Drama at 40,000 feet

tallaght01

Question/opinion sought from other docs/health professionals out there...In fact I'd be interested in what the wider community thinks too.

I was on a long haul flight a few weeks ago, when somebody became unwell. We were 4 hours from landing.

I'll keep the details sketchy for confidentiality's sake, as there were a lot of Irish passengers/cabin crew onboard.

Anyway, i helped the guy, and sorted him out with the aid of a physicians kit bag that was on board. I spent most of the 4 hours looking after him.

The airline gave me a signed statement saying they would cover any malpractise suit that arose from the incident.

Anyway, the guy made it to the airport, and I punted him off to hospital. I guess he's ok, but I never checked.

So today I get a letter from the airline. It was a lovely letter. Lots of thanks etc. Then at the end they said they were going to send me a gift, which they hoped I would be willing to accept.

Now we all like a gift at xmas. BUT, what I was wondering is.....would the fact that I accepted a gift for providing medical care mean that I took a "fee" for the service. therefore, from a medico-legal standpoint, am I putting myself in a position whereby I essentially gave a private medical service on the plane (in which case it's easier to sue), or does the fact that I didn't ASK for any payment mean that I'm still covered as a good samaritan, and the more lax legislation that goes with it (ie it's harder to sue someone who was helping you in good faith).

Does any of that make sense?

I know the airline said they will cover costs, and I'm sure the guy was fine, aswell as being very appreciative.

But, it was more of a general question that I had in my head. I'm going to ring my medical insurance people anyway, but I'd be interested in your thoughts about the right/wrongs of receiving gifts for medical care, and the potential difficulties that it may entail.

Dizzyblonde

I'm neither a medical nor a legal person, but in my opinion you helped out in a medical emergency and now the airline want to make a gesture of their appreciation. You didn't ask for or expect payment. You often see Thank You cards and bunches of flowers given to doctors and nurses by grateful patients. In my opinion this is the same kind of thing, but you're right to take advice because our society has become so litigious.
I know if I became ill on a plane I'd be very glad if there was a doctor on board, and I'd hate to think that fear of litigation would stop someone from helping.

GuanYin

I've seen this happen a few times (I was on a trip to a conference with 3 residents, 3 fellows and 2 attendings when someone took ill) and generally the airline will offer something (in our case it was an upgrade for our second leg, but travel vouchers and the like aren't uncommon).

In my experience, it's really up to you wether you take them or not. The US doesn't seem to have any specific policy on this matter (and we're FAR more litigation conscience than Ireland) and it tends to be don't ask don't tell.

The airlines point of view is simply customer service, you averted an incident on their part, to the detriment of the enjoyment of your flight. I don't think they have any motive, but I'd make sure it's ok wth your insurance.

Look at it like this, if you attended someone in a bar and the bought you a pint, would you accept? I constantly get fresh fish or oorganic veg brought into the clinic.

DrIndy

take it mate, you deserved it!

Most of my run ins on good samaritan deeds have not been as successful as yours and not on planes.....

Traumadoc

I have had a few "is there a doctor onboard" incidents on longhaul flights - nothing serious, always got a gift token for the inflight dutyfree (never an upgrade:() but took the gift anyway, I would not worry about being sued.

A guy I know a few years ago made the longhaul flight land, they had to dump 100,000 litres of fuel to land. The Doc got upgraded to first afterwards.

Dr Galen

i can see where your coming from alright but i'd say you'd be fine. Again i've heard of this sorta thing before and a token of appreciation is common enough.

Also as the girf is coming from the airline and not the passenger I think someone would have a hard time proving anything about you having a private contract with the man. If it was the dude himself, then that might be slightly different, but in effect if taken logically, the girt and the patient are unrelated.......my opinion anyways.

I've not ever read the full regulations for Doc's, but I know Nurses code of conduct allows for gifts, as long as they couldn't be misconstrued as being given or taken to gain undue influence etc. Thank god really, i think I've ate at leat a half ton of patient donated chocolates over the years!

godhatesme

Take the damn present.
More than likely its one of those airplane on a stand thingeys, a pen or some other crap from the gift catalogue on the plane.
It's a good thing you didn't do any of that "hero" stuff on Ryanair or they would be thanking you by selling you a gift from the inflight catalogue!
By the way,
The world will end on march 6th, check out eBay for all my stuff being auctioned. I ain't going to hell potless!
Toodles!

Nothingcompares

Don't know how to follow to the above post but I hope they give you a private jet.

metrovelvet

Im not a doctor or lawyer but I know its common practise in NY to bring baked goods and gifts to the midwives [who are actually obstertical nurses and not midwives in the Irish sense of the word] so that they are nicer to you in the labour ward.

Im guessing, given that this is recommended practise in a highly litigous medical field, accepting a gift is not a big deal for the circumstances you were in. It's not "payment" as such.

GuanYin

metrovelvet wrote: »

Im not a doctor or lawyer but I know its common practise in NY to bring baked goods and gifts to the midwives [who are actually obstertical nurses and not midwives in the Irish sense of the word] so that they are nicer to you in the labour ward.

