My good friend, Wen Dombrowski, MD (better known as @HealthcareWen for those of us on social media), recently shared her experience on a KLM International flight where the announcement came over the loudspeaker, “Is there a doctor on board?”
Her story and experience provide a great message and reminder that we still have a ways to go when it comes to our biases around gender and race. Plus, in true Wen fashion, she also provides a great reminder about over-reliance on technology and the lost art of “laying hands on a patient” medicine. Not to mention a usability and design lesson as well. So, I knew I had to share it with Healthcare Scene.
Here’s her story and lessons learned (shared with permission):
“IS THERE A DOCTOR ON BOARD? (Someone had fainted)
I get up and ask staff who needs help. They say they already have enough doctors, thanks.
I brief a sigh of relief and am grateful that other doctors offered to help, because it’s challenging to practice medicine on a plane. So I go use the restroom. But…
On my way back to my seat, I notice there is activity happening up the aisle around the scene. From the back of the plane it looks like the volunteers are trying to do a procedure so I’m guessing maybe they are putting in an IV? But it is so dark in the plane with the interior lights off in sleep mode.
So I go up to the scene to quietly shine the light from my phone onto the procedure…
I’m appalled to find 2 guys are fumbling to put on a blood pressure cuff. It is a simple cuff for well-known home BP machine, nothing fancy. I watch them try to figure out over and over and over again how to wrap the BP cuff around the passenger’s arm… inside out…upside down… they can’t figure out the direction and Velcro…can’t get the BP cuff onto the passenger. By the way, the patient was awake, cooperative, with normal habitus, so there were no barriers from that perspective.
After watching the 2 guys repeatedly struggle with this, I offer to help.
The airline flight attendant rebukes me, “Please sit down. Are you a nurse? because we already have 2 doctors”(while we watch these guys scrambling to figure out how to put on a BP cuff).
I tell her, “I’m a Doctor & a doctor certified in 3 Specialties.”
The 2 guys say they’ve got it under control (while still trying to put on the cuff backwards etc), they say they are an Internist and a Nephrologist.
(I think to myself what a sad state of Medicine to have Internal Medicine and Nephrology not know how to check a BP! It would be understandable if they were orthopedics or psychiatrists or ENT, but blood pressure management is the bread and butter of those 2 specialties.)
Meanwhile, while they struggle to get the BP cuff velcro’d around passenger’s arm, I ask if anyone has checked passenger’s pulse — Is it Fast or Slow? Regular or Irregular? Strong or Weak? Clammy or not? This would provide valuable triage info and could be been done in 5 seconds by one of the guys who wasn’t holding the BP cuff. I ask again if they or I could check the passenger’s pulse, but they ignored this (seemed like neither of them knew how or didn’t think it was important). I wanted to jump in to do it myself, but there wasn’t enough physical space.
After more than 10 minutes struggling, the “doctors” finally got the BP cuff around the passenger’s arm.
I’m sharing this story because:
1. I’m shocked at the sad state of Medicine that doesn’t know how to nor value laying hands on patients as part of assessing patients (flashback to the practical skills Housecalls and field medicine has taught me). The guys were waiting for “the machine” to tell them “the numbers.” I’m sad at the lost “art” of medicine – lack of common sense handson skills & not looking at the qualitative data, just waiting for the quantitative device data. A lot of valuable time was lost in caring for this passenger. (And while I love technology, sensor devices, and clinical decision support tools – I wonder/worry what will happen to future physician’s common sense and clinical reasoning skills?)
2. And sad about the lack of team mindset of these 2 guys, who insisted on doing it themselves, the blind leading the blind. Not accepting help from female colleague. Not acknowledging what they don’t know nor allowing for help.
I know they meant well and were just trying to help, but sometimes helping comes in the form of teamwork.
There’s a lot that I don’t know in medicine and I’m happy to delegate/consult that to others. But geesh, at least I know how to check a Pulse and Blood Pressure.
3. Not to mention the persistently gender biased attitudes of flight crews who decline help from female physicians, to the detriment of everyone’s safety. This problem has been documented many times by other Female & Minority Physicians, for example: http://www.idealmedicalcare.org/blog/female-physicians-told-to-sit-down-shut-up-and-get-out-of-the-way-during-emergencies-as-patients-nearly-die/
4. The BP cuff was basic and not at fault per se. But these crisis moments highlights opportunities to design it better, to improve its usability and accessibility for laypeople and those who aren’t familiar with it. Perhaps the BP machine company could print pictures on the cuff itself that show the up/down and in/out directions of how to apply the cuff.”
Thanks Wen Dombrowski, MD for sharing this story and your insights.