Should airlines pay for services they request a medical professional to perform?

[beardoc]

Lowns was a doctor, working in his medical practice, a doctor in the community and I don't think that is directly translatable to being in an airplane and potentially being asleep/affected by large doses of clonazepam etc (some doctors are obliged to use sedatives for flights if they themselves have medical conditions aggravated by lack of sleep).

Whilst not disagreeing with this, I would think that if they had come, knowing you're a medical doctor, and you'd been asked to assist, simply saying "no, thank you", would not remove your liability. You would have to explain to the staff that you are too drunk/too benzo'd/too unwell/too tired/not experienced to help. And you would have to be clear on that: "I am unable to assist because I am a dermatologist and inexperienced in managing patients with chest pain". But I doubt that you'd have the option to not attend because you would not want to.

 

[rechoboam]

But if I wake up after 20 minutes sleep, 24 hours after sleeping properly with 2 tablets of temazepam on board and someone is choking or whatever, while I might not be in an ideal position to assist, it's hard just to sit there and say I'm not fit, given the enbironment, if no one else is around. It's a dilemma.

 

[Simo]

God I am glad I am not a doctor.

I can just get on the flight and go to sleep.

Sounds like a legal minefield for Doctors with giving help in GS format.

Even doing the GS for a pax you could potentially still end up in court and lose many days or weeks out of your businesses.(I hate using the word practise in regards to the medical field)

 

[drmikki]

Even if I've been travelling for 24 hours and am jet-lagged, it's probable that I have had more sleep than if you were brought into a major hospital when I've been on call.... I believe my record was 37 hours straight without sleep, constantly operating and seeing patients. And yes, that was in 2011, not the 1970s, and it's (technically) legal. :shock:

And before you ask, no, I'm not missing being a surgical registrar in the slightest! Unemployment is much better:mrgreen:

 

[k_sheep]

...., if no one else is around. It's a dilemma.

Luckily with the relative oversupply of junior doctors around now and for the next few years, there will likely to be someone around who has done emergency medicine more recently than you!

 

[rechoboam]

God I am glad I am not a doctor.

I can just get on the flight and go to sleep.

Sounds like a legal minefield for Doctors with giving help in GS format.

Even doing the GS for a pax you could potentially still end up in court and lose many days or weeks out of your businesses.(I hate using the word practise in regards to the medical field)

I wouldn't worry that much. I can't count how many colleagues have helped out...there has never been the suggestion of legal issues in any case of theirs. I only got in trouble once when I went to maintain the airway of a pretty girl who was comatose on the sidewalk and it turned out to be the local uni lefties putting on "street theatre", she was a victim of US imperialism, boy did they scream the @&&@ out of me.

Even if I've been travelling for 24 hours and am jet-lagged, it's probable that I have had more sleep than if you were brought into a major hospital when I've been on call.... I believe my record was 37 hours straight without sleep, constantly operating and seeing patients. And yes, that was in 2011, not the 1970s, and it's (technically) legal. :shock:

And before you ask, no, I'm not missing being a surgical registrar in the slightest! Unemployment is much better:mrgreen:

It is a scandal in the true sense of the word. Colleagues have died in car accidents, seizures etc etc when there is no real reason 8 hrs in 24 couldn't be covered by someone else to allow sleep.

 

[jb747]

Even if I've been travelling for 24 hours and am jet-lagged, it's probable that I have had more sleep than if you were brought into a major hospital when I've been on call.... I believe my record was 37 hours straight without sleep, constantly operating and seeing patients. And yes, that was in 2011, not the 1970s, and it's (technically) legal.

I've always wondered how the medical profession gets away with that. It's not as if you get used to it. I'm surprised the lawyers haven't sued on the basis that you aren't fit for duty....

 

[Princess Fiona]

Luckily with the relative oversupply of junior doctors around now and for the next few years, there will likely to be someone around who has done emergency medicine more recently than you!

Probably not in my case

 

[drmikki]

I can't understand why the aviation industry can sort out reasonable management of working hours yet public hospitals in Australia fail to do so, with potentially disasterous consequences. Even the mining companies can regulate the hours of their workers (not to mention drugs and alcohol, which is an entirely different problem!) so I agree, it's surely only a matter of time before patients and lawyers get involved in changing the culture - unfortunately I feel that it's going to take a catastrophic error before it gets acted on, and people's lives and doctors careers shouldn't have to be sacrificed to change the culture. I've lost count of the number of times I have had to brush off questions from well-meaning patients asking if I have been home in the time between admitting them and operating on them, because the answer is 'no' :-|

 

[jb747]

I think the difference is that I can kill 500 people at a time, whilst you can only get one.

Jokes aside, I think it is a truly appalling situation, and I simply cannot understand why it still exists.