Im guessing, given that this is recommended practise in a highly litigous medical field, accepting a gift is not a big deal for the circumstances you were in. It's not "payment" as such.

My partner got a hamper today in work from a patient. It's probably 2-300 dollars worth of hamper (so worth about 2 euro 41 ).

All I've ever gotten is fresh fish and veg and a free meal in a restaurant once.

Victor

Its an odd one. I think its a nice gesture and I'd run it by the insurance people, but I would make the following points.

It is odd of them to ask do you want a gift. They should either send you a gift or not. If the send it and you don't want it, pass it on to a charity or someone who can make use of it.

Don't accept gifts that are excessive or inappropriate in nature. A trinket or discounted flight / free upgrade with the airline would be OK. Free flights or 3 weeks in Florida are too much. If you are offered his daughters hand in marriage - think twice.

A published policy of "free ........... if you render medical services during a flight" is improper. You'd have doctor administering slow acting poisons to their passenger at the departure gate if that was the case.

DrIndy

You've just demonstrated that medicine is still a vocation and not a profession where no matter where you are or what you are doing - you will still help someone who is in need of help - with no strings attached.

That is honourable and if someone wants to be honourable back with a no strings attached gift in return for your original gift - I would accept it.

eth0_

Hrm, I don't work in medicine but any company i've worked in has had a gift policy that you can't accept gifts over a certain value, you have to give them to HR to be raffled off at Christmas or whenever.

However, IMO this couldn't possibly apply to you in the situation you were placed in. You weren't representing your hospital, you were acting as a good samaritan. I'm sure it is fine to take the gift, ethically and legally too.

Fingers crossed it is something like a return flight to NZ :P

tallaght01

So, I got me gift today.

They're offering me an upgrade (one way only, mind :P ) on my next flight back to Ireland with them. Will definitely make the journey from New Zealand a lot more tolerable.

Just hope no-one decides to keel over when I'm stretched out in me bed, gettin massage from the air hostess :P

Coz I'll be leaving them to it lol

Victor

Ah, double edged sword - if you want you gift you have to fork out for a flight.

tallaght01

Victor wrote: »

Ah, double edged sword - if you want you gift you have to fork out for a flight.

It's true, victor. PLUS, I'm only allowed to upgrade to the next class....so to get in the cool business class bit I have to buy one of those "premium economy" tickets.

I'll just ask them for money next time

Faith

Ah, that's a crap gift! Although if it's BA, I'm pretty sure "premium economy" is the same as regular economy, just by a fancier name. I flew to LA on premium economy and I was shoved in the middle of a 4 seater down the back by the toilets.

They should have given you an automatic upgrade to first class.

tallaght01

well, I still have to say it's nice to have your willingness to help recognised.

I'm one of these really unlucky people....people collapse/get knocked down/get stabbed whenever I'm around. I couldn't count the number of times I've had to provide help to somebody when I'm not at work.

I've never wanted, or expected, anything in return. So, the quality, or otherwise, of this gift doesn't bother me. I've helped people in shopping centres/restaurants/cinemas and I was never offered shoping vouchers/free meals/cinema tickets in return.

You shouldn't feel that you have to reward a healthcare professional or student for helping someone who falls ill. So, while it's a definite "strings attached" gift, it's still nice to be recognised.

Though, as anyone who works in healthcare will tell you, the best gifts are the things like the thank you cards that the kids make you, or the letters their parents write. They're defo better than a first class flight.

Out of interest, how happy are people getting involved with providing care outside work? I know in a plane it's a different story, as you might be hours away from help, and there's always a physician's bag available.

BUt, if you saw someone on the street etc? I know I've helped a lot, but some people won't get involved for reasons of litigation/personal safety/feeling that it's pointless as they've no equipment. Any thoughts?

Victor

I'm not in the medical business, but in my opinion if someone goes down, there is no choice but to help. The alternative is potentially someone dieing when they need not.

On a bus once, a girl keeled over. I told the driver, called the ambulance, put her in the recovery postion and waited with another passenger until the ambulance crew turned up. One of her friends happened to phone and explained what her condition was (something reasonably sersious, but it escapes me at the moment).

The rush of other passengers to get off the bus (middle of the afternoon, not rush hour) and get the next one (hadn't arrived yet) was unseemly.

hunnymonster

Tallaght_01, apart from the business premises people, how have the actual out-of-hours patients responded? If a doc helped me, I would certainly feel obliged (and happy) to pay/do something in return.

tallaght01

hunnymonster wrote: »

Tallaght_01, apart from the business premises people, how have the actual out-of-hours patients responded? If a doc helped me, I would certainly feel obliged (and happy) to pay/do something in return.

I would never take payment from an individual for assistance given in a medical emergency.

People have mostly responded to me in the way you would expect (ie they were grateful)

A few years ago when I lived in Glasgow, a total skanger was getting battered in the street by a taxi driver. He was refusing to pay the fare, but the hiding was way out of proportion. So, there was a few of the guys visiting from back home, and we all legged it over and chased the taxi driver away. Saved this skanger from being seriously injured. Then i aksed if he'd like to me to have a look at his injuries too. He heard my accent, and said "I don't want no fenian c*nt near me, so f*ck off". Nice. Bigotry is, sadly, alive and well on both sides of the divide in some parts of Glasgow.

