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shtan

Duty vs Capability

17 posts in this topic

Just wondering about what other psychiatrist feel and would do.

Was going out for a few home visits and noticed ahead a slight congestion. When I reached the scene, noticed a car was on its roof. An ambulance was on the scene but the accident must be recent as police were not visible and the tailbacks were not too bad (was a major road and any accident would cause a major tailback).

Part of me was tempted to stop to see if I could do anything but... could I? Been in psychiatry for the past 6+ years and besides my PRHO year, have never done anything else besides psychiatry. Yes, I attended CPR training and special interest sessions in medicine but otherwise feel I am close to useless in a RTA. In a way, guess this similar to 'Is there a doctor on the plane?' scenario. (Faced this once actually... told stewardess I am a psychiatrist but willing to help if they could not find anyone else... they did, thank goodness).

Because an ambulance was already there (and paramedics know more about this part of medicine than myself) and that I know my 1st visit was important as the patient's wife was at her tether and was crying for help to CMHT (which lead to this visit), I admit I did not stop. Felt guilty all day though.

Has anyone stopped for a RTA? Did you do anything you thought was useful?

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I think I would have done exactly what u did- ur first job was an urgent home visit- and u did that.

As for the RTA- u r right- being in Psychiatry for so long has made us obsolete in acute medicine- i don't think I would have served any purpose in an RTA- of course one feels guilty- after all we r doctors and should save lives- but it is better not to use unupdated knowledge in such a situation

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I think you're absolutely right about the paramedics.  The fact that they were already on the scene would have reassured me.  I've been in a situation where a ward patient attempted suicide.  We did our best to resuscitate her - once the paramedics arrived, they smoothly took over and did everything a medic would have done.  I would have told myself that there are professionals on the scene who are better trained and equipped for this situation than I am.

Of course, others may disagree.

Addy

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I think you did the right thing. If the victim was alone, then as a doctor you might have had more responsibility to ABC as best as you could till the paramedics arrived. But in this case, help had already arrived and the paramedics would use their equipment with familiarity better than others.

I was on a plane once when they called for a doc. A GP seated next to me refused to budge and luckily they had found an experienced doc by the time i mustered the courage to go. I had jus finished my PRHO.

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I think only GPs HAVE to stop ...and only then ....

I mean its all about competencies ...what if the paramedics said to u 'alright doc, now take over' -what would u have done?? U said urself u've never really done this stuff, besides ambulatory medicine is a speciality in itself.

finally dont feel guilty safe with the knowledge that the paramedics will tell u that they 'haveit under control thanks doc' (as i have been told numerous times in the past!!) .....its not like ur on the airplane ....now that IS the dilema!!! (or not depending on ur personality!! ;) )

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While I was on this 10 hour flight to Colombo last year, they called out for a doctor. Having downed a couple of glasses of wine,my dilemma was whether to put my hands up or not ? But my conscience pricked and I gave myself up after a few minutes only to discover to my pleasant surprise that the pretty girl who was sitting in the same row as me was coming as well ! ;) (and I later found out to my big relief that she was an SpR in medicine  :-* )

While talking to the wife of this middle aged man who apparently had a fit minutes ago,we realised that he had not taken/forgotten to take his antiepileptic medication that morning ! (because of fear of flying ?? ::)).Thankfully his wife had some medication with her and we asked her to give it to him and from my part I gave some counselling/reassurance/telling off and impressed upon him the importance of taking the tablets.

Job done and then the rewards...chit chat with the air hostesses/captain, more wine and special/extra toys for my kid.  :)

My wife was impressed as well...I hope the registrar was impressed too !! ;):lol:

I feel doing some kinda help in an emergency is appropriate and unlike in India I hope that over here (and in the air )you do not get screwed for helping out by the police/court/relatives later if something happens to the patient !? :-/

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I think u reacted in the best way possible yme.

i too would have been at a loss in a similar situation, but as u say the paramedics were already there!

Time to brush up on those resuscitation skills again...

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I agree. if there was no one at the scene then we will be able to do something about it but if there are people who know the stuff like the paramedics, we will be more of a hindrance than help i think.

