Saving the Day at 30,000 Feet (Or Not)
Aaron Singh -- It was all quiet on the plane. The lights were dimmed; most passengers were asleep. The dashing young medic was in his aisle seat, talking to a hot young air hostess who was crouched in the aisle next to his seat, eyes wide in admiration at his tales of medical derring-do.
Then, suddenly, a cry from the opposite aisle! Flailing arms could be seen over the heads of snoring passengers. The hostess rushed off whilst the medic stood up and, with his keen diagnostic eye, spotted the unmistakable signs of a woman having an epileptic fit.
Gallantly he stepped out of his seat, mentally prepared himself, and strode over to help. The woman was in spasms, being held by her beautiful teenage daughter. The hostesses didn't know what to do and stood around with pillows in their hands. All their faces, with worry in their beautiful eyes, now turned to the medic standing authoritatively above the woman.
The medic, realising he was the woman's only hope, stepped down to take charge. As his strong powerful arms moved in to stabilise the woman, her young daughter's doe-like eyes turned to him, and her quivering lips parted for the words to stumble out:
"What the heck do you think you're doing?"
The medic stopped. Surely she hadn't meant to be so abrupt. Surely she realised one of the world's finest medical students was now bent above her mum trying to help. So he replied in a manly voice:
"Why, I'm going to try and stabilise her, of course." Brilliant smile.
The stunning hostess from before glanced shyly at him from out of the corner of her eye. He flashed her a confident smile for good measure. Then, with an adoring expression on her face, the daughter spoke again, uttering words in a tone he was sure would be nothing short of reverent:
"Get your hands off my mum!"
It was about then that I started realizing how big an issue patient consent was in this country. All those years I'd watched chiseled-jaw TV doctors rush over to help inexplicably beautiful women who collapsed before them on the street led me to believe you could just rush over and administer first aid to whomever you liked. In Malaysia that's certainly the case; merely being a medic meant people would be happy if you volunteered your services in an emergency, and would almost always let you take over. But in Britain the situation is different, as I learnt on one of my first-aid assignments; you can't simply run over in slow-motion with a first-aid kit whilst the theme from E.R. pumps in your mind. The patient would be well within his or her rights to tell you to sod off (especially if, like me, you can explain all the ionic receptor interactions that cause epilepsy at a molecular level but don't know jack about treating it. See my previous post for why). Just another manifestation of the Eastern reverence for (and the growing Western mistrust of) the medical profession.
But I've been thinking about whether patient consent is just another bullet point in the long list of things that have been caught up in the tide of political correctness whitewashing the country. Surely it serves as a safeguard to protect patients from quacks and incompetent practitioners (not that I'd know anything about that, of course), but where does it stop? At what point does the patient's ability to choose actually start to endanger him? Before going on a first-aid assignment, we are told to introduce ourselves properly to any patient, reminding him or her of our limitations as first aiders and asking permission to treat. However, this power that patients wield over us also lets them nitpick, going so far as to demand a specific type of plaster or bandage simply for cosmetic reasons.
All I know is that I'm going to make sure my first aid kit is well stocked with medium-sized Hansaplasts before going out on my next assignment.
December 14, 2006 | Permalink
Next time don't "stabilize" her. Extra hospital guidelines state you should only provide a injury free environment and in a post-ictus state convert to a side security position whilst monitoring breathing.
Good story though, best of luck in your studies.
Posted by: | Dec 17, 2006 9:29:45 AM
Hello! I agree with the previous comment. The guidelines are correct, but you also need to recommend a visit to the emergency room, for precaution. It's a great idea to carry a first-aid kit, but a first-aid course will be a better complement. I would encourage you and other med students and doctors to take the BTLS course, at least; the PHTLS would be better. After you take the PHTLS, I suggest the ATLS. The first two are pre-hospital care, and the latter is a hospital care course. These courses taught in the US provide standard protocols, guidelines, but not the only treatment options. You will learn a lot, expand your "off-hospital limitations", your knowledge, and any legal liabilities.
The difference between in-hospital and off-hospital care is that in the first case, patients come to you for help, in the second case, they are experiencing a medical emergency, but they still have not asked for your assistance. We have a tendency to help, it is our nature, or so I have seen in Medical students and Doctors, but patients still have the right to refuse medical treatment, even more so if they have not asked for it. I know that this is difficult to understand, but we have to keep in mind that we provide a service, and not everyone would appreciate our help.
Good luck next time (I hope there is no "next time"). Always remember to introduce yourself, at a hospital, your private practice, or 30,000 feet above ground to your patients, or potential patients. This might make a huge difference between accepting assistance or not.
Posted by: | Dec 17, 2006 1:58:06 PM
Hey from a fellow Malaysian studying in the UK (1st year here, but 3rd year)- in the same boat as you, probably. They're definitely very aware of their rights, and they make sure you know that too - I've been turned down a couple of times (and quite matter-of-factly too) when I've tried to take bloods from some of the patients. Though most of them, patients and healthcare workers, and friendly (probably friendlier than back home!).
Keep on writing!
Posted by: G Chew | Jan 10, 2007 4:00:15 PM
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