I do a lot of work at concerts/public events. When you're at the large raves, people can get pretty aggressive when they're being treated. But that's not the person talking, it's the drugs.

Usually, I'll help out. Then I'll wait with them until an ambulance arrives. If there's kit aboard the ambulance that I feel it's important to use on the scene I will do. Then i'll just leave them to it. I don't go phoning the hospital afterwards, and ill people are never too worried about collecting my contact details at the time, so I've never really had any feedback.

One time I was at a live gig in Dublin. Very famous artist (well, in Ireland anyway). He saw someone keeling over in the audience. So he stopped the show and asked was there a doc in the house. Me mate was locked and stood up shouting at the top of his voice "WE HAVE ONE OVER HERE. THIS GUY'S A DOCTOR. HE'LL HELP" while pointing at me. So, I had to step up and treat this guy while about 1500 people watched me, which gives the situation that extra edge.

I also worked at some athletics/football events in my time. I hate treating the athletes/footballers. They're often very dismissive of you, and act like you're below them. They're always angry, agitated, and annoyed with themselves for getting injured, so they take it out on the medic. They say the same things time after time "just put something on it to sort it out quickly". If you tell them they need to come off, it's always "I'm not coming off, just sort it out". I don't pander to them. i just tell them if they don't want to follow my advice, then that's fine, and I leave the field. I stopped doing those kind of events because of that attitude. I have to say they're obviously not all like that, just a higher proportion than in most groups. One reasonably well known sportsman once handed me a wad of twenty pound notes aftera match in which I'd treated him and got him back on the field. There was a LOT of money in that wad. I didn't accept it though.

hunnymonster

tallaght01 wrote: »

I also worked at some athletics/football events in my time. I hate treating the athletes/footballers. They're often very dismissive of you, and act like you're below them. They're always angry, agitated, and annoyed with themselves for getting injured, so they take it out on the medic.

gosh, I hope I'm not one of them.

tallaght01

hunnymonster wrote: »

gosh, I hope I'm not one of them.

I'm sure you're not.

Most of them, like most people in life are sound. But sompetetive sports at a high level do attract a particularly driven type of person, to whom getting on with the game is the most important thing, I guess.

skibum

tallaght01 wrote: »

well, I still have to say it's nice to have your willingness to help recognised.

I've never wanted, or expected, anything in return.

You shouldn't feel that you have to reward a healthcare professional or student for helping someone who falls ill. So, while it's a definite "strings attached" gift, it's still nice to be recognised.

Though, as anyone who works in healthcare will tell you, the best gifts are the things like the thank you cards that the kids make you, or the letters their parents write. They're defo better than a first class flight.

Fair dues to you, you certainly come across as a genuinely nice person, among the last of a dying breed in this rat race that Ireland has become.

tallaght01

Very kind of you to say, skibum.

But there's a world of good people in Ireland these days, if you look hard enough.

There's docs and nurses and nurses assistants and physios and scientists and social workers etc, all putting in more work than they're (often poorly) paid for, to help the punters who walk through their doors.

Apparently, there's even some good human beings outside healthcare, but that's yet to be independently verified

tallaght01

Interestingly, I got my quarterly magazine from my medical defence organisation today. It had a big feature on treating people on flights. A few interesting points were raised:

There's automatic cover for american physicians providing medical care on flights aboard maerican aircraft, under the aviation medical assistance act.

Some airlines don't cover a doc at all if (s)he helps somebody on a plane.

Quite a few airliners apparently only cover you if they specifically ask you for you help. So, in my case, I'd heard the cabin crew asking lots of people who travelled under the title "Dr" to help. These people all said they weren't medical doctors. As I wasn't travelling as "Dr Tallaght01", I offered my services. Therefore, I wouldn't have been indemnified by some carriers (though I'm covered by my own insurance).

1 in 160 flights has to contact a doctor on the ground for medical advice.

1 in 7,500 flights has to be diverted for medical reasons

On in every 14,000 passengers becomes unwell enough to require medical assistance on flights.

And the award for most useless information goes to tallaght01

Chunky Monkey

My mum delivered a baby on board a flight about two years ago. Unfortunately the little babba died, it was premature. Usually when we're on the street though and my mum sees something that may require a nurse or doctor she goes the other way. I've a feeling something happened in the past or maybe she's just spent too many years in healthcare.

Gotta agree with skibum that tallaght seems like a genuinely nice guy. There are good people here but you find yourself wondering when you hear stories like those two fellas who dumped the priest having the heart attack on the DART platform and hopped back on the train.

Chunky Monkey

The rush of other passengers to get off the bus (middle of the afternoon, not rush hour) and get the next one (hadn't arrived yet) was unseemly.

Probably better that they did, they could have gotten in the way of the paramedics. Plus if someone else is controlling the situation there isn't a need to stay. And it wouldn't have been fair on the girl to have everyone watching.