“You will bankrupt the hospital if this goes wrong”

By Nigel Brown

As part of #ThePursuit campaign, world renowned sports surgeon and author of Knife in the Fast Lane: A Surgeon’s Perspective from the Sharp End of Sport, Bill Ribbans talks to The Link about operating on Michael Schumacher, the role of the surgeon in sport, and why training the next generation of clinicians is still so important.

Legendary sports surgeon Bill Ribbans is due to put the scalpel down for the final time this March. His career has seen him consult and operate on Olympians and elite sportsmen and women — from Paula Radcliffe and Greg Rutherford to Michael Schumacher and Jessica Ennis-Hill — while also working for the British Boxing Board of Control, Northampton Saints, Northamptonshire cricket club and England’s rugby union team. However, there’s only one place to start with Professor Ribbans; that Michael Schumacher operation. Let us set the scene.

It’s 1999, Michael Schumacher has just crashed into a Silverstone wall during the British Grand Prix, after his brakes failed at 191mph. Schumacher was attempting to win a first drivers’ world championship for Ferrari. The German has a broken tibia and fibula and needs an urgent operation. Jean Todt, Ferrari’s team principal at the time, wants Schumacher to be flown to Paris for surgery, rather than be operated on in the UK.

“Looking back it was an incredible experience,” Ribbans says. “But you must remember, as a surgeon every patient should be treated the same. You head to your zone. I remember it well. Jean Todt was suddenly standing next to me, I’ve no idea how he even got into the operating theatre.

“He said while poking me in the chest: ‘I’m paying Schumacher $16m to drive for Ferrari. For me to allow Michael to have an operation in your hospital is a big responsibility, but it’s an even bigger responsibility for you.’

“The hospital chief executive was behind me. He was very pale and said: ‘You do know you will bankrupt the hospital if this goes wrong?’ — because Schumacher was an NHS patient.”

“It was a nasty tibia fracture but one we see all the time. Time to do our job and get on with what you do best. There were good medical reasons not to put Schumacher on a plane to Paris but I was also thinking: ‘Come on! If British orthopaedics, in the form of me, can’t sort this out then that’s not a very good advert for our surgeons.’ I was really pleased we managed to do it straight away rather than delaying — that was key to the success of the operation. I was home by seven that evening and it was all done and dusted. I was very happy with how it went.”

When discussing the operation Ribbans is keen to reiterate that as soon as he was in the operating room he was at ease. Comfortable in his environment. Comfortable with his craft. It’s at this point the interview turns to the need for education and the sharing of knowledge in surgical training. Experience for Ribbans is paramount.

Covid-19 has presented new challenges for trainee surgeons, in terms of access to the operating room, but it has also accelerated a need to educate, empower and encourage the next generation. For Ribbans, everything starts with not just better, but more education and collaboration.

“The most important area in surgery and one that I’m passionate about is training. Training is paramount from every part of the profession. There is so much know-how, so much expertise, so much knowledge to be passed on, shared and most importantly used. You don’t learn on your own and it’s modern tools that we need to embrace. It’s these technologies that can transform surgical training, democratising and increasing the sharing of expertise.”

Discussing education and his own career, it’s natural to ask how a young surgeon could look to specialise in sport, and how that pathway has evolved over the last 15–20 years.

“You didn’t really specialise in my early days,” he explains. “That was something that just developed. It’s not as simple or as linear as that. You can experience lots of different scenarios before you settle into an area where you are a so-called specialist. You can be encouraged to do that earlier and earlier, when the real aim should be the best all-round education and experience. That has to come first and foremost. Then after that you should follow your passion and what comes naturally.”

So, what would be his advice to surgeons who do want to specialise? And how does he think the pathway in sport will evolve? With healthcare moving to a pre-monitored, pre-emptive approach — simply reacting to sport’s injuries is a bygone strategy. A more holistic approach is evolving.

“You already have a wider team, more standardised so-called professionalism, protection and expertise available, which was the complete opposite to what it was like previously, or when I started. I mean you basically volunteered for free — in order to better help and understand your athletes. Its professional evolution has accelerated over the last 15–20 years, which I hope will only lead to more opportunities and better patient care.”

But for Ribbans, the most important question was the same then as it is now.

“You still need to ask, have you got the right experience and help in the room? That’s the key point for me. Technology and tools will allow for a more holistic approach — pre-emptive and ultimately athletes being more closely monitored. You know more about an athlete these days.

Sport’s institutions for example are more informed than ever on their players. With that in mind, the best will employ the best with a view to scenario planning, you can only see it heading more and more that way, so hopefully there will be more opportunity for those that do eventually want to specialise in sport. However, I would stress, start with experience, start with an open mind and build from there. Embrace the tools to learn and get those hours under your belt.”

Ribbans talks passionately about education. He wants to share his experience and his knowledge base. That’s what excites him in this next chapter of his career. An educational legacy is at the heart of what he wants to leave behind. While having a more than healthy surgical success rate, it comes with performing more than 700 procedures per year over a long period.

“I’m just beginning to wind down now so I have done less and less in terms of operating over the last year or so. I thought it would get easier as you get older and you’d be able to rationalise it. But I have to admit that I still have sleepless nights about patients. That doesn’t go away. It’s instinctive. It comes naturally. You just want to do your best for all your patients. I’m 66 and we’ve four grandchildren to look after, and I’m going to stop operating soon. I’ll still work as a sports doctor but I’m going to lay the scalpel down and focus on education. That’s somewhere I feel I can really make a real, long lasting difference because I’m passionate about it.”