Categories
Uncategorized

Doctor

Let’s say that you were having a medical emergency on-board an aircraft. Who would you rather have helping you: a paramedic, or a doctor?

You might be surprised. The doctor in this case was clearly over her head. I’ve done more with less. The vast majority of doctors are so specialized that they know little to nothing about medical emergencies. Imagine a doctor who can’t even take a blood pressure.

15 replies on “Doctor”

Don’t have to imagine it, been dealing with that very thing can’t r several months now.

I’ll go with the paramedic. Since childhood, I have rightly held doctors in low regard, though I’ll not bother to recount my reasons for arriving at that opinion here.

Thing is, doctors now may have lots of education (assuming their retention is any good), but standards have been lowered, and those who entered the profession in the last 10-15 years are certainly not up to the standards that existed in the 80’s and even 90’s. American medicine still does triage fairly well, but much else is very badly lacking now, and poised to get so much worse.

The way so many doctors followed the company line over covid to the letter revealed not only their lack of critical thinking, but a willingness to knowingly do the wrong thing simply to protect their career and credentials.

I saw an ER nurse with a T shirt
“ER Nurse. The person you see after saying ‘Hold my beer and watch this.'”

Hmmmm, guess all those years flying (helos) I wasn’t “really” hearing anything as I used my stethoscope……in flight.

Dunning-Kruger raises its ugly head again. She’d have done better just keeping her mouth shut. And I have to question her basic med-school. TMK, they’re all required to have an ED rotation, so somethings fishy there……

Word, re choosing the paramedic. I’m a cardiologist (two freaking post-residency fellowships, actually) and have long said, “Unless it’s a cardiovascular (CV) issue, you want a paramedic, not me, in a field emergency.”

And frankly, unless you have a field-portable miniature cardiac cath lab (/sarc), all I can really do is confirm that it is a CV emergency and call for an ambulance.

@BRD: I’m one of the only MDs at my hospital who is (at least openly) anti-vaxx. Maybe the others are smarter and just keep their mouths shut, but they also got jabbed. On pain of firing if they did not. I wrangled a 1-year deferral (I don’t personally see patients these days, so I had a wee bit of slack), but that’s expiring soon. We shall see if they fire me….

That was the point of this post. Medicine is too large of a subject for anyone to be an expert in all aspects of it. Paramedics are simply extremely specialized in an extremely narrow field. They are used to making do with poor equipment and conditions, but at the end of the day, like the rest of the medical field, don’t fix patients without being a part of a (much) larger team.
It wasn’t until relatively recently that emergency medicine became its own specialty. It used to be that doctors from any specialty would do ER rotations. I have had a few podiatrists, oncologists, and proctologists try to take charge of my patients at the scene of accidents. Until you point out to them that, if they want to take charge, they have to sign my report confirming that they are assuming patient care and accompany me to the hospital.
A doctor has a ton of knowledge, but is largely useless without support staff and lots of equipment. A paramedic can operate without much in the way of support or equipment, but doesn’t have the knowledge or support that a doctor does.

Separate comment because these are just “war stories” about airborne emergencies. For values of “emergency”.
1. So I was on my way to Reno for a medical meeting. First leg of the flight they called for a doctor to look at a young woman with abdominal pain. I sat tight because who knows what the hell that could be. (I don’t know nuffin’ ’bout birthin’ no babies.) Some other doctor responded.

Second leg was another call for “Is there a doctor aboard? A passenger might be having a stroke.” Well, that’s some sort of vascular thing, embolic or hemorrhagic, and my training is cardioVASCULAR medicine, so I guess I’d better speak up, I thought to myself. Went to see the older man sitting in the starboard window seat. The FA gave me the “med kit” (yep, a $5 stethoscope, a shitty manual cuff, an oral thermometer, and I think some gauze and tape). FA told me the wife told her that hubby was “nonresponsive and not responding to her questions.” So I talked to the guy’s concerned wife, and then the guy himself. Turned out he was A&Ox3 and consented to my taking his vitals. Normal vitals, normal bedside-type neural exam. I got the FA to take the hovering wife away and talked to the man some more. He grinned slyly. “I got sick of listening to my wife yammer, so I turned off my hearing aids.” Hahaha! Crisis averted. On my way back to my seat the guy in front of me grabbed my wrist. “Glad you took that,” he said. “I figured a pediatrician wouldn’t be much help” he laughed, jabbing himself in the chest with his other thumb. “Gotta gynecologist buddy up in first class (those bastards make lots of money, har har har), but he probably wouldn’t have been any use either!” I said we could have used his buddy on my prior flight.

Anyway, the FA came to my seat about five minutes after this drama. “Just wanted to say ‘thanks'” she said. “In the old days I could have bought you a beer, but we can’t do that any more. Um. Can I give you some more peanuts?” Double hahaha! I was “paid” literally peanuts for a CV consult.

2. My Greek friend Petros was flying back to Athens when a patient in coach had a mysterious “spell”. They called for a doctor literally midway over the Atlantic. Nothing to be done if it couldn’t be handled on the plane, since turning around wouldn’t have helped. Petros gravely examined the patient who by then seemed okay. “What can we do, doctor?” asked the FAs. Petros thought a minute and said, “She seems better now, but I think she needs more air and more room. Put her in first class. And she’ll need close medical supervision until we get to Athens. Put me next to her.” So Petros upgraded himself to first class for the remainder of the trip. Petros has always thought quickly on his feet.

