Doctor's Review: Medicine on the Move

August 22, 2017
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A challenging season

Can the hockey playoffs help an FM resident pass his boards?

Preparing for the Family Medicine licensing exams is a daunting task. But with the exams this year coinciding with the playoff run of my beloved Toronto Maple Leafs, I was faced with a serious time-management challenge. If it were just the games it wouldn't be such a problem. However in hockey-mad Toronto, playoff coverage consists of at least two radio stations and one television station broadcasting the latest injury reports and prognosticator predictions 24 hours a day. Staying current is a full-time job -- so is studying for the exam.

I've always been a devoted Leafs fan. I remember seeing Borje Salming, the Leafs all-star, at a family bar mitzvah when I was just a kid, and that moment is still etched in mind, though I haven't the faintest memory who the bar mitzvah boy was. When I was planning a rotation in sports medicine, I contacted the physician who worked with the Leafs. I was heartbroken when the secretary told me that the resident isn't permitted to see the players (for obvious reasons).

The licensing exams were fast approaching; the Leafs were continuing to win games. Both needed my undivided attention. The hockey fanatic was at war with the conscientious resident. I needed a plan, and fast.

That's when it came to me: what if, instead of studying sports medicine out of a textbook, I were to read around the injuries which the Leafs would incur, injuries which were bound to happen with players swinging sticks at each other while travelling 100 kilometres per hour on a sheet of ice. I could examine the mechanism of each injury while watching the game, decide what investigations I would order and arrive at differential diagnoses and a treatment plan. I could then turn to my textbooks to learn more about the diagnostic possibilities and then check with the radio the next day to see if I was right. It seemed like the perfect marriage of textbook medicine with hockey fanaticism.

My first opportunity occurred during Game 4 in Ottawa. Mats Sundin, the Maple Leaf captain, was on a breakaway, about to score a goal (I'm a little biased) when he was tripped from behind and slid awkwardly into the end boards. Judging from the numerous replays, I concluded that he twisted his ankle along the boards when he collided with them and was travelling about 10 kilometres per hour at the time of impact. He was able to leave the ice on his own, but was obviously favouring the injured side and did not return to that game. I thought he suffered an ankle sprain, probably involving the anterior talofibular ligament. I considered using the Ottawa Ankle Rules to determine if Mats should get an X-ray, but balked at employing anything named after the Leafs' hated provincial playoff rivals. I figured that the captain and star player of the Leafs would get an MRI anyway. My treatment plan consisted of analgesia, ice, compression (a tensor bandage) and non-weight bearing activities for a few days, with a gradual return to normal activities.

I anxiously awaited the papers the next day to see if I would be proven correct in my assessment. As I sifted through the sports section the next morning, the front-page article included a terse statement from the coach that Mats Sundin had suffered a lower-body injury and his status was "day-to-day."

As I combed through the dozen or so other articles discussing the previous night's game (all in the cause of exam prep, of course) there was nary a word from the athletic trainer, team physician or Sundin himself. It would seem that divulging any information about a player's injury or the status of his return to play might give the opponent an unfair advantage. I suppose that philosophy might prevent an opponent from taking out a player's weakened knee, but it certainly didn't help me master the area of sports medicine. My management of Mats Sundin's injury might have been just what the doctor ordered or have been so misguided that it could have ended his career. I'll really never know.

Due to lack of cooperation from the Toronto Maple Leafs hockey organization, I now have to contrive a new approach for studying sports medicine for my exam. It's too bad, because sitting in the library with a bunch of textbooks isn't as appealing as watching a playoff hockey game, and as far as their comparative usefulness in preparing for the Family Medicine licensing examination, I guess we'll never know.

Jonathan Friedman recently completed his residency at St. Michael's Hospital at the University of Toronto and is awaiting the results of his Family Medicine exams. He began his hockey career as an undergraduate in McGill's intramural league and went on to play with his medical-class team at Queen's University. He is currently a free agent.

 

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