"Pre-flight Check – Medical Style"

Meeting people all over the world is one of the greatest gifts of blogging and social media. 

Dr Judith O'Malley-Ford, is one of those people. So what's a medical doctor doing reading an aviation blog? Becoming inspired.And as it turns out... she is inspiring others. We've heard from Dr. Judith in previous posts with her Reflections of Antarctica, and her contribution to Aviation Humor. She's not only a doctor, lover of aviation and travel, but an author. Her medical dictionary could save her life. Today she's back!

Dr. Judith O'Malley-Ford: 

"Recently I read Flight to Success blog entitled "Preflight Check"... a great lesson in being prepared and having a well practiced emergency plan. My pre-flight story has a slightly different connotation.

My background is in medicine. I'm a Family Physician. And as much as I hate to admit it, I too have an emergency plan which I rehearse mentally more often that I care to admit.

Long ago in the good old days, when I first began work in general practice, you don't know it, but you really are a "rookie", albeit a medical one. Highly trained in medical diagnoses, but not necessarily street smart in aberrant patient behavior.

Patients arrive, sometimes with the aid of a sizable tail wind, and can send you into a stall or a head spin before you know it. Unlike aviation emergencies, medical emergencies take various unpredictably unpredictable forms. There is no warning, no flashing red light, no bells or whistles, no pervert alert, and no "danger zone" alert. There is no simulator to practice these sorts of medical emergencies. You improvise every time. 

Medical Indemnity companies not infrequently ask us these days,

"Do you practice defensive medicine”, i.e. practicing to ensure that you, the practitioner remain safe, and that you head off, as much as possible, any unwanted nasty practicing outcomes. Having an emergency plan is part of the universal safety net strategy. Safety is no accident as you would know in the aviation industry.

Every doctor has to start somewhere, and no one teaches medical rookies where to look for the “danger zone" when it comes to crossing the yellow line of patient behaviour. It's not like you're playing in the “danger zone" opposite Tom Cruise in Top Gun, but sometimes if feels like it.

When I say medical rookie, I mean inexperienced with some of the potential physical dangers that can lurk behind closed doors in the confines of the medical consultation room.

But you soon learn to be on your guard, and learn that there are subtle warning signs of danger approaching in a consultation. Body language warning signs should not be ignored or are ignored at one's own peril. Sometimes the signs are much more subtle. You learn to ask the right questions, respond according to your instinct and soon enough all is revealed.

By this stage of my medical career, I have any one of a number of well practiced emergency strategies, and variations on the main theme. A plan for each situation. The plan has evolved over time, and no doubt will continue.

Sunrise Amsterdam Arrival

It all started like this..... 

One day, I was talking to one of my medical friends who disclosed a rather disturbing incident that occurred to him in the preceding days. Those were the days when all general practitioners did house calls for a variety of reasons, however trivial the request.

My doctor friend Danny (not his real name) was asked to do a house call to one of his known patients, not a frequent attending patient but Danny thought he knew him reasonably well. Danny worked at a different surgery to me, but we talked regularly and shared problems. 

The nature of the medical problem had not been disclosed at the time of the request for a house call. Soon after arriving at said residence after the end of the evening consulting shift, the good Samaritan doctor found himself in the kitchen with the patient brandishing a carving knife to Danny’s throat.

"Just take what you want, and I'll leave," said Danny. After a period of time and tense-filled bargaining, Danny beat a hasty retreat. Those were the days when all doctors who responded to requests for home visits carried heavy-shit pain relievers. Those days are now gone. He told me that he reported this incident to the police as a criminal matter, which was dealt with appropriately. After that incident, Danny stopped doing house call entirely.

Sunset Amsterdam

I was also doing house calls for medical problems in those days. Sometimes the reason for the house call was more a question of convenience of the patient than the perceived severity of the medical complaint. But we complied with the request of the patient, as a matter of courtesy and professional pride in providing a quality, sensitive, responsive service.

One Sunday evening just as we were about to close for the night, my receptionist received a request from a middle aged woman for a house call. She said she was suffering from renal colic. I noted that renal colic was a common complaint for her, and occurred not uncommonly on a Sunday night about this time. She rarely if ever attended the surgery in person, and the reason for a house never seemed to vary.

