong to think that the circuits will be losing a prestigious money-making event (countries might be, clubs might be, fans might be . . .); in FACT, they’ll be (temporarily, see below) losing their biggest headache of the year. As a taxpayer here in Belgium, the question of who exactly is going to foot the known and expected loss from the upcoming Belgian GP is a perennial favourite, of which I’m growing quite sick.
  • FOM cannot, by the nature of the series, reduce the number of European/North American/South American races well below half (or slightly more) of the season. How many corners on ANY new-ish circuit do you remember? Is there an Eau Rouge? A 130R? A Becketts-Maggotts complex? A Tabac? This is not a diatribe about circuits, but dammit, they really ARE intimately involved in what we love about the sport. People will not get up early, or stay up late, to watch a race if this is not felt viscerally to be a EUROPEAN series. They’ll watch the evening news, and see the best overtakings and the results . . . and there go your TV revenues Mr. E. Sooner or later, European races will have to comprise close to the bulk of the season, with a smattering of exoticism added, because it’s F1.

Enormous advantages would accrue from a system like this. Not least would be a significant lowering of ticket prices, and an opening of the sport to a wider audience AT THE CIRCUIT. And as you all know, once you’ve seen this sport live, you’re hooked forever!

A different system for distributing revenues from the sport would vastly increase the “health” of the infrastructure supporting it. The team principles, until now staggering by how completely they ignore the long term interests of the sport that gave them all yachts and Gulfstreams, and FOM itself, would have to make do with slightly less. But the pillars of our sport would survive and flourish, and government support for what many view as a frivolous pastime would largely become unnecessary.

Rant over.

Part 2: Todt & Saillant – le dénouement

(Link to first post: Todt & Saillant: le dénouement part 1)

On January 16 2015 I received an answer to my request that the FIA open an Ethics inquiry about Gerard Saillant’s trip to my hospital to interfere with my employment. Here is that answer (click on it to enlarge – open it in another tab so it’s easier to follow along):

PreviewScreenSnapz002

I think it might be useful to just consider this letter, point by point. As I mentioned in my last post, I think this letter is illustrative of just how detached from the real world the FIA hierarchy is.

The author is Todt’s chief of staff. He was previously in charge of sports-related stuff on Fillon’s (ex-French PM) staff. I have never met him. He would appear to be part of a wave of ex-political types hired by Todt, apparently desirous to be surrounded by people felt to be able to help his unquenched political ambitions.

Let’s proceed.

1) I do not PRETEND to be anything, my dear Jean. I WAS outraged, and now am left with only residual nausea. But really, sir – how Putin-esque can your language be? Private and informal? Do you really take yourself seriously? I will comment no further on this point. The ridicule and scorn of those who will now see it suffice largely.

2) For someone who worked under a Prime Minister, Xavier, you’re not doing a good job of advising Jean about the not particularly difficult-to-fathom notion of what the word PRIVATE  actually means. I’m glad you’re a chief of staff and not a judge! Private  in this sense, Messieurs, is meant to distinguish those aspects of my life that are the proper purview of my EMPLOYER, and therefore subject to a specific set of rules and regulations, from those that are nobody’s business but mine. It has nothing to do (this would be laughable if it weren’t so pitiful) with how large the AUDIENCE of that activity might be. This is not a question of 4 people at a dinner party being private, but a blog being public. Again, if you actually MEAN what you write about this, it’s totally shocking that people with such flimsy notions of fundamental principles are in any sort of position of responsibility.

3) I’m rather surprised that this private and informal (can’t help the chuckles!) visit concerned a subject about which I’d not written for 6 MONTHS. Yep. Nothing about Michael since June 2014. And the visit took place in December. WTF? I guess the FIA is a great lumbering machine, and that it took time to book the tickets for Gerard. OR . . . this was about something else. Something rather more contemporaneous to the visit. Hmmmm. Wonder what that could’ve been? Grin crosses face. Smug grin.

4) OK, I’m starting to feel bad now. I think you should have written to me in French, because it’s impossible for me to imagine that you don’t know that the word, and process of, DIAGNOSIS involves examining a patient, taking a history, doing examinations and considering a range of differential diagnoses. Why, oh why, do you conflate what I wrote about Michael with DIAGNOSIS? I surely didn’t, and if you’d bothered to read, and tried hard to understood, my writing, you’d know that. My blog has 1.5 million readers (I know, right?!) and almost none of THEM were confused.

5) Allegations? I’m growing weary of your consistent misuse of my language. I considered a range of possiblities when discussing Michael’s situation. Nothing more and nothing less. By the way, just so it shouldn’t be total loss, Jean, here’s the definition of “allegation”:

“a claim or assertion that someone has done something illegal or wrong, typically one made without proof”

Are you SURE you’re talking about Michael here, and not something ELSE I might have said???

