Advising young women on choice of contraception
Dr Julian Kilburn has completed many assignments as a ship's doctor – and discovered you need to be ready for anything
After many years of practicing medicine I was ready for a refreshing change of direction. I remembered a colleague who had been working on a cruise ship so I wrote to P&O Princess Cruises and was given the post as junior doctor on the Royal Princess in 1997.
Over several years I have managed the medical department on a number of P&O Princess cruise ships while travelling the world. I have been involved in some of the most high-profile, modern-day maritime medicine cases.
An average day is comprised of two-hour passenger clinics in both the morning and afternoon and two daily crew clinics lasting one-and-a-half hours each, as well as the usual out-of-hours emergency calls. As you would expect, a ship's doctor is on call 24 hours a day, seven days a week, but there is support from a team of staff, typically a junior doctor and a number of nurses.
The kind of daily cases we deal with range from minor trauma incidents such as trips or broken bones from the passengers and crew, to respiratory, cardiac complaints and even some exotic illnesses.
In reality, a senior ship's doctor has the opportunity to operate an A&E centre, intensive care department and, often at a much earlier point in his or her career, run a traditional GP practice for the crew – a rare and incredibly rewarding and valuable career combination.
Aside from the day-to-day influx of typical complaints, I've faced a number of difficult decisions and unusual scenarios. Perhaps the most memorable incident was when a passenger brought a norovirus on board.
I informed all senior officers and initiated the company's prepared response procedures. Passengers were treated symptomatically and given advice on how to avoid contracting the illness.
This scenario gave me the opportunity to test the on-board management systems I had developed after the company paid for me to take a major incident management course. I was in charge of a situation that was making front-page news every day.
Luckily the company was carefully handling the political pressure so I was able to get on with my job.
Occasionally we are required to disembark passengers who require further urgent
medical attention outside of our onboard capabilities.
A case I was involved in required my decision to evacuate a patient experiencing acute respiratory failure by helicopter over the Bay of Biscay. The procedure affects everyone on board – the captain needs to be consulted to gauge feasibility and passengers have to be marshalled.
A typical P&O Princess Cruises's medical department comprises of two doctors' offices, nursing station and treatment areas, and a laboratory for testing illnesses from influenza to malaria.
There are critical care rooms with cardiac monitoring facilities, patient wards, a well-stocked pharmacy, anaesthesic machine, X-ray facilities, and even teleradiology and telemedicine facilities, and satellite link-up so doctors can liaise with colleagues around the world.
Though three years postgraduate experience in A&E, ICU and CCU and current full registration is the minimum preferred requirement for entry, I soon discovered the other characteristics and skills required of a ship's doctor.
A senior doctor is a manager, responsible for the department and team. Paperwork and meetings can be an initial challenge but beneficial to your career and similar to A&E practices. Sociability and a caring, personable approach must be combined with an understanding of the general management of the ship.
The key to enhancing your career is striking a balance between time spent onboard and off. I spent a year at sea and then left for two years to study for the MRCGP and FRCS exams. I believe in being 'future proof' and taking appropriate qualifications that will enable ship's doctors seamless re-entry back into the system.
There are currently measures being put in place so ship's doctors will be appraised to the same standard as UK doctors and progression will therefore be recognised throughout the profession.
With the responsibility and advancement of career, a ship's doctor experiences the most luxurious holiday lifestyle. Aside from the four months leave each year, the port-intensive cruises allow you to visit some of the most desirable locations, take advantage of all onboard facilities and treat loved ones to greatly discounted holidays. Ship's doctors also work in a tax-free environment with little opportunity to spend money.
Overall, I would describe being at sea as the most interesting thing a doctor could possibly do. It can be a rollercoaster ride, especially when you are the key decision-maker in pressured situations, but it is highly rewarding as you get to work with your patients from start to finish and manage your own team. You will experience a wide range of emotions and need to be ready for anything!
If you would like more information on the benefits and requirements of becoming a ship's doctor, visit www.shipsdoctors.com or contact Christine Green, Fleet Personnel, on UK +44 -23 8065 5186.
Julian Kilburn is a senior doctor on P&O Princess cruise ships