Dr Gerard Panting looks at the issues involved in giving medical attention in an emergency, while off duty, and discusses the GMC’s guidance
Hearing the question "Is there a doctor in the house?" just before the curtain goes up on an eagerly anticipated show is every doctor’s nightmare.
Will you miss so much of the play that you know "whodunit" but you have no idea what they did? And with none of the usual medical supplies to hand, what will you be able to do anyway?
With luck, someone else will beat you to it. Bill Simpson, who played Dr Finlay in the TV series, tells of the time he answered the call only to be pipped at the post by a doctor of theology and a doctor of philosophy, and graciously gave way.
But if you are the only doctor in the house are you obliged to assist fellow theatre-goers, and if so, what can reasonably be expected of you? What if it all goes wrong – is there a prospect of being sued? And what compensation or recompense can you expect or request?
A doctor sitting in the stalls has no legal duty of care to those around him. If you ignore the call for help you cannot be sued if the widow of the person who was sitting beside you before collapsing with a myocardial infarction later discovers that you are a doctor but did nothing to help, providing you did nothing to impede other attempts to help.
But such a callous response could well result in criticism from other quarters. The media might have a field day with "Dr Dolittle" headlines or, worse, a graphic account of the heartless response to the emergency.
More serious than the press might be the response of the General Medical Council to the widow’s complaint.
The GMC’s guidance in Good Medical Practice includes the following: "In an emergency, wherever it may arise, you must offer anyone at risk the assistance you could reasonably be expected to provide."1
So although there is no legal duty to act, there is a professional obligation to respond, and failure to do so could result in a warning or more severe sanctions being issued by the GMC.
How can you help?
What if you do help? What can be expected of you? Presented with an unexpected emergency, there may be very little you can do apart from confirm the potential seriousness of the situation, protect the airway, make sure an emergency ambulance is called straightaway and also ensure that in the meantime nothing is done that might make the condition worse.
The show need not necessarily go on pending evacuation of the casualty – giving the management the medical authority to call proceedings to a halt and bring up the house lights might make a life-saving difference by allowing the ambulance crew to move the patient out of the theatre more quickly. But without medical equipment, it is unlikely you can do much more.
Despite all this, the man from seat M27 may still succumb. What if the widow sues now?
Having given assistance, a legal duty of care has been established, but there are a number of obstacles the claimant would have to overcome before being able to recover damages.
As in any other negligence claim, compensation is only due if there was a breach of the duty of care with resultant harm. But in these circumstances there is also the public policy issue, i.e. whether Good Samaritans can or should be held liable.
In many jurisdictions, including most states in the US and provinces in Canada, the law prohibits recovery of compensation from Good Samaritans. Although there is no equivalent law in the UK, it is likely that the courts would be extremely reluctant to award damages unless there was evidence of recklessness or malice,both of which are improbable.
In the unlikely event that the court would entertain the claim, there is still the question of what standard of care should be expected, which must obviously reflect the circumstances – in this situation it is ludicrous to expect a doctor of any specialty to provide the same level of care as an A&E department facing a similar clinical presentation.
And then there is the point about preventable harm. In this example, the patient has died. Sadly, that may have been inevitable; for damages to be recovered the claimant must prove that but for the shortfall in care the death would have been avoided.
These causation issues are often the most difficult aspect of clinical negligence cases and would certainly be extremely awkward for the claimant in this example.
Should any of these medico-legal horrors come true, the good news is that indemnity for Good Samaritan acts is an integral part of all MPS subscriptions in all jurisdictions around the world. So the one thing you do not have to worry about is whether you can ask for help if the nightmare becomes a reality.
The management should ensure that you and the other members of your party receive tickets to another performance of the play so that you can enjoy it uninterrupted, but if not, a gentle reminder would certainly be justifiable. The pitfall to avoid is submitting an invoice!
- General Medical Council. Good Medical Practice. London: GMC, 2001