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Is there a doctor onboard? Uh oh! Me?!

August 30, 2009

Just after I graduated from medical school, I was taking the ferry to my new home town.  I had my bike with me, and was pretty tired from a weekend in the big city. I found a quite place and decided to listen to some music and try for a nap. As I was drifting off, I heard overhead “if there is a doctor on board, please report to the Chief Steward’s Office.”

“Really?” I thought. “It wasn’t a dream?” Hmmm. I guess I’d better go. I took a few seconds to gather myself and my panniers, and walked slowly up the stairs to the next deck. I presented myself as a newly graduated student, now resident, but offered to help to the best of my abilities. They wanted a College number from me – which I did not know – for insurance purposes, I presume. So, nervous about needing to help and eager to get on with it, I threw them one of my medical association membership cards and they quickly jotted down the info. They took me where the first aid station was and filled me in on the case. Well, it wasn’t a big deal; I did a brief exam with what tools I had (none), quickly determined the patient was well enough, and gave some advice about treatment and when to be worried.

To be safe, I advised them to follow up at the hospital if there were further concerns, and was ready to go back to my nap. I think I was a bit flustered having been a bit out of practice with face-to-face patient assessments as in a clinic; my last rotations were radiology, plastic surgery overseas, ER where few patients were conscious and even fewer spoke English, and inpatient psychiatry. I hadn’t done “reassuring” in a long while. I did what I could and tried to get out of the way, because I worried if I spent too long, it would give them the impression I was very worried. But I had known from when I walked into the room that this was not a sick patient. Telling “sick” from “well” is the best trick in medicine, and it can be harder than it seems.

I left the room, but not before feeling co-erced to sign a form that said I had examined the patient and determined they were ok. I wrote my phone number and a brief note about the patient, to cover my own ass, because I didn’t know what I was signing and they didn’t listen to me when I said I was pretty sure I wasn’t allowed to be the “most responsible physician” (MRP). It was the first time I’d ever been in this position and I was uneasy. I thought I was offering my aid as an educated passenger, not as a working healthcare employee.

Nervous about what legal entanglement I had just gotten myself into, I decided to take a big breath and walk around on the outer deck. Unfortunately, the Steward caught me and expressed copious thanks. She wanted to give me a gift from the gift shop. I tried politely to decline, but she insisted. I explained that it wasn’t necessary, as she put a gift bag in my hand. I tried to be gracious and said my thanks, refusing the offer of coffee and snack that she tried to add. I felt like a fraud. An inexperienced “doctor,” just trying to help someone because that’s what a person who can should do. If  a passenger had been in cardiac arrest, I would have been useful, truly. This particular case could have waited until the boat landed – but the first aid attendant didn’t know that.

I am fortunate that nothing further came from this incident. If I am in that position again, I will refuse to sign the form.

Many doctors, medical students, and residents will find themselves in this place. En route to or from vacation, minding their own business, when someone needs their help. And our Code of Ethics compels us to help. But there is a line.

A Montreal doctor (also trained as a lawyer) discovered this line in 2006.  While travelling with his wife Ellen to Paris, Dr. Henry Coopersmith helped a woman who was having a panic attack on board an Air Canada flight. Later in the flight, he was then asked to see two more ‘patients’ – one with a headache and another with a panic attack; there was another doctor on board, who was about to give an injection of Valium to the second panic-attack patient but the flight attendant didn’t trust the 2nd doctor; she proceeded to wake Dr. Coopersmith in order that he might intervene. The airline had him fill out a bunch of paperwork, and as a result of all this action, he was unable to sleep on the flight.

He requested two business class tickets to Paris and the airline replied with a “Thank You” letter and the equivalent of a short-haul flight in Aeroplan miles. He wasn’t impressed, so he pressed onward, requesting compensation for his lost vacation day, medical services at an hourly rate, and the cost of the flight. Judge David Cameron eventually ruled that Coopersmith was to receive $1000, which the GP subsequently donated to his local hospital. Canadian Medicine wonders if this will set precedent for compensation of MDs asked to provide non-emergency services.

