By Dr. Robert Quigley
A very important person 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 so many questions?” you ask. “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, in-person doctor visits, the doctor is assessing a number of nonverbal cues while listening to a patient’s concerns. Phone-based medical providers don’t have access to all of the visual, auditory, behavioral 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 guest’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, their last appointment, etc.
Since yacht guests are generally unknown to the remote medical provider; the doctors need to be very careful if prescription drugs are to be recommended for the patient.
As medical professionals, we need 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.
Gender, age and physical condition are also extremely important to consider when prescribing a drug. For example, a combination of medications may be perfectly safe for a healthy 30-year-old male, but absolutely contraindicated in dose or side effects for a 2-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.
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, it is a critical fact to know. Babies are not small children, children are not small adults, and those age 70-plus 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 insect stings, penicillin or 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 and 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 is: 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.
From my experience – 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.
Dr. Robert Quigley is MedAire’s medical director. MedAire (www.medaire.com) provides phone-based medical assistance and shore-side support for yacht crew and their guests. MedAire is an International SOS company. Comments are welcome below.