6) While we’re still on this paragraph, rich with confusion, I’m not clear where Jean Todt was mandated by anyone, as president of the FIA,  to become involved in what was written about Michael Schumacher (as far as I know, no longer under Todt’s employ for quite a number of years now). Did the FIA Senate decide that this was worthy of the FIA’s time and money? Was this a whim of the president, or did the proper structures approve the funds for the dossier, for the hundreds of hours of secretary time to constitute it, for Saillant’s train and hotel? Did the General Assembly? Do you even realise that using corporate funds for private tasks (yeah, PRIVATE, and here I’m using it correctly) is ILLEGAL??? This is what your ethics committee was requested to consider. Your utter blindness to this speaks volumes as to your sense of good governance. Shame on you.

7) Because Michael was never my patient, the usual tenets of medical ethics, which involve the relation of the patient to the health care system and its constituent components, do not apply. My relation to the person next to me on a bus or on an airplane is governed by ETHICS, not MEDICAL ethics despite the fact that I happen to be a physician! Thus the same rules apply to what I write as to anyone else: as long as what ANYONE says publicly is neither slanderous, libellous, or dangerous, and conforms to very few other exceptions (eg, holocaust revisionism is illegal speech in France), HE OR SHE IS FREE TO SAY IT.

8) My past position at the FIA is what it is. If it increases my readership, so be it. On the other hand you again are using words you don’t understand. Slander is defined as “the action or crime of making a false spoken statement damaging to a person’s reputation”. Find where I was slanderous. I dare you.

9) You and Gerard have your reasons for wanting me fired. In fact, you actually fired me! We’ve understood that for some time now. But let’s be clear about something: you might not like what I write, but there is absolutely nothing unethical about my blog. You, on the other hand, with your “discuss with a fellow of the medical community” line are again being disingenuous, to not say mendacious.

10) Professional ethics authorities? You keep repeating yourself. THIS HAS NOTHING TO DO WITH MEDICAL ETHICS. I don’t fancy myself a journalist (I don’t drink enough!), but what I write on my blog would  involve journalistic ethics rather than those you so conveniently (and wrongly) obsess over.

11) As for your closing, here’s an analogy:

you : sincere = me : batman

There, guess that just about takes care of it.

Sound of grimy hands being wiped on overalls. Sound of overalls being burned!

I’ll post a bit about the “dossier” Jean had the FIA assemble within the next few days, then I’m done with this, and with them.

Todt & Saillant: le dénouement part 1

I wanted to finish up once and for all, and relate the “dénouement” of the Saillant-gate affair. Here’s a link to my post immediately after finding out Saillant had paid a severely ill-intentioned visit to my boss here at the hospital:

An open letter to Gérard Saillant (oh yeah Jean Todt too)

My boss, who is also the Dean of the Medical Faculty, asked Saillant (the president of the FIA Medical Commission and of the FIA Institute) two questions: 1) does Gary speak in the name of the hospital? 2) does Gary reveal information that is obtained illegally or that represents a violation of doctor-patient confidentiality? Because the answer to both is, of course, no, Saillant was sent packing. The next day, my boss gave me the “dossier” that the FIA had painstakingly put together detailing all the reasons I should be fired. We will look at this together in a subesequent post.

My attorneys informed me that because Todt and Saillant’s underhanded, slimy and reprehensible act caused no actual damages to me, legal recourse would be moot. I therefore decided to request that the FIA convene their ethics committee to enquire about this affair. I therefore addressed the following registered letter (click it to enlarge) to Todt just before Christmas 2014:

PreviewScreenSnapz003

I was, of course, under no illusion as to the outcome of this request.

We will dissect the FIA’s response in my next post. It is highly instructive, and provides fascinating insight into just how perverse these guys’ concept of governance is. And just how oblivious to any normal standards of behavior they are.

More importantly for now is for me to highlight the fact that within days, Todt and Saillant viciously attacked Philippe Streiff. This, the same Philippe Streiff who idolized Saillant as his savior (I will omit details of his case that would rather call this into question!), and who entertained extremely close relations with him for almost 30 years. Philippe, a staunch defender of Todt and Saillant, was unceremoniously thrown under the bus, like an old newspaper. He was humiliated into publicly backing down and apologising (the fact is celebrated in the twitter feed of Xavier Malenfer, Todt’s chief of staff!), under threats of legal action based on some imagined “calomny” (their threat of a legal case, naught but an odious scare tactic, would have been thrown out perfunctorily – there was neither libel nor slander). And for what?

