FEATURE Dr James Robson: 'My job is one of the most privileged but the toll it takes is phenomenal'

After 33 years of attending to the medical and emotional needs of Scotland’s players, Dr James Robson would have known not to rely on a victorious farewell as he bowed out of international rugby in Dublin last Saturday.

At least there were no orthopaedic calamities to concern him, and he had a close-up view of the courage and resilience Gregor Townsend’s team displayed under heavy Irish fire despite ultimately coming up short at the Aviva Stadium.

‘The Doc’ or ‘Robbo’, as he was more familiarly known to hundreds of players during a storied career with Scotland and the British and Irish Lions, had already been granted his valedictory goodbye three weeks earlier on home turf.

The sight of Robson, 66, being lifted into the Murrayfield sky on the broad shoulders of Scotland prop Pierre Schoeman and hoisting the Calcutta Cup aloft, before being serenaded by a jubilant crowd on a lap of honour with the players, was a memory this most dedicated of rugby men will treasure as he heads into retirement.

“It was truly unbelievable,” Robson recalled. “I was standing at pitch-side delighted that we’d won and that we didn’t have any serious injuries and all of a sudden Finn [Russell] said ‘Doc, take the bib off, you’re coming with us’.

“I thought I was maybe going to get the privilege of standing to the side but they ushered me round into a central spot and next minute Schoe’s head pops up between my legs and then I’m on his shoulders and Finn comes and gives me the cup… it’s like a dream now.

“I thought I’d get that over with, get down off his shoulders and that’d be me done, but the boys said ‘you’re coming with us round the pitch’. It was truly magical for me and for my family.”

It certainly resonated with players and colleagues who have had cause to be grateful for Robson’s sterling service, knowledge, advice and support over the past 33 years. It took several days to respond to more than 500 messages he received following  his Calcutta Cup lift. “It’s truly remarkable. I didn’t know I knew 500 people.”

I could go on for another two or three years, I think, but time is marching on. I am 66. I am slower, but I’ve got enough experience that I can compensate for slowing up a little.

Look carefully at a clip of Duhan van der Merwe’s stunning second try against England that day – the touchline sprint from 60m out and flamboyant finish at the left corner – and you’ll see Robson scurrying up the same side of the pitch for the first 20-30m.

It’s not entirely clear if he’s running a good support line hoping for a pass or expecting the big wing to pull a hamstring at any moment, but perhaps illustrates his well-honed nose for where he might be needed next as a game unfolds, despite his advancing years.

“I was holding back to make him look quicker!” Robson quips. “He wasn’t carrying a 12lb bag, he was carrying a very light ball! Seriously though, I know I have slowed up. I could go on for another two or three years, I think, but time is marching on. I am 66. I am slower, but I’ve got enough experience that I can compensate for slowing up a little.

“You put yourself into the position where you can see what you need to see. That’s what I say to young doctors and physios coming through. You have to learn the intricacies of the game very carefully. You have to know where your position is. You don’t necessarily have to be that fast, you’ve just got to be accurate.”

Since he was first asked by the late Donald McLeod, then Scotland’s team doctor, if he could take three weeks off work to join a tour of North America as a physio in 1991, Robson’s judgement and diagnosis has rarely been anything but, and yet he admits he fell into rugby by chance.

While he was away in Canada and the United States that summer, the regular Scotland physio was headhunted by Glasgow football giants Rangers and in a Rugby World Cup year, the SRU were suddenly searching for a permanent replacement.

“They came back to me and said ‘is there any chance of you getting six to eight weeks off?’” Robson said. “I went to see my trainer and he was a Scotland fan…really it was an accident. I went into the consultant, all my colleagues had agreed I’d work five months solid, then I’d go. I put the form in front of him and he said, ‘before I sign it, you wouldn’t have access to two tickets to the Ireland game, would you?’ So I put two complimentary tickets that Donald had sent in front of him and that was it.”

After those first few years where his entire holiday allowance would be used on rugby tours and tournaments, Robson eventually had to give up general practice as his commitment to the sport expanded and the game became professional.

Doddie has a special place in my heart. He was such a gentle giant and would do anything for anybody. For somebody who was in such a rich vein of form, he needed that information but it was devastating for him.

Robson’s sprightly, watchful, fidgety pitch-side presence – ready to run on at any moment – was a constant across 284 Test matches, including eight Rugby World Cups (he missed the 1999 edition due to commitments with other Scotland teams) and six Lions tours from 1993 to 2013.

The second of those Lions expeditions in 1997 – “still the best tour that I’ve ever been on” – made Robson something of a household name, at least in rugby households.

The seminal ‘Living with Lions’ tour video brought the close relationship between the squad’s medics and players into sharp focus, no more so than in the heartbreaking scene when Robson had to give Doddie Weir the distressing news his tour was over after a notorious piece of thuggery from Mpumalanga lock Marius Bosman, who stamped on Weir’s knee.

“Doddie has a special place in my heart,” Robson said of the inspirational former Scotland lock, who died in 2022, six years after being diagnosed with motor neurone disease. “He was such a gentle giant and would do anything for anybody. For somebody who was in such a rich vein of form, he needed that information but it was devastating for him. Somebody said to me at the time, ‘why didn’t you wait for the scan?’ But it was a clinical feeling, I just knew his knee had gone, and it was such a dastardly act. So that was one of the worst.”

On the same tour he gave life-saving treatment to former England centre Will Greenwood, who stopped breathing for several minutes after suffering a serious head injury against the Cheetahs in Bloemfontein. Greenwood describes Robson as “just an amazing human being”.

