Working with a phone-based medical provider
The VVIP on board had an unfortunate run in with a sea urchin. She is in extreme pain, and you need to get her assistance – and fast.
The last thing you want to do is play 20 questions with your remote medical provider. “Why?” you ask. “Why so many questions? Just tell me what to give her so she feels better and this doesn’t ruin our charter”.
But the doctor on the phone persists. She says that to provide the best care possible, there is some information that she needs to know.
During regular doctor visits, the doctor is assessing a number of non-verbal cues while listening to a patient’s concerns. Phone-based medical providers don’t have access to all of the visual, auditory, behavioural and palpable cues that occur during an in-person consultation.
Therefore, they have to ask questions to get a better assessment of the situation and refine the diagnosis.
In addition, a person’s regular doctor at home will likely have records of their previous medical history. The home doctor can refer to their records if they have any concerns about drug allergies, current prescriptions, the patient’s last visit, etc.
Since guests are generally unknown to the remote medical provider; remote doctors need to be very careful about what they recommend should they need to prescribe drugs for the patient.
MedAire, a provider of phone-based medical and shore-side support, recently published a paper on best practices for working with remote medical providers.
“We want to ensure the treatment prescribed does not interact with current medications, and that there is nothing significant in a person’s medical history that could cause the treatment to have unexpected, unintended and even possibly serious adverse reactions,” said Dr Robert Quigley, a medical director at MedAire.
Gender, age, and physical condition are also extremely important to consider when prescribing a drug.
For example, the combination of medications may be perfectly safe for a healthy 30-year-old male; but be absolutely contraindicated in dose or side effects for a two-year-old child or a healthy woman in the first trimester of pregnancy.
That is why, for the safety of the patient, remote medical providers need to ask demographic questions; ask about past medical history; and clarify present medical complaint details for which they are making remote ‘prescribing’ suggestions and clinical recommendations.
THE BASICS:
Expect a medical provider to ask the following when you call about an ill or injured guest:
• Age. Since almost all drug dosages vary by age, age is a critical fact to know. Babies are not small children; children are not small adults; and those aged 70+ may have considerable physiological susceptibilities that generally do not affect adults between 20 and 65. Even simple over-the-counter drugs have widely varying dosages between infants, toddlers, adolescents, and adults.
• Allergies. Allergies to penicillin, insect stings, any other drugs - and the nature of the allergic response is important to note. Is the threat anaphylaxis (life-threatening) or less severe (a skin rash).
• Medical history & the current complaint. When did the issue start? Did anything provoke it? Does anything make it worse? Does anything make it better? Have they ever had it before? If they had it before, what happened? What did they try in the past to resolve the issue?
While the questions may be frustrating, think how frustrating it would be for your guest to receive a course of action that has already been tried and has failed.
A good rule to follow when speaking with a phone-based doctor? Anything you or the patient thinks may be significant, probably is. Share the information with the medical provider.
Remote medical providers are there to provide the best possible care. Your assistance in obtaining the information from the guest – or encouraging the guest to speak directly with the doctor – is extremely important to providing quality, safe, expedient medical care.
“It has been our experience that the best outcome for any medical event at sea is based on a good (two-way) communication platform, the accessibility of pertinent medical history and current complaint, and following the medical professional’s recommendations,” concludes Quigley.