For an interview that was hardly seen by anyone, but was widely quoted. For saying what needs to be said: that the FIA has not been open about their “inquiry” into the circumstances surrounding the Jules Bianchi accident.

I believe that both Philippe Streiff and myself drew the gangster-like wrath of these two critters BECAUSE THEY ARE PANICKED. It is my firm belief (and their actions certainly don’t belie this!) that they are SO legally vulnerable for the management of the Bianchi accident that they probably fear not just for their cushy posts at the FIA, but for their freedom and fortunes. If Mr. and Mrs. Bianchi decided to hire lawyers and to demand clarity, I am relatively certain that the fact that Piette deliberately ignored HIS OWN REGULATIONS (as concerns evac, among other problems) would be ruled legally as contributing significantly to his current state.

Let me make things as clear as they can be. I worked with Jean-Charles Piette, the current F1 Medical Delegate from 2008 to 2012. During this entire period he was OBSESSED with the rules governing helicopters at F1 events. Remember, this is the man responsible legally for the medical/rescue services at F1 races. It was he who held up the GP2 race at Spa in 2012 until the helicopter returned from evacuating a previous casualty . . . for well over an hour. And yet, inexplicably, despite weather conditions that were known to preclude landing with a victim at the designated receiving hospital, he let the race proceed. And then, he allowed a profoundly comatose driver to be ground evac’d (40 minutes vs 20!!!!).

I’ll post and analyse Todt’s reply (actually written by his hatchet man Malenfer) to my ethics request later, and look briefly at the absurd “dossier” they compiled. Then we’ll be done with this. And I, hopefully, will never have to mention either of these . . . people . . . again.

A win for Formula 1

No matter how you slice it, Fernando’s decision to not drive in Australia is a proof of his intelligence, maturity, and understanding of “the big picture”. My assumption is that he is suffering from concussion. Although there are curious elements in the story we’ve been told, if we “simply” put together a few relatively objective tidbits, they would appear to spell “concussion”:

  1. an impact to the head
  2. talk of loss of consciousness
  3. talk of retrograde amnesia (loss of memories of events BEFORE the trauma)

What we’re worried about is twofold. In order of importance this would be: concern about a driver whose brain was not functioning optimally at the helm of an F1 car, and concern about second impact syndrome.

(here are links to previous posts about concussion, or MTBI):

https://formerf1doc.wordpress.com/2013/10/26/we-really-need-to-have-a-word-about-baseline-concussion-testing/

https://formerf1doc.wordpress.com/2013/10/27/what-about-return-to-competition/

That’s why it’s crucial that all symptoms and signs (respectively subjective and objective) of concussion are totally resolved before resuming competition. Let’s briefly remember two things – both of them correlations. First of all, we have to remember that the correlation between the force applied to the head and the severity of the concussion is quite . . . coarse. Every ER doc has seen patients with huge hits who are only mildly concussed, as well as patients who’ve only tapped their heads mildly and are totally in outer space! This might help us understand how Fernando could have a concussion that’s enough to keep him out of action this long with an impact that was, all things considered, not that heavy (although I HAVE heard it was, in fact, high speed). The second correlation that’s notable for its weakness is between the severity of the concussion and the time it takes to get over the symptoms. My conclusion? There’s nothing suspicious here . . . yet. Statistically speaking, there’s an extremely high probability that Fernando will be fine for Sepang. What about if not? I think that if for some reason Fernando doesn’t drive in  Malaysia, we’ll certainly have more information by then – because at that point, we’d very clearly be into new territory (still conceivable, but . . .) in terms of concussion recovery in our sport. Lastly, I’m immensely proud of this sport. This is a mature decision, clearly prioritising what’s important. It indicates just how pervasive the culture of safety regarding head injury is in Formula 1 – a wonderful legacy of Prof Sid!

Let’s make this short and sweet

Ahem. Aheeeemmmm. Throat clearing noises. Rusty voice.

Hello all.

In the midst of this hopefully flash-in-the-pan little incident I just wanted to make a few points. So here goes:

1) behind this all is Fernando. Certainly at least the equal of the best driver of his generation, a fantastically nice guy, courageous and generous – a real star. Just get better fast Fernando!

2) let’s also remember that we have no right to any medical information. It’s just not our business. But Fernando is a public figure, and so his fans DO have a right to be treated with some degree of respect.

3) The confusion, improvisation, inconsistency, and outright silliness of the various press contacts most certainly do not represent malign intent. Between privacy concerns, insurance issues, sponsor considerations, getting comms right in these circumstances is not easy. As, ummm, we’ve just seen.