Imagine for a second that you were a ring doctor. It's your job to make decisions about the physical well-being of fighters and whether they can continue to fight or not. Sounds like a pretty cushy job, yeah? You get ringside seats to every fight, and how hard could it be to look at a cut and say, "Yep. That's a cut. Better call the fight."

It can be very hard. It's a much more complicated job than it seems, coupled with the fact that every decision a ring doctor makes can have serious repercussions across the board. Make a decision that's too liberal about a fighter's injury and you could be responsible for that fighter having permanent physical debilitations. Make a decisions that's too conservative about an injury and you could impact a fighter's career, the fights he can get and the decisions other ring medics and fighters make about him moving forward for the rest of his professional fight life. A little bit of pressure? You bet.

At the 2005 International Professional Ring Officials Association, (IPRO) convention, Dr. Margaret Goodman, one of boxing's most preeminent ringside doctors, spoke regarding the role of the ringside medic and the decisions that face him or her, as well as the important keys a ringside doctor should always keep in mind.

Ever heard boxing related to Gestalt psychology? Ever heard of Gestalt psychology? In case, like me, you're a little light on remembering your Psych 101 class, Gestalt psychology basically says that the outcome of any event isn't made up of a series of individual small events but is actually the sum total of all of those events put together. So, for example, a fight isn't just about the punches landed, it's also about the events going on with the officials, the response of the crowd, the history of the fighters, the temperature of the room, all of these things merging together to form a single experience. Dr. Goodman considers this a key point, emphasizing that when making decisions about what to do in a certain instance in a fight, doctors must consider the summation of all events that are taking place to impact that fight.

Dr. Goodman also emphasized early on, that the job of a ring medic is very simple. Said Dr. Goodman, "Our job as ringside doctors is to enable the fight to proceed to its natural conclusion." So go ahead and add another thing ringside doctors need to think about when making a decision! Just looking at a simple cut, a ringside doctor must consider the overall state of the fight, the fighter's safety, the logical natural conclusion of the fight, and, when you get into detail, there's so much more that must go into every decision a ring medic makes. Dr. Goodman's presentation went on to detail decision making and key points to consider in specific situations.
 

• Assessing a Cut...
  Should a cut cause a fight to stop? Obviously, the answer is "sometimes yes, sometimes no." What factors should a ring medic consider when assessing a cut? The list is long, and some of them may surprise you.
  
  The first things to consider are the most obvious ones about the physical nature of the cut at that exact moment. Is blood getting in the eye? How big is the cut? Could the cut disfigure the fighter permanently? If the answer to any of those questions is "Yes," or "It's huge," then the answer is obviously that the fight needs to be called. But there are many other things to consider that aren't as obvious. For example, is the cut's location somewhere where the fighter has recently been hit before? If so, that may lessen anxiety for the doctor because the severity of the cut may not be from the hit that caused it, as much as from having the more fragile skin near the old cut easily aggravated. Also, what round is the fight in? Cuts in later rounds may not be called for stoppage as much since it's more likely that the fight's natural conclusion would involve the cut fighter being able to safely fight for a minimal amount of rounds – as opposed to early rounds where a larger cut clearly would impede the fighter from finishing many more rounds. Was the cut from a head butt? These cuts are deeper and usually cause more problems than hit cuts. Who are the fighter's cornermen and do they have a good history of being able to effectively treat fighter's cuts in the corner?
  
  You'll notice that much of the information a ring medic must know to make a call about a cut means that the ring medic needs to have a decent amount of background information on the fighter. Dr. Goodman emphasized repeatedly the responsibility of ringside doctors to "know (their) fighters" so they can make good ringside decisions. In fact, Dr. Goodman went on to say that ringside medics should actually "know even more about the fighters than the TV commentators do."
  