I dunno about smarter than you, but I’m pretty sure Petros is smarter than me.

Something I left out about Hearing Aid Guy, but it’s to your point about being highly specialized and needing equipment and support. Lots of both. So right after I did the bedside-type neuro exam I noticed a woman standing in the aisle looking at us. (My SA was shot to hell focusing on the “patient”.) I raised an eyebrow and she introduced herself. “I’m an interventional neuroradiologist. Came by to see if I could help, but looks like you’ve got it covered.”
MC: You are? Great! This sounds like more your thing than mine. Lemme get out of your way.
INR: I can’t think of anything to do that you haven’t already done. If we had a CT or an MRI, not to mention my lab I could be more useful. [“lab” = basically an OR set up for catheter-based interventional procedures]

She was a nice lady. Turned out there was an INR conference in Reno and she’d be there for a few days. Hearing Aid Guy and the Missus were on their first visit to Reno, for the casinos. INR Lady gave HAG her cell phone number. “If you’re new in town and don’t know anyone it can be difficult. If you have any neurologic symptoms, call me. I don’t know Reno, but I know lots of the neuro people who work here, and I can help you get to the right places.” How nice of her to do that.

Oh yeah, I took the extra two (TWO!) packets of peanuts from the FA. I am not proud.

I got my wrists severely slapped on a work first aid course. I can’t remember the exact scenario but the “casualty” was lying on the floor and the instructor said “OK, what do we do about this?”

I replied “I’d undo his fly buttons but who listens to a sex therapist at a time like this?”

Same sort of scenario but with someone with even less skills applicable to the situation. >};o)

Don’t forget to change the batteries regularly on those automated blood pressure cuffs and pulse oximeters in the emergency kit, or you have none.

Epi ampule but no epipen? Oh the horror! Draw it up and inject? Impossible! (just as well I ‘spose, she wouldn’t know the dosage anyway)
Hey doc, if you can’t hear with the el cheapo stethoscope, think way back to the days they taught you how to take a pulse and palpate the BP.
Sheese, what a waste of schooling.
I’ve had a dermatologist try to take control of my trauma pt.
My response was exactly like DM’s, Assume full liability or GTFO!

True story:
Co-worker was at 40,000′ somewhere east of newfoundland when the passenger next to him vapor-locked (She’d had non-stop cocktails, chasing a handfull of Xanax for flying jitters. Pro tip: Bad idea.)
Co-worker is another multi-decade ER nurse. When they asked for medical help, they got a retired OC paramedic, and a neurologist MD from SAfrica.

Short story longer, the doc was irritated that the ER nurse and retired fire paramedic did everything necessary – like placing her on oxygen for a severely depressed respiratory rate – while totally ignoring doc’s suggestions to do a neuro exam (on the unconscious patient).

Patient recovered, and was handed off to EMS at Heathrow, doc huffed off and effed off, and my friend and his helper got comped to first class for their return flights by the airline, as a “thank you”.

We used to get between 10 and 50 nosey “consults” a game from doctors in the stands during Rose Bowl games, every time somebody in Nosebleed Row two rows from the top got chest pains or Shortness Of Breath, because between USC and UCLA alumni, you couldn’t swing a dead cat in the stands without hitting a doctor of something.
So, like the Old Man At The Bridge, we had three questions:
1)”What’s your specialty?”
Among the actual answers received (hand to God): French literature; podiatry, and dermatology.
Thanks, but we’re going to do oxygen and aspirin, Professor. If we need anything from Dumas or Voltaire, we’ll give you a holler.
2) Are you board certified and licensed to practice in California?”
No?: Sit down, and go back to the game. Yes?:
3) “You understand that if you want to assume care of the patient, we’d be happy to have you, but you have to stay with him all the way to the ER, and miss out on the game you paid $500/seat to come to, right?
In every single case save ONE: “Oh, hey, no, never mind, you guys are doing great, carry on!”
The Lone exception: board-certified interventional cardiologist from local Cath Lab, who stayed with the patient, managed all care, rode to the ER with paramedics, gave a detailed hand off to the ER docs for the patient having an acute MI (heart attack), and by way of thanks, Pasadena EMS drove him right back to the gate, where he returned to his seat and caught most of the second half.

Most docs without a hospital are out-of-practice EMTs, at best, in field situations, and the brighter ones (which thankfully is most of them) know it without being told.

FTR, all the FAA requires for an in-flight medical kit is a cheesedick $5 steth, crappy manual cuff, and thermometer. OSHA requires a small bandaging kit for the crew (screw the passeng-cattle, amirite?), and the better international and domestic lines carry AEDs and an O2 tank. FAs are loathe to open any of it, because then they have to do company paperwork and re-inventory it, and it’s a bitch to get another cheap-ass complete kit so they can take off again.

Before 9/11 I flew with my complete “O-Shit!” medic jump bag as one of my carry-ons. Now I leave out the sharp pointy scissors, and just take the blunted trauma shears and the round kindergarten scissors. Even the TSA dorks don’t get hissy about that.

Comments are closed.