A Moment of Truth for Every New Doctor
Aaron Singh -- There comes a moment in every medical student’s life, when he realizes that all he’s learning is not just for exams, that one day he will be out there on his own, with real live patients and no medical professor leaning over his shoulder to guide him.
I knew it would happen.
And this week it did.
I have blogged here before about being a first-aider, and here about my University having a highly theoretical premedical course without much clinical skill development. Back before my encounter with an epileptic woman aboard a plane, I wouldn’t have hesitated to rush forward during a medical emergency and volunteer whatever help I could. Then I read the comments under the first-aid post, advising me not to rush into situations. I also heard horror stories from other medical students about medics and doctors getting sued by people who didn’t want to be saved. And I hesitated. All that I had believed about medicine was challenged. You couldn’t just rush in and save someone if they didn’t want to be saved. And if you didn’t know EXACTLY how to help and what to do in that situation, it was better perhaps not to step forward at all.
It was a normal Monday afternoon. I spend my afternoons in Pharmacology lab sessions with about half the medics in my year. This particular afternoon’s practical was a laid-back, slow one, and I was at my table, mixing drugs up, when behind me I heard a loud crash.
I turned around and saw that the whole lab was still. Whatever had happened was hidden from my view by another table, along with the medics sitting at it. Other medics were craning their necks to get a good view, but no one seemed to be moving. Nothing seemed urgent. I assumed someone had dropped another test-tube or beaker, or some apparatus had fallen to the floor, and everyone was taking advantage of the interruption to take their minds off their work for a while.
But people kept staring. I got that feeling you get in your stomach when you know something isn’t right. No one was moving, not even the demonstrators. I asked around, “What’s happened? Did someone drop something?” but no one answered. They just kept staring at the floor.
So I crossed the lab and came around the table. And lying on the ground before me, in the middle of a slowly growing crowd of onlookers, was a student. Passed out on the floor.
No one moved. A lab full of some of the brightest medical students in the world, and none of them had any idea what to do when someone fainted in front of them.
Then it kicked in. I was a first-aider. I was a MEDIC. I could DO something here. Go forward, you fool. She could be hurt. I started to step forward…
And through my mind flashed a single question, a question I am ashamed to admit ever crossed me now, especially at such a critical juncture:
Will I get sued?
Seems ridiculous in retrospect. She was just a medical student who had passed out in the lab. Not a patient going into cardiac arrest or requiring complex surgery. But that’s what flashed through my mind.
I was afraid to practise my art. Afraid to accept responsibility.
Everyone kept staring, myself included now. Finally a grad student raised his voice, “Is anyone here a first-aider?”
I started to reply, “Ye—“
Then a long white coat flashed by me. A tall handsome demonstrator, exactly the kind you’d expect to come zooming out of the sky to save you in a crisis, rushed past and bent over the girl, carrying a first aid kit. I blinked. A senior first-aider! Now maybe I could help.
So I joined him and introduced myself. The girl was already recovering consciousness; she had just fainted momentarily, probably due to tiredness. In a few minutes she could stand, and we sent her home. The tall demonstrator clapped me on the back and went back to work. No harm done.
But the incident is still ringing in my mind. I’ve got a long way to go before I’m out there on my own, but it scares me. Both that I hesitated, and that I was afraid to perform my duty. The first duty of a doctor. I’m safely ensconced in preclinical medicine now, with supervisors looking over my shoulder to clean up any messes I make, but it’s only a matter of years before I find myself in a white coat and having to tend to real patients. And when that time comes, I pray I do not hesitate.
February 23, 2007 | Permalink
well aoron its medical practice here in use which is like that....infact someone told me that it happened in chicago that a guy drove to emergency room got out of his car and then collapsed few feet from the door of ER and the people over there opened the door and looked over each othre's shoulder and said oh yeah there is man laying and no one went to rescue..so that man died and so do others....i think its different in other parts of the world but nay how system has pros and cons...
Posted by: sam | Feb 23, 2007 1:54:31 PM
I completely understand how you feel. I have one of those insane cat-like reflexes when it comes to someone who needs help. I'm scared to death that my impulsive desire to help people will one day land me in litigation. Actually, I've already had one person get upset with me when I simply ran over to them after they had fallen and tried to ascertain if they were okay. Isn't it sad that we have to be afraid to do the very thing that we've spent years of our life learning to do? But I am sure that when the time comes, you will absolutely do the right thing.
Posted by: Kendra | Feb 23, 2007 4:31:57 PM
iam a second yr student too but difference is im in india so if a situation like this had occured here lots of ppl must be there helping that girl i dont kn what kind of system is in ur world if u are helping someone u all fear of been sued its crazy srry to say that u all will be standing there and not helping a person even u know that person can die its really strange to me i never know something like that this is strange to me ppl over here will be thankful if u help them in need and i guess same a person will do there but who ami to comment on this srry but this is a very strange thing i know taking responsibility is different and it is very difficult but still i hope my self if im lying on floor fainted i wish someone can help me
Posted by: | Feb 24, 2007 8:20:15 AM
i'm malaysian student doctor(faculty of medcine uitm).
my university started to introduce "early clinical exposure" to the 1st year student. there wil have a visit to the ward after finishing of each module that they learned. it's really help them to know the disease since i dont have that opportunity. at least can give the expereience in early age.
