Wednesday, March 2, 2011 | Categories: Dr. Brian's Blog
When we put out an all-new episode of White Coat, Black Art, we hope (and dare we say expect) for some reaction from you. But, when we re-broadcast an episode, we kind of figure you've already said what you want to say about the subject. This week is a big exception to the rule. Our show on health professionals who act as Good Samaritans generated as much heat this time as it did when the show first aired last season. Click below to jump to your comments.
Quite a few of you came out in favour of the Good Samaritan and against Dr. Cooper-Smith, the Montreal physician who sought compensation from Air Canada for being called three times during a transatlantic flight to assist an ill passenger.
"This was more of an occasion to knock the airline rather than examine the realities of an in-flight situation. For thirty years, I was an in-charge flight attendant with Air Canada. My co-workers and fellow in-charges were flight attendants and never referred to as stewardesses or in-charge stewardesses except by the woefully ignorant. If I ever had a medical incident on a flight my first reaction was never to call a doctor. I'd assess the situation and if it called for some re-assurance in the event of a panic attack I'd give it. If it were a situation that was easily remedied with a band-aid or headache pill I would give it. Once, I relieved a male passenger who was choking on a snow pea by application of the Heimlich manoeuvre without ever asking if there was a doctor onboard. If I ever thought that a passenger needed more help than I could give, I called for a doctor. Only once did I run into any problem with this. The occasion was on a flight that had left London, England for Edmonton en-route to Vancouver. A woman seated with her husband complained of a fierce headache. She was sweating heavily and her skin was ashen in colour. It looked serious. I asked if there was a doctor and found one who agreed reluctantly to see her but only if she made her way to the rear of the aircraft. As he was the only doctor onboard, I felt I had no choice but to bring the woman to the rear of the aircraft where the doctor almost immediately realised that this woman was in the throes of a heart attack. We pulled out every piece of equipment we had and battled to save her life. Unfortunately, she succumbed and as soon as that happened the doctor stood up, pronounced her dead - and went back to his seat. I was left with the dead-body on my galley floor and an unbelievable mess of medical equipment. That, on top of an afternoon tea service scheduled to begin in less than ten minutes. Retired as I am, if ever find myself on a flight that has an emergency in my assistance would be an asset., you can count me in." From: Jim Cowan, New Westminster, BC
"I am a volunteer fire fighter and paramedic with over 20 years experience. Several years ago I was in Florida visiting my parents. On the return flight from West Palm Beach, I heard the flight attendant ask if there was a doctor on board. When she hurried past me I told her I was a paramedic and offered to help. She directed me to an elderly gentleman who appeared to be in full cardiac arrest. He had no pulse so I asked if there was an Automated Electrical Defibrillator and oxygen on board, and these were brought to me. I delivered two shocks and got a pulse. At this point the patient's wife asked if her husband was dead and I said "not anymore". The plane landed in Philadelphia and the patient was taken to hospital by paramedics. US Air upgraded me to first class on the flight to Seattle. I would never hesitate to step in to assist a person in a life-threatening situation. In fact, I do not know any volunteer fire fighters who would not do the same. I think any physician that withholds medical care during a life-threatening situation should have their license removed - two scotches or not." From: Bill Elsner, Sechelt, BC
"I am an ICU nurse. I have stopped repeatedly at emergencies - and even if all I am qualified to do is keep an airway open, or hold a hand, I'll do it. And we are restricted by law from providing care that we are not trained to do. Finally, doctors make a lot of money. Should the airlines provide compensation? To someone who flies enough to get enough points to fly business class? Give me a break. Yes, a thank you should be forthcoming but that's enough. And it would be interesting for us to tally up how many times we are really required to provide this service.... if it's even yearly, I would be surprised. So what's the big deal?" From: Constance Roy, Powell River, BC
"There are some professions where the uniform is always worn. Firefighters, police officers and physicians. and yes, even us clergy. We, too, are on call 24 hours a day no matter where we may be, on a plane, on the street, or in a store. We are there if we are needed, and it often isn't an emergency, but a needed reassurance, as the one doctor described the situation of the woman who was panicking. He talked her down. He was the needed ear who was seen to have some authority. It worked and all was well. Isn't that what we are all called to strive for?" From: Rev. Sherran Schick, Foam Lake, Saskatchewan
"In 1998, I got my husband aboard an Air Canada flight from Mexico. He was ill, but we managed to get aboard, through Los Angeles and on to Vancouver. On the descent into Vancouver, he began to fail, and I asked for assistance. The purser asked for a doctor on board, and a lovely young woman appeared, and immediately began to assist my husband. When we got to Richmond, all emergency services were in place, thanks to that doctor. My husband survived, although his situation was considered critical for the next six weeks. To every trained medical practitioner, no matter what you consider your competent area to be, please always assist. And thank you." From: Jessica Hadley, Oliver, BC
"I'm a huge WCBA fan - I download the podcasts to listen to while I run. I'm also a physiotherapist, and listen intently for any mention of those in my profession. We got a mention in the Good Samaritan show, but only to say we might not be great in an emergency! I work at a well-respected sports medicine clinic and do a lot of sports event coverage. Whether I'm covering minor hockey, university football, or Skate Canada competition, I am the first responder - even before the doc on my team. I'm well trained in emergencies, but still feel a bit unsure of announcing "don't worry, I'm a physio!" at the scene of a car crash. One of the greatest hurdles in my profession is that our many diverse roles are often misunderstood. We work in a variety of settings and perform many different roles, from emergency to palliative care. Maybe a future WCBA show could shed some light on other medical professions besides MDs and RNs." From: Meaghan Shearer Adams
Some of you came the defence of health professionals who refrain from acting as Good Samaritans.