Alarm bells rang, as this is a frequently repeated story of a person seeking narcotics for their drug addiction. I advised the receptionist that I would see her only in the surgery, and if necessary would wait for her. The messages went back and forth between the receptionist, the patient and me in my consulting room with the patient protesting about having to leave home on a cold night to visit the doctor.

Sunset Amsterdam

"She says she really needs the morphine tonight for her renal colic. She is aware that some patients request house calls just for the morphine, but she’s not one of these patients, and says the reason she knows about these things is that her son has just been released from jail. He is currently living with her. She says that he was convicted of a series of armed robberies at pharmacies for the purposes of obtaining narcotic drugs."

I imagined myself being greeted by the son. I didn’t fancy the idea of receiving a head injury with a brick or a gun or a baseball bat in hand, in the dark by the hedge in her front yard on a dark Sunday night.

"I'll see her here," I replied, “but I'm not doing a house call."The woman arrived within a few minutes, all complaints about being inconvenienced at this time of the night at having to attend the surgery.

I told my friend Danny about this incident.

"You were right not to go to her house. You have to stop doing these house calls, or offering them. It was bad enough for me, but it's not appropriate for you as a women doctor, placing yourself at risk like that." said Danny.

"I know,” I replied.

My decision to discontinue house calls created a "situation" with my male counterparts at my clinic.

"Would you prefer me dead or alive?" I asked. The question was a no brainer really.

 Aurora Australia

Sometime after that and as an unrelated matter, I saw a distressed 30-something year old woman who complained of having relationship difficulty with her partner at home. The more she spoke, the more the story struck a familiar note. It transpired that I had seen her de-facto a couple of weeks earlier. He appeared anxious and very agitated as he told of an incident at home the previous night. He showed me a number of bruises and abrasions, and I noted for my records.

"She just went crazy," he said, "then she started throwing carving knives from the kitchen drawers at me with such force that they stuck into the walls. I left and drove off and slept in the car that night. I haven't been home since. I'm scared to go home."

Lisa (not her correct name) complained that she hadn't seen him for the last couple of weeks, and that she couldn't live without him. She said she had a liking for knives, and reached into her large shoulder bag that lay beside her on the floor.

"Ones like this," she explained, as she pulled out a large carving knife.

"Oh,... really..., " I replied. I paused for a moment. "Lisa,..." I said, “Could you... please....just... excuse me.... just for a moment.... I'll be back."

I returned with one of the other doctors, a big burly male with a deep voice, big boots that resounded as he walked down the corridor towards my consulting room. He cut a commanding presence. We stood in the corridor, with him interposed between me and her, and suggested that she might care to leave the premises. He suggested that we could arrange an admission for her to the local hospital. I have had no further contact with her to this day. 

Sunset Amsterdam

On another note. I have a special interest in prostate cancer. This might seem strange to some people, as they have said,

"But, she's merely a GP, and a woman at that."

Currently, the general screening test for prostate cancer is a blood test called a PSA (prostate specific antigen). It does involve more than this, but as this blog is not intended to be a lecture on the pros and cons of prostate screening, I won’t bore you with any further details. But the general male public places a great deal of faith in this test. Regardless of the level of the PSA test, some men are quite literally "sitting on a time bomb" to put it bluntly. Another instance of requiring a potential emergency strategy. A solution will emerge one day that will make current prostate cancer protocol obsolete. Hopefully, I will be part of the solution, and the bigger picture.

Each profession or industry carries with it a unique set of potential threats to safety and to the safety to those who are part of the service. It is the responsibility of each and every one of us to identify those threats, and as far as possible minimise those threats, on a personal level and for the benefit of those who depend on us.

Sunset Amsterdam

I would like to share with you, one little fact about me personally. One additional personal safety plan. I have a private, personal emergency alarm device, for when all other strategies fail or are impractical.

I could of course, tell you exactly where it is locate, but then I’d be compelled to send you either to the psychiatrists who have various techniques for erasing your memory of the fact. Alternatively, I could send you to the pathology department in a vast multitude of a series of "specimen containers" as part of the implementation process of my personal emergency risk reduction plan.

That’s at least part of my Pre-Flight Check Medical Style emergency risk reduction plan in a nutshell."

THANK YOU Dr. Judith!! 

Enjoy the Journey!

XO Karlene