Maritime medicineBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7546.s146 (Published 15 April 2006) Cite this as: BMJ 2006;332:s146
Kaji Sritharan describes the life of a ship's doctor
Imagine the comfort of a luxurious hotel, fresh sea air, and waking up each morning to a different shoreline. Add unpredictability, adventure, and scope to develop professionally—what do you have? A career in maritime medicine.
Invited aboard the Aurora, I asked senior ship's doctor, Lynn Gordon, what life was really like on the high seas.
Life on the Aurora
The Aurora can best be described as a floating five star hotel with a twist. Equipped with state of the art medical technology, it boasts six wards, a high dependency unit, an intensive care unit, and a fully functional theatre.
It also has a laboratory with facilities for performing a wide array of blood tests and scope for performing simple radiological investigations such as ultrasound and x ray examinations. Digitally generated images can be transmitted via satellite to a specialist reporting service based at the University of Galveston in Texas. Impressively, the laboratory and radiology facilities are all manned by the ship's medical staff. “It's a really challenging job,” says Gordon, who has worked in maritime medicine for over eight years. “If you need to transfuse a patient then it's up to you to cross match the blood and find a suitable donor on board.” Despite access to so much technology, however, the expectation is that the ship's doctor performs only tasks within his or her ability.
The Aurora typically carries 2000 passengers, and there is a seasonal variation in the age range (though two of the ships on the fleet are completely child free). In addition, there are 860 to 900 crew. Medical care is delivered by two doctors (one senior and one more junior), supported by four trained nurses.
What to expect
“There is no such thing as a typical day,” says Gordon. “That is the main attraction of the job, it is unpredictable. Some days are relaxed. Other days I start at 8 am and am still awake at 8 am the next day. Theoretically at least, there is an afternoon and a morning clinic—each usually lasting a couple of hours, which is very similar to a GP [general practitioner] clinic. People are aboard for months at a time,” Gordon explains. “So we deal with a range of things from coughs and colds as well as pre-existing conditions such as chronic leg ulcers. I remember one hectic clinic though where I saw 150 patients with sea sickness.
“What happens in between clinics is variable. On the last cruise we had a lady with haematemesis, which progressed into a major cardiac resuscitation,” recalls Gordon. Much like the NHS, emergencies are graded and coded alpha, tango, or papa, the last two denoting trauma and paediatrics respectively. “Cardiac arrests at sea are more personal,” says Gordon. “There is greater contact with the family. It's not just a case of purely treating the casualty. The people element is greater, which can make things harder, but at the same time also more rewarding.
“There are also well defined policies and protocols to cover every situation from major incidents to outbreaks,” Gordon reassures. Furthermore, in the unlikely event that the medical centre should ever exceed capacity a back-up secondary medical space with duplicated supplies and equipment can be opened.
Calling for help
Depending on where you are in the world, specialist advice is always at hand, and radio contact can be made with consultants worldwide at any time. “At the end of the day, you can only do your best and nobody expects any more,” says Gordon. “You're often in remote places and that is where inner strength and confidence in your own ability and team comes into place.” What makes being at sea different is “that there is only finite a number of people to deal with each situation, so time can be pressurised,” says Gordon. “You are dependent on every member of the medical team and teamwork is paramount—even more so than in a hospital.”
Who should become a ship's doctor?
“It takes a definite personality to do the job,” says Gordon. “Someone who likes challenges, has the ability to mix well with people from all backgrounds, and is flexible. The job is likely to appeal to someone who really enjoys medicine,” she continues. “When you are on board, you are on-call 24 hours a day, seven days a week.
“You need to be a Jack of all trades,” adds Gordon. “In hospital medicine you more or less practice within a particular field, such as orthopaedics or cardiology. Here, you diagnose and treat whatever comes your way. You don't transfer anybody off to an inferior standard of care and therefore you often treat someone from start to finish, which is incredibly rewarding. You're a doctor in the true sense of the word.”
As a senior doctor, in addition to clinical duties you are also concerned with other aspects of ship life, such as management, health and safety, hygiene, and public health.
Factors to consider
You can bring your partner or spouse with you, but it may be difficult if you are married or have kids. “The job usually attracts either single or slightly older doctors who want to get away for short periods of time,” says Gordon.
“The medicine on a ship is no different,” says Gordon, “But training in protocols and using the computer systems is needed.” A handing over period of three days or more is available for those new to sea. In addition, there is training on equipment use as well as refresher courses.
A clinical audit system is in place, which ensures standards of care are maintained, and junior doctors have two monthly formal appraisal by the senior doctor on board. Activities on board can be accredited as continuous professional development, and five days of these activities are paid for each year. There is also an established programme for updating skills and access to journals online. “Much of the training on board comes from your senior colleague,” says Gordon. “You learn from each other. And it teaches you to be a strong team leader.”
“Working in maritime medicine is becoming looked upon more favourably, especially the experience gained,” says Gordon. Standard entry requirements for maritime medicine are three years' postgraduate experience, preferably in emergency medicine and general practice. Full up to date registration and advanced life support certification are mandatory.
“I joined in 1991,” says Gordon, “and only intended to stay six months. I've been here for eight years now. This is an incredible opportunity to travel. Furthermore, as an officer, you have your own cabin and you can forget the mundane things in life such as paying bills, ironing, and cleaning.”
Contracts are for four months on board with a six to eight week holiday. The financial incentives are also considerable. UK residents at sea for 183 days in each financial year may be eligible to receive a reimbursement of taxes paid. When this incentive is included, new entrants can expect an average remuneration equivalent to a shore side package of about £65 000-70 000 (€95 000-102 000; $114 000-123 000) a year.
How to apply
If you would like more information and to submit your curriculum vitae or wish to speak to a current ship's doctor, visit P&O's medical recruitment website (www.shipsdoctors.com) or contact Christine Green (tel 02380 655186). Alternatively, write to Christine Green, P&O Princess Cruises, Richmond House, Terminus Terrace, Southampton, Hampshire SO14 3PN. ■