"I have had quite a bit of experience with in-flight medical emergencies and have little sympathy with the physician who objected to being asked to provide medical assistance while flying. Would an off-duty fire fighter walk by a burning building? Would an off-duty policeman not intervene when he saw a hold up taking place in the corner store he had gone to get a quart of milk? I have had some interesting experiences while flying. On one trip to Cuba, I was called to help a pregnant woman who passed out in a washroom and had jammed the door (it had to be taken off its hinges to extricate her). On another flight, an elderly woman was having angina only two weeks after having had a coronary bypass operation. The flight crew brought an oxygen cylinder but it was empty. My most interesting in-flight emergency occurred on a flight to Amsterdam. Half way across the Atlantic, the flight attendant woke me from sleep to attend to a woman who was having a stroke. On the same flight, less than an hour out of Amsterdam, I was awakened again to see a young man who was having an epileptic seizure. I managed to get him lying down in the aisle and he recovered consciousness. His blood pressure was low and his pulse barely palpable. Every time we tried to get him back in his seat he would lose consciousness and have another seizure. We had to keep him lying down and when the crew insisted that he had to be in his seat while we were landing because of regulations. I asked them whether they preferred a dead passenger in his seat or a live passenger who was defying regulations. These flights were over a decade ago and I found the airlines were little prepared for emergencies. Perhaps they do have better first aid kits now. Thanks again for a great series." From: Bob Nelson, MD, Ottawa
"Dr. Cooper-Smith's transatlantic flight experience tells me that common sense unfortunately is uncommon. What did Air Canada achieve aside from bad press and legal expenses. I don't think the doctor sued Air Canada because he needed the money. He did so on principle, in my opinion. The Small Claims Court judge should have awarded him far more! By the time he arrived in Paris, his blood pressure must have skyrocketed. As a busy professional, his personal "down" time is precious and irreplaceable! As a retired lawyer, I can relate to this experience. One evening, I was having dinner with a friend in the dining room of the inn that she owned. Her husband, a client of mine, was out of town. At a table nearby, a woman took a forkful of her salad and found a piece of glass lodged in the roof of her mouth. I pressed my friend to go to the table, apologize sincerely and offer to pay for the meal and provide the couple with a gift certificate. I added that she was probably looking at a lawsuit if she did not do as I suggested. She did as I asked. Most people will react positively when there is acknowledgement that they have an issue that needs to be addressed. Courts are a last resort for civil wrongs. The best results are achieved when people engage themselves to resolve issues." From: Tarry Hewitt, Milltown Cross, PEI
"I am a firm believer that the airline should have a doctor on call that they can phone for assistance if required. I work in a bank. I hate it when I go to a dinner party, and people ask me for a loan. I tell them to book an appointment with me Monday to Friday. I think you're "off" time should be exactly that. Just because you're a doctor doesn't mean that you're at everyone's beck and call." From: Gail Baldin, Calgary
"The story about physicians downing two scotches to "get out of the game" when on a plane brought back an uncomfortable memory from 30-some years ago. At the time, I was a neurophysiology post-doc in the UK, returning to the UK from a conference in the US. Unbeknownst to me, the travel agent had booked me as "Dr. Emerson", a title that I rarely use for exactly the reasons described here. About an hour over the Atlantic, a flight attendant approached me, using the name "Dr. Emerson". I replied that I wasn't a medical doctor." The flight attendant insisted that I must have had medical training. As I reluctantly headed towards the distressed passenger, I had visions of performing a tracheotomy on a passenger. Fortunately, the passenger quickly felt better; he had been having a panic attack. I've often wondered who was luckier: the passenger or me? The passenger got first-class seating. What did I get? Nothing." From: Victor Emerson, Ottawa
"I found it rather interesting how quickly every contributor came to refer to the passengers as patients. As a final year medical student, I can't help but have admission orders, DNAR forms and the like come to mind. I was left wondering about how the story typically unfolds with these on-board impromptu consults, especially, when as was intimated, these individuals increasingly carry with them a burden of chronic disease and multiple illnesses. After the plane lands, do I continue my vacation, or am I awkwardly, inevitably and likely begrudgingly left as the most responsible physician? I've heard of physicians being 'forced' to remain with unwell yet stable patients for hours, with their family listlessly waiting in tow, desperately attempting to navigate the process of signing off." From: Chase McMurren, Hamilton, Ontario
"I totally understand why some doctors don't want to be bothered while on vacation. But why, then, do they book the tickets or otherwise identify themselves as doctors while traveling? Airline personnel don't have ESP. It seems to me this is really about ego and the need to put "Dr." in front of their names. Love your show." From: Donna Troicuk, Sydney, NS