On the flight back from Holiday In africa, the captain called for a doctor and i thought they would have someone trained in Medicine as i continued to Enjoy my food(really good food.) then after 2 minutes still they were making the announcement and i stood up. the airhostess said. please sit down sir we are looking for a Doctor!! i said i am one. ofcourse after 3 weeks in the desert i was unshaven and with unruly hair so they may be expected a doctor to be in a suit??!!

the person i had to see was just dehydrated. if there was anything worse, i think i would have explained my EXPERTISE and warned them before i did anything. or more so nothing!

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You should be aware of mdu policy guidelines in such a situation.God forbidden if something goes wrong in helping somebody in this country you will be the first one to be sued and also the first one to be disciplined by the img friendly GMC.

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interesting thread!

I've often wondered about this. As psychiatrists our skills in acute medicine might not be up to date. If I found myself in that situaation I think I'd say I'm a psychiatrist and offer to go forward if there's no other physician.

It is important to keep up, at the very least, with Basic Life Support skills. There were sessions on this at the last college AGM, and most Trusts organise them about 6 monthly too.

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docsanju2003,

What is MDU's policy? I thought the Good Samaritian rule still apply.

And thanks all for the kind words.

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I've always stopped at RTA's,helped people out...gained consent(very imp unless the person is unconcious)......never had a problem and I still think Yme did the right thing.

I've waited till further help arrives/ambulance ready to take them away.

The ambulance crews alway take a lead.....(and I'm more than happy to let them)but are always happy to have a helping hand.....remember only two or three people arrive on the scene first......and you've had 5 or more years of medical training.

As for the the MDU remember that the courts look lightly on those who seek to preserve life....but it is your choice and good samaritans are few and far between.

If you would like to brush up your skills ...there's nothing stopping you

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it is interesting because it is often alleged we are not 'proper' doctors. one of the consultants recently did actually say this. i feel we have done a basic medical degree and though we are in a speciality that does not have hands on dealings with physical stuff this should be looked into. after all the drugs we give people lead to a bunch of physical side effects. psychiatric units are often not on the the main general hospital site. old age psychiatry has lots of cases with physical complications. i don't know the overall answer but i wouldn't mind if a basic competence in acute medicine is added to our curriculum. what do others think?

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I agree with toyota's comments about adding acute medical management to our training.

Come on guys, first and foremost we are doctors! Fair enough the chance to practice practical hands on medicine in our daily jobs is rare, but we should still be expected to manage the initial stages of an acute medical emergency. The potential for such incidents is huge in psych hospitals, especially old age and long stay wards, but also with DSH, OD, suicide attempts, etc on the acute wards. I often feel that there are so many more things that could be done in Psych hospitals, that patients often just get transfered for. Diabetes is something we should all know how to handle, given the changes in BMI that our drugs can cause, anlong with other endocrine imbalances.

Everyone should be comfortable with CPR, as I'm fairly sure we're all expected to have at least yearly updates of basic life support. And you never know when it will come in handy, just look at the stories on this thread about good samaritan acts.

When you consider that GPs can diagnose and then thrombolise MI patients in the community prior to transfer to hospital, I think our patients sometimes have treatments delayed because the set up in psych hospitals is not geared towards the treatment of physical illness.

As always the flip side is that medical and surgical wards are just as quick to bleep and transfer patients who have psychiatric problems, as they 'don't have the training' to manage them...

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Do people think it's ok to post confessional accounts, such as this post, when is's easy to trace actual identities ?

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I have successfully passed my Advanced Life Support course, conducted by the Resuscitation council,UK in 2000 & 2003(it is valid for 3 years) & will be doing it later this year too.

Professionally, I would come forward to see what I can do(After explaining my expertise is not in medicine to the family).If the patient is unconscious, then one is protected(Unless you are on an American Airline!) by Common law doctrine of necessity & also under article 2 of the ECHR(Right to Life)

what to do if in an American Airline?

Wont buy my ticket with my title &quot:lol:octor' ;)

Disclaimer:- take this reply of mine as that of a doctor in training & not that of an expert on this subject.Contact MDU,MPS for guidance :lol:

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If the problem is at work, I would not hesitate to do the needful.

Within the UK, Even on the streets, I would do whatbest I can to help people.

Apart from US &US airlines, I am ok anywhere :D

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