Posted by: nik_jime | Feb 24, 2007 11:17:37 PM
An amazing story, with a beautiful save from the senior first-aider. One day, you will be like him, unhesitant and beautiful as well. :P
To be unhesitant, you need to be hesitant first, and regret it. (trying to sound like yoda with correct grammar)
Posted by: CambMedic EL | Feb 26, 2007 5:48:16 PM
Hi, I'm MS4 at Dominican Republic. I understand what you felt in that very moment. When I read your story I understood the great opportunity we have here in Dominican Republic, here we can develope clinical skills since the very 1st year, so when we were at my year MS4 we are no ready at all but we were unhesistant in most of the situations, and freak out in others. But still I'm very scare of the day I should move on by my own. But I'm sure that all of us will make the correct desicions in every situation. Good luck!!!!
Posted by: Ayeisha | Feb 27, 2007 10:39:22 AM
That's a pretty funny story. Students faint on such a regular basis at my school - during the first physio blood lab, dissection and once in the case of my friend, upon being introduced to an entirely innocuous looking clavicle. But I can't imagine everyone not rushing forward to try to help, or show off their dubious expertise. Maybe it's because the system is alot less litigous in India, but I never thought about the issue you've raised of make sure you know what you're doing before leaping to the fore! It's weird though, people in med school are usually such over-achievers you'd expect everyone to jump up and be like, "STEP ASIDE! I'm ALMOST a doctor."!!
Posted by: Sukanya | Feb 27, 2007 2:02:21 PM
I can see clearly what has happened. I think it is important to practice your diagnostic and technical skills as a first-aider constantly.
I would say every week. Otherwise you might be getting this feeling again and again.
Sometimes it is also good to learn emergency protocols at the facility and let its administration to know upfront that you are first-aider so they could advise you what is the best way under circumstances.
Posted by: Dmitry | Feb 27, 2007 2:10:29 PM
Aaron, sorry I just read your last post and had a question. You said surgeons are referred to as Mr. in the UK. Erm, so... would that be a Mr Susan Smith? No, really, I'm curious:)
Posted by: Sukanya | Feb 27, 2007 2:18:15 PM
what is a first aider? and what is a medic? i'm confused with the terminology.
Posted by: | Feb 27, 2007 2:27:09 PM
In our CERT (Civilian Emergency Response Team) training here in California we are told that, while we are NOT legally required to respond to anyone in distress (unlike paramedics, cops or medics in CA) if we do step forward to help someone before more qualified people reach the scene, we are protected by the Good Samaritan law. The Good Samaritan law states that someone who gives emergency first aid (like CPR, Heimlich, stopping bleeding, basic rescue) to another person in obvious distress is PROTECTED from any sort of malpractice or legal suit as long as they accept absolutely NO payment for their actions. So, as long as you don't allow them to take you to dinner, buy you a drink, or materially show gratitude (verbal thanks are fine) the person you help has no legal excuse to press charges.
At the very least, in the States, this is a legal precedent that you can remember and use in your defense. What court can argue that the old woman you revived via CPR is being unreasonable for complaining that you bruised a few ribs and smeared her lipstick?
(And how sad is it that we have to even discuss this kind of thing?)
Posted by: Susan | Feb 27, 2007 3:14:26 PM
Sukanya: Heh. Sorry, what I meant was that in the UK, surgeons revert to the title 'Mr' upon achieving surgical qualifications. That means female surgeons get to be called 'Ms' (or 'Mrs') again...forcing them to add 'Mr' to their names would result in quite a few lawsuits in Britain, the Motherland of Political Correctness :)
The basis of this is that in the past, surgeons were considered simple barbers and butchers, and did not gain the title 'Dr' as opposed to physicians, who were seen as proper doctors. How the tables have turned, eh?
Anonymous@Feb 27: Sorry, I meant 'medic' to mean medical student, and 'first aider' to mean a person trained in first aid. They're not the same, though you'd think medical students would do first aid :)
Posted by: The Angry Medic | Feb 27, 2007 7:46:30 PM
I am an EMT in New Hampshire and we are NOT covered by the Good Samaritan law. EMT's, paramedics, and trained emergency response personel are bound by the 'duty to act'--which basically means that if we are in a situation where someone needs basic life support or medical care within our protocols, we have to act wheather on duty or off. And, if we screw it up, we are legally liable because we are trained. Kind of scary if you ask me, but I think generally if a medic or EMT is making a clear-headed effort to help the law looks favorably upon that. Hopefully this will give me a bit of an edge when I apply to medical achool this fall, but I hear that many pre-meds are getting their EMT-B these days. I think it's the experience that really counts. Any MS here have their EMT or medic licence before med school?