His worst experience on a rugby pitch – but perhaps his finest hour, in a professional sense – came at Cardiff’s Principality (then Millennium) Stadium in 2010. What proved a career-ending neck injury to Scotland wing Thom Evans might have been so much worse but for the skill of Robson, assisted by Wales counterpart Mike Fardy and Scotland physio Lisa Casey.

The surgeon who operated on him that night said there was literally millimetres of leeway.  It goes without saying that once you analyse it, it becomes more horrendous.

“You knew as you got to him pitch-side that something was really seriously amiss,” he recalled. “Thom said to me, ‘James, I can’t breathe’. I said, ‘Thom, you can breathe because you are speaking to me. Anything else?’ He said, ‘I can’t feel my legs’. That is just the worst thing you can possibly hear. We had to get a young man in his prime, from nose down to face up, onto a stretcher, triply immobilized without moving his neck.

“The surgeon who operated on him that night said there was literally millimetres of leeway.  It goes without saying that once you analyse it, it becomes more horrendous.

“We had just started doing the pitch-side care courses and were training for that very eventuality, hoping it would never happen. Fortunately for us there was an immense outcome. Thom did really well and is doing really well.”

Robson has been at the forefront of advancements in pitch-side care and protocols around head injury assessments. A year earlier, an incident in another Scotland v Wales fixture, involving another Scottish wing, proved pivotal in the development of the HIA process.

“The seminal point for me was when we played Wales and Simon Webster got injured,” Robson said. “I missed that – the world saw seven replays of Simon getting knocked out temporarily. What we learned from that was video, and people observing the game, can actually help to inform the medics. Then you get the HIA advancements, now we’ve got the mouthguards. I think we’ve got another year or two in that journey for the mouthguards, but with the strides we’ve made even in this Six Nations, I have to compliment World Rugby for their vision in pushing it.”

Robson raised his fears about where the game was heading after the second Lions Test of an enthralling 2009 series in South Africa. An epic encounter in Pretoria proved a particularly busy one for Robson and his staff, with five Lions players – Adam Jones, Gethin Jenkins, Brian O’Driscoll, Jamie Roberts and Tommy Bowe – all ending up in hospital.

“It was the most brutal game I have ever been involved in,” Robson recalled. “I said that at the time and even on reflection, that hasn’t changed. I remember being quite angry about what was happening in the game with the collisions and the brutality. I think that came across and we started to move away from just running into each other after that. I believe that game was quite critical and from that low point, I believe everybody is striving to make it safer and therefore preserve it.

“We should never shy away from the discussion that is happening – about whether children should be tackling, at what age kids should be. A few years ago someone asked me if I was worried it would put people and parents off when you are talking about injuries. I said they should be more worried if we are not discussing it. We have to continue to have a healthy debate. You’ve got the people who think rugby should be banned altogether, and you’ve got people who think rugby has gone soft. There is a large swathe of us in the middle and we’ve got to find a way through.

“We’re moving forwards and I hope we continue to move forwards because we can never rest on our laurels. We endeavour to make the game as safe as we can, and I hope that my successors will continue the work we’ve done.”

I sleep badly because I am on for 24-hour care. I am the only person in the group who goes to bed with his phone on, thinking I might get called. Twenty out of 21 days you don’t, but the one time you do, you can be up all night. It is the anticipation of that need.

It is perhaps a sign of Robson’s phenomenal expertise, dedication and breadth of experience that Scottish Rugby are recruiting separately to fill the two positions – Chief Medical Officer and Scotland Team Doctor – he has held for the last 19 years.

One of his legacies will be the brain health clinic at Murrayfield he helped set up two years ago for former international players to be assessed for risks to future brain health, including preventing or slowing down dementia in later life.

He hopes to stay involved in some aspects of player welfare and is “in negotiations with a few people” about a possible part-time role. Rugby, after all, has been his life. “It’s a drug,” he admits.

But the past few years have also been challenging, with the family of the late former Scotland international Siobhan Cattigan initiating legal proceedings against Scottish Rugby and World Rugby.

Robson is unable to speak publicly about that particular case, but he did acknowledge more generally the impact of making critically important medical decisions, being in almost constant demand on tour and so closely connected to so many players down the years.

“As a doctor, you endeavour to do the best you can every day. Sometimes it does involve legal issues, but at heart, people don’t go into medicine looking to be obstreperous or blocking. They go into it because they actually care.

“My job is one of the most privileged in that you get to know someone’s intimate personal life – illness, infection, surgery, a relationship break-up. It is a privilege to be allowed into that space and share those anxieties. But it has a knock-on effect because you can only deal with that so much.

“Over the last 33 years, I have prided myself on trying not to make too many mistakes. You’ll always make mistakes but you endeavour to make as few as you can. The toll it takes on the clinician is phenomenal. I sleep badly because I am on for 24-hour care. I am the only person in the group who goes to bed with his phone on, thinking I might get called. Twenty out of 21 days you don’t, but the one time you do, you can be up all night. It is the anticipation of that need.”

Robson says he coped with the pressure by “compartmentalising”. When not in “rugby mode”, he tried to stay in “family mode”. Some travelling with wife Christine, rather than a huge squad of players and staff, is firmly on his retirement agenda.

“The way I have dealt with my stress over the years is to make sure I take my family on as many holidays around the world as I possibly can and leave my phone in the drawer so I can’t possibly answer,” he said.

Not that it always worked. Robson recounts a tale of when he was out on a 15-mile trek in Perthshire with Christine during Covid times. He had left his phone at home. Christine hadn’t.

“All of a sudden a call came through from the SRU and she just went bananas! We were seven miles in and they were asking whether Edinburgh could fly to France because of Covid. I was like ‘guys, give me a break’. Sometimes you have to remind other people that even the doctors and medics need some breathing space.”

He’s earned his, that’s for sure.