Sorry Mr Villas-Boas. “Concussion call ALWAYS belongs to Doctor.”




The BJSM represents an authoritative voice in sports medicine so it would be negligent if BJSM did not comment on the widely-reported ‘Loris concussion’. We begin by emphasizing that BJSM knows the Tottenham medical team and they are excellent. In 2012, they helped saved Bolton’s Fabrice Muamba’s life on field – and provided a global illustration of world’s best practice.

In my editor in chief role, I also underscore that this blog comment comes without having been at the game between Tottenham and Everton, without having watched the footage, and without having assessed the player.

The focus of this letter is on a media report, with the caveat that media reports can be wrong.

If the media reports are accurate, my respectful point Mr Villas-Boas, would be – ‘Please learn from this incident that the concussion call does NOT belong to you.’  Mr Villas-Boas, the  world concussion experts, including FIFA representatives, met in Zurich in 2012 and agreed that potential concussion incidents need medical assessment. This is in the best interests of player and of coaches. Imagine how a coach would feel if he or she were to overrule a doctor, insist a player return to play, and then watch helplessly as that player bled to death later in the game, or that night at home.

Letting a concussed player return to sport is not validated by how the player performs later in that game; nor does a normal MRI scan mean it was safe for the player to return. An MRI only visualises structure – it cannot measure the complexity of brain function. Many former NFL players with chronic headaches, depression, and suicidal ideas had normal MRIs shortly after their concussion episodes.

An entire BJSM issue, supported by various sporting bodies including FIFA and the IOC is freely available by clicking here.

I cannot pretend to imagine the pressures of being an Premier League coach and I apologise for writing in a public forum. But as BJSM editor, I have a responsibility to my constituency as you do to yours.

This open letter/blog merely comments on what has been attributed to you – “the call always belongs to me”. If this was an inaccurate quote, or out of context, I apologise sincerely in advance. If you agree that medical decisions should be made by your expert medical team then you and I  agree. If you believe that you, as coach, have ultimate medical authority, over and above the medical team, I have a professional responsibility to disagree vehemently. Given how widely this incident has been reported, your quote “the call always belongs to me” needs to be countered strongly in a public forum.

I have worked with many excellent coaches/managers – coaches who have reached the pinnacle in professional and Olympic sports. They unequivocally support the position that the medical team must have the final say in the concussion decision. In other clinical settings, such as after a hamstring strain, ‘return to play’ and ‘availability’ decisions are ‘joint decisions’. The medical team provides input to the player and the coaches/manager make a decision. The very crux of ‘evidence-based practice’ has the ‘patient’ at the centre of decision-making model with options explained by the clinician.

But concussion is different. Because of the player’s mental state, he/she is not any position to make a call. Coaches are not trained to make the call. World Cup Final. Champions League Final. Premier League clincher. It matters not. In suspected concussion Mr Villas-Boas, “the call always belongs to the doctor”.

I’m signing my name as a professional responsibility and I’m happy to discuss this if you feel anything I have said is not respectful or not true. I wish you and your team every success and I underscore what a great medical team you have.  Most respectfully, karim khan.


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