  Part of the equation, obviously, is the question of when a referee should bring a fighter to ringside to see the doctor during the fight. Quite simply, the referee should bring the fighter to the doctor whenever the ref is worried about the fighter's safety, but there are some easy check points that can guide the process. Is there a lull in the action that makes it easy to bring the fighter over? Does the referee have a strong sense that the fighter is outclassed and the fight will need to be stopped later? If so, the referee should start the process of bringing the fighter over to the doctor early on to build the foundation for stopping the fight later. Is the fighter clearly bothered by the cut? Is there concern about the cut's location? Is the fighter otherwise hurt or losing the fight? All of these things should play into the decision to pull a fighter ringside for an examination by a doctor.
  
  Even if the ref doesn't bring a fighter over to see a doctor during a round, it's the ringside doctor's responsibility to get a look at the cut during the round break. Even if it's from a distance, the ringside doctor must make a call as to whether the fighter can see or not, how dangerous the cut's location is and whether or not there needs to be concern if the cut continues to bleed or get bigger.
   

• Headbutts. Ouch.
  What you need to remember about a headbutt is that, as an IPRO member pointed out, it's often the hardest punch of a fight. A headbutt is what is technically referred to as a "deceleration" injury, which means that a head that was in motion is suddenly caused to have its motion stopped by a solid object (another head). That's a very technical way of saying that headbutts are incredibly dangerous to the fighter, and doctors should treat them with the same level of care they would an extremely hard punch. Cuts from headbutts are often deeper than punch cuts, so doctors need to examine them more carefully. Additionally, headbutts are prone to cause concussions. More than one fighter, Dr. Goodman pointed out, has lost a fight because he or she suffered a concussion in a headbutt that didn't get diagnosed. The rule of thumb when looking at a fighter after a headbutt? Remember how hard the hit to the head was and how much danger the fighter who received the head butt may or may not be in.
   

• Eye Swelling – How good can a one-eyed fighter be?
  When do you make the call to stop a fight because a fighter took a punch to the eye area and the eye is swelling? ABC official and Chief Executive Officer of the California State Athletic Commission, Armando Garcia, has an easy answer. "Would we license a one-eyed fighter? No. So why would we let one fight?" Good point, and a nice one to follow. If you want to get into deeper details, a ringside doctor should consider the following when looking at a swollen eye: Has the fighter lost the ability to defend himself? Why is the eye closing (could it be because of a fracture underneath the swelling, which would cause an immediate stoppage)? What does the eye look like underneath the swelling? Who is the cornerman and how well is he able to treat the swelling?
   

• Assessing a fighter after a KO or a tough round...
  This is one of the most loaded calls a medic can make because it can dictate the outcome of the fight and the future health of the fighter so intensely. What should be in the doctor's mind when evaluating a fighter after a KO or an extra tough round? Run down the checklist.
  
  - What round is it? If it's early on, the fighter has a better chance of recovering and continuing to fight since he or she will be fresher and stronger.
  - When in the round did the KO happen? Early on or late enough that a corner break is about to happen when the doctor can do further evaluation.
  - Was the KO from a flash punch or a series of punches?
  - What is the fighter's experience? Has he or she handled big punches before?
  - How did the fighter's gait look when he or she walked back to the corner.
  - What shape was the fighter in coming into the fight? When was his or her last fight? How much time off has the fighter had? Did the fighter have to struggle to make weight?
  - Is the fighter hurt or just tired?
   

• Less is More...
  With all those factors to consider, you'd think a doctor would want to be in the ring or the corner as much as possible, but that's not the case at all. As Dr. Goodman pointed out, every time a ring medic comes into the ring, it breaks the flow of the fight, which impedes both fighters. And the solution isn't to come into the corner as much as possible either, because corner time is valuable to fighters and every moment that the medic spends in the corner is less time the fighter can spend listening to his or her corner. The solution? Follow the keys above and only examine the fighter when it's necessary to do so. And, after all, if a fighter is in a condition where he or she needs to be checked by a doctor round after round after round, should the fight really continue? Less is more.

Still seem like a cushy gig or more like a million factors that all need to be considered at once? I'm overwhelmed just looking at notes from Dr. Goodman's presentation at the IPRO conference! In short, the job of a ring medic is much, much more than just looking at a cut. It's a huge responsibility to consider all of the elements of a fight, a fighter and a situation and make a call that's almost always a tough call.

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