Posted by: MicahMan | Feb 28, 2007 9:25:48 AM
Put your child or mother in the patient's shoes, you wouldn't care who stepped forward to aid as long as someone stepped up!!
Posted by: laura | Feb 28, 2007 10:59:10 AM
Don't forget "implied consent". As this patient (victim) was unconscious, she is deemed by law to have given consent to be treated. That is, any patient that is unconscious can (must) be treated unless covered by a DNR or other legal document.
I was an EMT and I remember one case where a woman was in and out of consciousness on the sidewalk. She initially refused treatment, then collapsed in front of us, so we loaded her into an ambulance. While on the way to the hospital, she would awake and tell us to take her home or let her out of the unit. A few minutes later she become unconscious again.
The result: We zoomed to the ER (red lights and siren) while she was unconscious, and drove s-l-o-w-l-y back in the direction of where we found her whenever she was conscious. Eventually she was delivered to the ER.
Even in this extreme instance, where the patient verbally prohibits assistance or treatment, once unconscious, all bets are off. In fact, if then fail to treat you could get into hot water (think "abandonment"). Keep in mind that the same is true with mentally altered patients: Implied Consent is there.
Posted by: Phil | Feb 28, 2007 12:13:58 PM
I am not sure if you guys were taught this in medical school but anyone can be sued even if whatever it is you did was in an excellent fashion. Now a days law suits are brought about for any foolishness. My point is if you do the right thing (Do whatever it is that you are qualified to do and not more or less until another trained individuall comes and can relief you) even if you're sued you're covered by the good samaritan act. This is what one should dwell on not law suits and moreson helping someone in need.
Posted by: Claudia | Feb 28, 2007 12:26:05 PM
I'm a 4th year med-student from Chile. Here we have the chance to practice clinical skills very early. When we get to 6th year we have patients under our care and we give tratment, of course our doctor-tutor checks everything. I find the story really sad, I mean, how can someone freeze under such a trivial situation, probably it was just and hipoglicemic episode, considering it was in the afternoon. You should have at least checked her airway. But I understand you, the fear of being sued doesn't exist among med-students here, although is becoming like a fashion between doctors.It must be hard for you to study and practice under those circunstances. Just be brave and follow what your duty tells you. One grateful patients compensates for all the other ungrateful assholes.
Posted by: Jose Andres Estay | Feb 28, 2007 2:10:27 PM
I am a Malaysian student studying in Australia. And I have heard the Good Samaritan Act because suing is also a trend here in Australia. I was quite surprised when I first heard that we can get sued for helping people when I first got here.
But I can understand ur hesitation. I would have to if I encounter that situation in Australia. But in Malaysia, I would probably do the decent thing and help anyway.
Posted by: | Feb 28, 2007 3:07:57 PM
it really is an amazing story.i read it yesterday and thought about it for a while and said to myself that everyone has fear in the field of medicine.Its of two types...1 is the fear of helping and 2 is the fear of not helping others. so if we want to be succesful we have to have the fear of not helping others.hope this helps and enjoy seeing your patients.
Posted by: pranathi | Feb 28, 2007 3:18:48 PM
hey aaron-thanks for clearing up between medic/first aider. your school system seems very interesting. i guess only a few medics are trained to be first aiders? are you selected for that honor? or do you have to sign up. b/c i would think that all medics would WANT to be first aiders-so that could get competitive. Here in the states, we are only trained in basic life support. So, as a fourth year med student, i am still scared about being the only person there to help someone,and i'm just about ready to graduate!
Posted by: | Feb 28, 2007 3:48:42 PM
The Good Samaritain Act in Australia is still reliant on the doctor speaking up and offering assistance! Remember even as a doctor the only thing you can physically do for a person outside hospital is basic first aid and summoning help. Don't panic! :)
Posted by: Kath | Feb 28, 2007 4:10:23 PM
Once my friend had an epileptic attack in my hostel room in my 2nd yr of med school. And just like your labmates, we froze with fear. It was shocking cause like you said, the place was filled with the best students in the country and yet no one could do anything. At that moment, I felt like the most useless person on earth. My response? I picked up the phone and called one of my lecturers. Thank god everything worked out fine. But till today, I still wished that I could have done more then just calling for help.
Posted by: Juve | Feb 28, 2007 4:40:24 PM
You are medic or not ,it is everybody's duty to go and help the person in emergency situation.Dont worry re outcome, those first seconds are most important in saving lives.In EUROPE YOU WILL be sued for not helping.ALWAYS HELP!!!!!!!!!!!!!!!!!
Posted by: Ann | Feb 28, 2007 6:24:17 PM
Sorry to hear about your trepidation. Remember, ‘we only get one kick at the cat’. NEVER, be afraid to rock and roll at the drop of a hat. First prepare yourself mentally for helping the ’next-one’ then do it!
Posted by: | Feb 28, 2007 7:20:42 PM
if u dont know what to do.. just remember ABC.. that would probably make difference
Posted by: | Feb 28, 2007 10:17:35 PM
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