 

[Princess Fiona]

I've always wondered how the medical profession gets away with that. It's not as if you get used to it. I'm surprised the lawyers haven't sued on the basis that you aren't fit for duty....

Sadly I don't think that's ever likely to change.
I remember vividly as a very junior doctor leaving my home on a Friday morning and knowing I wouldn't be back until Monday afternoon with brief snatches of sleep interrupted by my pager beeping.
I'm sure drron and kpc have similar/worse experiences

 

[Will]

Actually, in Australia, there's is a clear duty to attend if you are currently able to and you have been identified as a medical practictioner because of the Woods vs Lowns case in NSW. It's a case where a child had an epileptic seizure and the mother sent her other child to go to a nearby doctor's surgery to summon help. There was dispute over whether a request was properly made (the sibling identified that she talked to Dr Lowns and that Dr Lowns refused to come, insisting that they should be brought to his surgery, but the doctor denied that he said this). The court deemed that the doctor had been requested and then had a duty to attend, and in not doing so, was negligent. If they know you're a medical doctor and you're in any condition to attend, and you refuse to do so, you can be sued. ...

See post 42 of this thread

On the other hand, is there a possible negligence claim in failing to attend? One would hope not, but the NSW supreme court has made clear that all doctors have an obligation to everyone, patient or not - see Woods v Lowns NSW SC for a precedent-setting illustration. You might think that over-indulgence in the wine was a perfect excuse, but could you prove it? I'm not sure.

I only said it was not established as it was just a NSW SC finding, and the case was settled before the high court could hear it - I am sure we are yet to hear the final word on the matter!


As regards the other point - fatigue - there is no good reason why it hasn't been properly tackled by regulators, other than
(a) there is no effective regulator of safety of medical practice
(b) there aren't enough staff to ensure safe working hours for all. Junior medical staff (mostly registrars) supply the majority of acute medical care in this country, and they mostly work extremely hard. If we cut them all back to 38 hours a week, we'd need to increase their number by around 150% (my estimate).

 

[drmikki]

Agreed, jb747 - but then again, I don't have a second pair of eyes or any computer regulation second guessing the decisions I make as I make them - just the fear of the boss's criticism the next morning, and/or the fear of the coroner... :shock: I am definitely impressed by the work you boys do though - had a massive geeky moment in the coughpit. When I was about 15 I wanted to be a fighter pilot (perhaps blame JAG for that!) but had neither the eyes nor the money for flying lessons :-|

In 2 months time I will get to go on (?hang out of?) a helicopter for the first time as part of the medical team for the Abu Dhabi Desert Challenge rally - I may come back with the urge to have flying lessons, but I'm not sure my bank manager will approve! :mrgreen:

 

[medhead]

I spend a good chunk of my time too resuscitating people in CT scanners

In the scanner tunnel or just on the scanner bed?

Even if I've been travelling for 24 hours and am jet-lagged, it's probable that I have had more sleep than if you were brought into a major hospital when I've been on call.... I believe my record was 37 hours straight without sleep, constantly operating and seeing patients. And yes, that was in 2011, not the 1970s, and it's (technically) legal. :shock:

I doubt it was legal. There is a hard 16 hour limit in OHS legislation. That is why mining companies have this cough sorted out, because if someone broke the 16 hour limit and died, something that is very easy to do in a mine, the company would be dragged through the ringer.

How does medicine get away with this? well I have my theories but I can't share. And even if I could, it might offend some doctors. Will this change? Only once enough doctors decide to break the cycle of abuse. I've experience an attitude in the military of "we got treated like rubbish when we got trained, so these new ones can get it as well". I suspect that some doctors have that same attitude. Not all! But some.

Anyway, what would I know.

 

[medhead]

As regards the other point - fatigue - there is no good reason why it hasn't been properly tackled by regulators, other than
(a) there is no effective regulator of safety of medical practice
(b) there aren't enough staff to ensure safe working hours for all. Junior medical staff (mostly registrars) supply the majority of acute medical care in this country, and they mostly work extremely hard. If we cut them all back to 38 hours a week, we'd need to increase their number by around 150% (my estimate).

If the regulators don't know about it they can't do anything to stop it. There is a very effective OHS regulator in every state. I have no idea why they don't come in and start handing out $100,000 fines.

 

[drmikki]

medhead - I believe they get around it legally by us being "oncall" - if there is no work we can go home. Which is of course BS, cos even on the less-busy nights we are still woken by phone calls. This was also a bit of a con, since when we were at home we earned $6/hour, even if we spent the entire night awake on the phone. We only got paid actual rates if we had to go into the hospital, although I believe this has now changed slightly.

