Tuesday, November 24, 2009

In-Flight airway obstruction - what would you do?

Had an interesting discussion today in Anatomy dry lab. We were examining pictures of the larynx and describing how someone would do a crichothyrotomy. We discussed how that is done quickly on the street to open an emergency airway vs. the tracheotomy that is typically done in the hospital and can be a more time consuming procedure...
During this, one of the fellow students gave an anecdote (I couldn't find it online) about a physician on an in-flight airplane that performed a crichothyrotomy and saved the passenger's life. After this, the patient turned around and sued the physician for scarring their neck/larynx by doing the procedure that saved his/her life! The student then went on to say with the way malpractice suits are in the US, that he would not do the same thing.
I was shocked by this and argued that I would do the same thing and that it is our responsibility as physicians to help in an emergency. He said if he is not working in the hospital then he is not responsible for what happens. I countered that society has invested great resources to train us as physicians, to which he retorted that he is paying for his education and that he would not run the risk of being sued. As this was during lab, I only got partway through explaining that the government (society) sponsors our loans and didn't get to mention medicare funding for residency positions. Nevermind the ethical implications.

Now, both of our positions are based on our very limited understandings of lawsuits, mainly anecdotally or research, and our lack of having been in a similar situation with the ability to do something about it. But, it made me wonder: has the malpractice industry gotten that out of control - or at least the perception of it - that those with the power to save a life would just look the other way?

What would you do?

1 comments:

Ishie said...

I think in those sorts of situations, even physicians have at least partial protection by good samaritan laws, provided they don't abandon the patient after initiating care or do something grossly reckless (sawing through both carotid arteries in an effort to trach someone with a pen because you saw someone do it in MASH).

If I were a doctor, I would certainly render aid the first time. A malpractice suit doesn't mean a lost license. It also doesn't mean a win. If I actually *lost* a lawsuit due to that case, I have to admit I'm jaded enough that I might not do it again (though I still might). I can't say I'd do it if there were a direct threat to my license (though I can't imagine a scenario where there would be). Worked too long and hard. Plus, you could just as easily be sued and have a less defensible case for being the only doctor on a plane and *not* rendering aid.