"On a flight from Mexico to Canada a woman checked in very early to get a bulkhead seat to give her room to have her small dog in a carrier cage on her lap. A woman two rows back complained that she was allergic to dogs. The flight attendant offered her another seat, but the complainer insisted the woman with the dog should move instead. The woman with the dog refused. The complainer said she was having an allergic reaction and I answered the call for a physician. I was a fourth-year resident in surgery at the time and was quite sure I could deal with anything. However, I was rather intimidated by these two women. I assessed the woman for a possible allergic reaction and found nothing of concern. Now, here is my mistake and warning to younger colleagues. I reassured the woman that she was not having an allergic reaction because she was not short of breath, not itchy, did not have watery eyes. Pleased at my mastery of the situation I returned to my seat, only to be disturbed minutes later by the flight attendant. She told me the woman I had assessed was now complaining of - you guessed it - shortness of breath, terrible itchiness and watery eyes. In the planes medical box I found an antinauseant. With great flair, I made quite a show of injecting this woman, counting more on the drug's sedating effects rather than any anti-allergic effect. It worked like a charm." From: Rod Syme, Surgeon, Ottawa
Some of you wrote in to clarify some issues from the airline's point of view.
"I fly as a Captain for a major airline (not the one featured on your show). We indeed have medical occurrences on our flights regularly, and we do indeed page for medical assistance on board our flights. But, it is not accurate to state that all airlines "rely" or "depend" on physicians without taking responsibility as well. In fact immediately after paging for inboard assistance (even if it is forthcoming), we contact paid on-call medical services via air to ground communications. While incredibly less likely, I can only imagine if a pilot expected compensation if called upon to assist on board an aircraft. I really enjoy your show." From: Jeremiah Gillett, White Lake, Ontario
"In regards to your closing comments suggesting that airlines should have medical personal available 24/7, I would tell you that Air Canada does. There is medical support available via airborne communication to medical specialists on the ground. This is available to the in flight crew at all times. However, it does make more sense to solicit the help of a doctor on board who can make physical assessments. In fact, there are cases where the doctor on board has communicated with the medical help on the ground." From: Peter
Winter, Squamish, BC
"Congratulations on a wonderful program - thoroughly enjoyable. Medicine and flying share a commonality in that both are complex. However, air transport can be totally unforgiving unlike transport by sea or ground. When a medical incident or emergency occurs onboard, it is not only a doctor onboard that may feel hostage but also the crew and passengers for various and many complex reasons. Depending on the severity of the medical emergency, the decision to divert can be compounded by numerous factors. The captain and crew are tasked with achieving a safe flight and also coordinating the emergency. By the way, the airlines do indeed have 24/7/365 medical advisors on the ground, upon which the captain can rely on for advice via onboard satellite radios while the doctor attends, assesses, and assists the passenger in need. Life is not as simple as, "gosh, I worked all day and looked forward to this trip and now I have to work again". Safety at 35,000 feet involves the selfless cooperation of everyone onboard where nobody can afford the luxury of being an island. Travel by air today appears to be simple largely because it is so safe to the point where too often the public have the misconception there is little to it - nothing short of magic. There is no financial fudge left in the industry today. The capital and labour inputs are enormous. In spite of this, most airlines carry expensive onboard emergency medical kits, Air Canada being a pioneer in the concept. After 40 years in the business, I can offer the reassurance that a high, possibly 95%, onboard medical emergencies are a result of stress, anxiety, dehydration, low blood sugar, and fatigue. In many cases, a passenger stands up to go to the washroom and collapses. The first assumption is the person is having a heart attack. Doctors are highly respected passengers and can look upon themselves not so much as working but as occasionally serving mankind in a way few others can do. Another technical point worth mentioning is that doctors are given immunity when onboard an aircraft. All decisions are made and all documentation of the emergency signed by the captain." From: Michael Lang, Toronto
"Your episode brought back to mind that when I trained at Toronto General Hospital School of Nursing (class of '65), many of my classmates were getting their degree with plans to go on to being flight attendants. It was considered a dream job to see the world. At that time, being a registered nurse was a prerequisite to being hired by an airline. Perhaps if that training was still as important to the airline industry today, many non-urgent problems arising during a flight could be handled by airline personnel, leaving doctors to be called on for only urgent needs." From: Joan Garrett, Woodstock, Ontario