And as for how they get away from it - you're exactly right, it's the culture. That whole "when I was a junior I worked every second night on call, you guys are weak" ideal still permeates, particularly in the surgical training system. One boss told me (at the end of 4 days straight in the hospital) that in his day it was 1 in 2 on call, and he was disappointed on his days off cos he might miss an interesting case that came in! Rose-coloured glasses in retrospect, perhaps! In addition, should you complain about anything, you're labelled 'not tough enough' or 'a whinger', and since the people in charge of training (and often jobs) are a small select group, there are few junior doctors who want to speak up. Some of the abuse and bullying I put up with when I was there was unbelievable- wouldn't be tolerated in the Army or any other workplace but seems to be tolerated in the surgical training system.

At the time it seems reasonable, but now I have had some time away from the system it's madness...

 

[medhead]

medhead - I believe they get around it legally by us being "oncall" - if there is no work we can go home. Which is of course BS, cos even on the less-busy nights we are still woken by phone calls. This was also a bit of a con, since when we were at home we earned $6/hour, even if we spent the entire night awake on the phone. We only got paid actual rates if we had to go into the hospital, although I believe this has now changed slightly.

Well on call is another thing, but even then there'd probably limits. I was more thinking 37 hours straight or operating and seeing patients. Anyway, it's happened now.

And as for how they get away from it - you're exactly right, it's the culture. That whole "when I was a junior I worked every second night on call, you guys are weak" ideal still permeates, particularly in the surgical training system. One boss told me (at the end of 4 days straight in the hospital) that in his day it was 1 in 2 on call, and he was disappointed on his days off cos he might miss an interesting case that came in! Rose-coloured glasses in retrospect, perhaps! In addition, should you complain about anything, you're labelled 'not tough enough' or 'a whinger', and since the people in charge of training (and often jobs) are a small select group, there are few junior doctors who want to speak up. Some of the abuse and bullying I put up with when I was there was unbelievable- wouldn't be tolerated in the Army or any other workplace but seems to be tolerated in the surgical training system

Yeah, someone tried that yelling/bullying stuff on me once. I don't think they liked me yelling back, lucky I don't need them for my job. Anyway, they are on my list and I'm waiting for their next stuff up. Anyway, with my career background I have some fun at times. (um, I can't really say much more, work policy and all that) but I should add that I have seen some people that seem very good and have lost the culture.

 

[drmikki]

Well on call is another thing, but even then there'd probably limits. I was more thinking 37 hours straight or operating and seeing patients. Anyway, it's happened now.

It was 37 hours straight awake and operating - but the way administration get around it is by saying you must be in-house 07.30-2300 then oncall until you handover the next day to the next sucker; then you work a normal workday (ie til about 6pm, but can be much later). However, if you happen be in-house and awake all night (not uncommon) they can point to the roster and say "Oh, she didn't HAVE to be in house, but it was busy and she got called in..."

I think my oncall record was 96 hours... I didn't leave the hospital, but they did provide a nice apartment where you could sleep. I'm not sure if there is a limit for on-call hours - I think it has to be 1 in 3 or more though, otherwise you get bonus pay.

 

[drron]

And to think that in NSW the 40 hour week was granted to junior doctors in 1974.
There are things that have changed since that time though.At the time we had every medical organisation in the country campaigning against us-yes even the AMA.At least they have now they are onside.The number of senior members of the profesion now agreeing with safe work hours is very much greater than it was then.But yes the surgical streams are still the bastion of the dinosaurs.
And yes there are the horror stories.When I was a JRMO(not called interns then as not enough US doctor shows had screened in those days) we worked a strict 1 in 2 roster.On your night off you had to be back in the RMOs quarters and be on call for your ward by midnight.
then I was the RMO on for orthopaedics over the easter break(pun intended) at RPAH.All injuries from the bike races at Mt.Panorama came our way.began work at 0700 Thursday and finished 1100 Sunday with just 2 hours sleep.Went home,went to bed and awoke for lunch on monday.
Though there were the funny moments.One night on call I was told that i had to collect blood for electrolytes every hour overnight on a renal patient by a registrar.I did and dutifully rang him each time with the results.After the second phone call he said-i did not tell you to phone me with the results,only do so if they have changed significantly.Well i said if it is important enough for me to collect blood every hour it is important enough for you to know the results.Next collection was at 0730.No collectors in those days the JRMOs did it.

Finally it is really disappointing what happens now with junior doctor hours.it goes against the spirit of that 1974 judgement.

 

[straitman]

medhead - I believe they get around it legally by us being "oncall" - if there is no work we can go home.



At the time it seems reasonable, but now I have had some time away from the system it's madness...

The Civil Aviation Orders manage to cover the balance between on call and work so there is no real reason why the medical profession could not do so.

The CAOs are not perfect but obviously a lot better than what you are describing?