Was he being a good Samaritan or was he providing a professional services? Airlines do encounter cases like this often, and compensation varies from no expression of “thanks” to in-flight upgrades. Though I felt exceptionally rewarded on the ferry, it felt that I was providing a service rather than intervening as a concerned bystander who happened to know a bit about medicine. I would have preferred to be treated as the latter, actually.

I guess the best part of all this is that the patients were all fine, and we doctors didn’t shrink down in our seats. If I’m called on again, I’ll be happy to help, but I won’t sign the papers. If they insist, I’ll record that it was ‘under duress.’  Then, the transit company can ask over the PA: “is there a lawyer on board?”

7 Comments leave one →
  1. Anon permalink
    August 30, 2009 2:24 pm

    I have a friend-no names-who has a high ranking position at a hospital in the GTA. Some of her staff members at her hospital decided to start utilizing the unused OR time for medical tourism from the US. This caused a major moral dilemma for her, but not for a lot of others she talked to. Finallly she was able to put her finger on why it was bothering her so much—her doctor colleagues felt themselves to be entrepreneurs–thus well within their right and prerogative to chose when and where and under what circumstances they practice, while she considered physicians to be public resources, given so much of their education is subsidized, the compensation, professional privilege etc. I guess your question on being a good Samaritan or professional in this example comes down to how you essentially view yourself. I dont have any answers, just food for though.

  2. August 30, 2009 2:44 pm

    Are you not covered by the good samaritan’s act if you’re in a situation outside the auspices of your profession (ie: if you’re just being Jane Smith on the ferry)?
    Also, aren’t you covered by malpractice insurance as well?

    • August 30, 2009 2:49 pm

      My malpractice insurance is provided by the hospital I work at; their lawyers work for the hospital, not for me. I could/should get CMPA protection, and that’s something we ought to fight for when re-negotiating our contracts.

      I don’t think the good Samaritan act would fully protect us, as we are held by the College to higher standards. There have been lawsuits (mind you, in the US mainly) around doctors providing poor care in a “Samaritan” setting.

  3. August 30, 2009 2:49 pm

    @Rach I can’t speak for medical malpractice insurance, but with other professional “insurances”, actually making a claim is a career ending move. No insurer will take you on again.

  4. August 30, 2009 10:59 pm

    I never mind helping out when I am needed but the paperwork for a “Good Samaritan” act sounds concerning. Is this a Canadian thing? I’ve never heard of a US physician having to sign papers before offering free help in a public emergency.

    I once witnessed a bad car accident and helped the victims till EMS arrived. I did everything right but wondered if I would be liable if the victims had a bad outcome later. I gave the patients to the able care of EMS and left without ever giving my name. To the patients and the ambulance crews I was just a nameless doctor on the side of the road.

    I am always there for people who need me, but I wouldn’t sign anything like that unless I read and understood it thoroughly. Interesting story.

    • August 30, 2009 11:03 pm

      I think it is as per the company arranging the travel; they are trying to cover their backsides against litigation…. so instead, they turn the responsibility onto the care provider. At least, that’s my worst-case assumption.

  5. TREVOR permalink
    September 7, 2009 4:44 pm

    Dr.Ottematic, hate to break the news to you were the MRP and have a license to prove it (if you engage you are it). It is an educational lisence, so your supervisor? Probably your program director. In Canada, something negative has to have happened because you intervened (versus just an intervention itself) for there to be cause. And if you were ever called to court, you are judged against standard of care at the level of your peers, that is as a newbie. The PD? Not in any hot water as you were dealing with an emergency. Just be sure to keep a journal specifically for strange medical encounters with family, friends and strangers as your ‘written record’.

    And those forms… read them. Only sign the ones that ‘RELEASE’ you of financial liability (eg. Air Canada’s is quite good – it says that for that period of time you were working for them and they will cover the cost of any such action). Regardless, what judge is going to blame you for the crazy situation you find yourself in.

    Final piece of advice… avoid putting your hand up when your skunk DRUNK!

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