Radiologists, Don’t Fear “Is There a Doctor on Board?”

June 13, 2016

A dreaded question for many radiologists can be a teachable moment.

On a flight to Hong Kong, I hear overhead “Is there a doctor on board?” As an intern, I’m still a newbie but eager to flex my muscles. I look around to see if anyone else has volunteered. Nope. I make my way towards the front of the plane and I see an attendant leaning over an elderly woman slumped in her seat. Oh dear, this could be anything from a stroke to pulmonary embolus to vasovagal reaction. We happen to be 10,000 feet high in the middle of nowhere, 8 hours into a 14-hour flight.

While I examined and treated the patient, I had the strongest feeling of loneliness I’ve encountered so far in my career. I felt alone in my ability. There’s nothing quite like taking care of a patient on a plane; I was separated from equipment which is usually an arm’s reach away, isolated from supportive medical staff, and instead examined by rows upon rows of curious eyes; I had to perform all the functions while forming a differential and treatment plan in my head. Luckily, the woman recovered and we did not need to make an emergency landing.

When I told this story to my friends after the fact, I ended with a joke, “On a plane full of Asians, you’d think there would be more than one doctor!” They laughed, and then someone said, “Maybe the other doctors were all radiologists!” This comment stuck with me. What was that supposed to mean? Radiologists don’t want to help people? That we are too specialized and lost the ability or interest to assist during emergency situations? I went into medicine to help people, no matter what form that takes. If I could only hold pressure to a bleeding wound, I would still jump up and do it. Any insinuation otherwise is offensive to all of us.

However, maybe there was some truth to that statement. A 1997 survey among internists showed that most respondents would help provide emergency care in a restaurant (69%) and airplane (54%), 44% would help in a highway accident, 33% in a subway, but only 2% would help a man lying on the sidewalk. Reasons cited for not helping included concern for personal risk, it was not their responsibility to help (52%), risk of contracting infectious disease (36%), lack of comfort with medical skills (29%), and fear of legal liability (17%).[[{"type":"media","view_mode":"media_crop","fid":"49382","attributes":{"alt":"Reluctant radiologists","class":"media-image media-image-right","id":"media_crop_4463120778116","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5951","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©shockfactor.de/Shutterstock.com","typeof":"foaf:Image"}}]]

In cases in which a physician refused to act and was brought to court, the jury has not been very sympathetic to these reasons. “A jury of laypersons is not likely to view with great enthusiasm or sympathy statements offered by the defendant radiologist that he or she refused to render care to a patient who was in immediate danger of serious injury or death because the defendant ‘wasn’t qualified,’ ‘didn’t think it was his or her responsibility,’ ‘didn’t want to get involved,’ or ‘was afraid of being sued.’”1

Since 1959, Good Samaritan laws have stipulated that citizens have no legal obligation to provide aid; provided immunity from malpractice litigation if aid is provided, unless there is gross negligence or lack of good faith; and no payment can be accepted for aid given. Only four states - Louisiana, Rhode Island, Vermont, and Wisconsin - have enacted failure-to-act legislation that assigns an affirmative duty, enforced by criminal punishment.

Good Samaritan laws are open to interpretation, and physicians must fulfill numerous conditions to obtain the benefit of immunity. Leonard Berlin, MD, writes, “A physician asked to help during a life-threatening event will find that calculating the legal variables immediately to decide whether a Good Samaritan statute applies is an impossible task.” The number of malpractice suits in the United States has actually decreased about 10% every year for the last three years, according to Berlin. Ultimately, potential legal liability should not be the main decision-making pivot point but rather based on individual moral-ethical values.

I know that feeling of loneliness on the plane won’t be the last time. We have all chosen a road of long training, stressful decisions, responsibility for human lives, and loneliness that comes from specialization and excellence. However, being lonely is a state of mind as much as a behavioral pattern. As it is, we can change this by forging connections with others: by teaching, mentoring, recruiting help, directing, and managing so that we can successfully work together to solve problems. In the cases in which you do happen to be alone, like on a plane, follow your moral compass, and you won’t be wrong. It’s time for radiologists to stand up and stand up together, raise your voices and lean in. Let’s not be excluded from critical events whether real or perceived.