Columnist Dr Shaba Nabi looks at GPs’ duties outside of work and recalls her own experiences of helping with emergencies in the community
The recent headline about a passing doctor being reported to the GMC for failing to assist a person who was threatening to jump off a hospital roof highlights our risks and responsibilities regarding Good Samaritan acts.
Obviously, none of us can know the full details of that case, but what is apparent is the patient had booked into the emergency department and was waiting to be seen by the psychiatrist, when he went out and climbed up to the roof. Attempts to talk him down by a nurse and policeman were met with demands to speak to a doctor who happened to be entering the hospital, who refused to assist. The GMC concluded this was more an issue of miscommunication than misconduct, but the case has inevitably polarised people into two camps.
Although there is no legal requirement for doctors to assist with medical emergencies outside the workplace setting, the GMC’s Good Medical Practice states: ‘You must offer help if emergencies arise in clinical settings or in the community, taking account of your own safety, your competence and the availability of other options for care.’ Most medical defence organisations provide indemnity for Good Samaritan acts, and the Social Action, Responsibility and Heroism Act 2015 also provides some legal protection against resulting liability.
So, if indemnity isn’t an issue, then what is? Obviously, safety and competence are important, but what about the availability of other people at the scene? In the case outlined above, why would the person demand to see a doctor above any other healthcare professional?
My own experiences of assisting with community emergencies have been less than positive. One incident involved assisting a choking child during a busy May Day fair, which I was attending alone with a baby and a two-year-old. When the drama and back slaps were over, and the child was fine, I stood up to find my two-year-old son was missing. Those next 30 minutes were probably the worst of my life, as I saw the world through the prism of the McCann family, whose tragedy had occurred exactly a year earlier. Eventually, I was reunited with him after someone identified his flying jacket spinning round in the helicopter ride that he’d managed to get onto alone!
Another incident also occurred when I was alone with a child, this time my seven-year-old daughter who had just had a swimming lesson. As we were about to leave the changing room, I witnessed a woman having a seizure on the floor and had no option but to assist with my daughter by my side. The seizure was short lived and the woman was fine, but my daughter was traumatised by the experience, and continues to have significant anxiety over any illness.
I hope I will never again be in a situation where I have to choose between helping with a medical emergency in the community and protecting my child’s mental health. I speak to my children openly about my roles and responsibilities, and fortunately they are older now, so they can independently walk away from a situation I might be dealing with.
But what about the thousands of other doctors with young children, or those who are caring for another vulnerable person or who have any of a number of issues that make helping while off duty problematic? Who decides whether our GMC duty to help should trump our obligations to ourselves and our families? I guess we won’t know unless a precedent is set in a tribunal – but I doubt that anyone is eager to test this.
Dr Shaba Nabi is a GP trainer in Bristol. Read more of her blogs here
Dreading the request for help from the flight attendant because I missed the day at medical school where they taught you to treat a tension pneumothorax with a coat hanger, catheter and bottle of Cognac.
Dealing with many things like this can be ordinary work for a rural GP, and, indeed, for any person, but especially, it seems, ladies that run farmhouses.
I would strongly recommend you support your daughter (and any other children) to attend First Aid training with St John Ambulance, which could help to relieve illness anxieties, help to prevent them (even in 5-8 yr-olds), and help our youngsters to gain confidence in dealing with not just illlness, but many kinds of emergencies and other unusual happenings, and also build them a good ring of friends and social life.
I found FA training to be great fun when I was young, and have helped to train at St John and Sea Cadets to return some of that skill and fun to youngsters today.
No, I have never had to decompress a chest in an aeroplane with a coat-hanger, but on one occasion we used the hospital’s whole supply of chest drains (2) on a single patient (both sides), prior to going with him in the ambulance (held together with sticky tape) the hour to the ‘big hospital’.
Very nice chap, about 70, I think, hit by a falling tree while working in the forestry, and walked into our A&E with odd bilateral chest signs and ‘too short of breath to run’ !
Excellent idea. If I am ever called upon midflight I shall immediately demand a coat hanger, cather and bottle of cognac
Doctors are damned if they help and damned if they don’t.
Heathrow airport 10 years ago. Taxi rank outside terminal. Woman collapses to floor, young. Normal vitals not obviously fitting but unconscious. It was just as well I was there to stop the member of the public who had seized a wall-mounted defibrillator from shocking her (or trying to). Anyway cos I was on scene the medical crew took 45 minutes to get there instead of immediately. She came round in a minute or two but was dopey. Vasovagal I reckon. Was an hour late home, no thanks from anyone. I also had upset kid in tow.
Once I stopped my car on a holiday journey out of London to assist a woman who had been knocked over by a car… she was conscious, clearly had a fractured leg, she was in pain but having checked vital signs, she appeared stable. There was actually little more I could do little pending the arrival of the ambulance except to calm her & make her as comfortable as possible, manage the gathering crowds, & call a relative on her behalf…. Though as a Dr I might have made a difference, in this case essentially I was a reassuring presence. The ambulance arrived promptly and I melted away unnoticed, resuming my journey an hour or so later.
In most cases, the ambulance is more appropriate. Doctors need time off too. There should be a rule that anyone occupying top ranks of GMC must be a working clinician so they don’t get out of touch and create ridiculous rules so one is dammed both ways.
That’s the last time I drink on an aeroplane.
I’d hate to be drunk while on duty.