Tuesday, July 2, 2013

Not Being an Asshole

Last week on a plane returning to Los Angeles, a flight attendant asked if a doctor were on board. A passenger was ill. Reluctantly, I raised my hand.

Walking up the aisle, I relieved my fears by recalling that hotel employees who tell me a guest is seriously ill are usually wrong. I learn this by talking to the patient. That’s how a doctor gets most of his information.

In answer to my questions, the passenger revealed that he was forty with no medical problems. His only medication was a tranquilizer which he didn’t have. His complaint was a tight chest and difficulty breathing, but he appeared to be breathing normally. He didn’t object to my diagnosis of anxiety attack; he’d had them before. I reassured him and reassured the flight attendant that he’d be OK until the plane arrived. This turned out to be true.

After hearing the story, my wife said that she expected no less of me because I’m a caring, compassionate doctor. She often says things like that which is one reason I love her.

In fact, I raised my hand because I believe that a physician asked for help has a moral obligation to respond. If he doesn’t, he’s an asshole. Responding did not make me feel good, but not responding would feel worse.

Plenty of doctors keep quiet under those circumstances and comfort themselves with excellent reasons. It was unlikely that I could handle a genuine emergency. I haven’t performed CPR in decades; in any case doing so in that packed cabin was impossible. The plane was an hour from landing, so diverting it would not have helped. Standing by helplessly would make me look foolish. Doctors hate that. The passenger might sue. This has happened. You’ve probably heard of “good Samaritan” laws, but they are not absolute, and any good lawyer can find a reason they don’t apply.

The problem is: if you behave like an asshole for excellent reasons, you’re still an asshole.

The moral obligation to respond is not universal, although physicians don’t disagree unless they’re sure you’re not overhearing (for example on physician internet forums where they express other opinions you don’t want to hear – see my blog post for February 12, 2010).

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