Intended for healthcare professionals

Reviews Soundings

Busman's holiday

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:505
  1. Trisha Greenhalgh, professor of primary health care
  1. University College London

    If you want a good holiday, go well beyond the range of your mobile phone network and leave your stethoscope at home. Better still, sign up for a boat trip in a tropical ocean and spend at least four hours a day under water chilling out with the fish. As all scuba diving doctors know, as soon as the boat has pulled out of port for its seven-day “reefs and wrecks” tour, the captain will ask if there are any medics on board.

    The reluctant doc on a live-aboard operates in what sociologists call a “liminal zone”—a place betwixt and between, with neither the reckless abandon of the holidaymaker nor the formal mandate of the professional. Could you hack it? Try this quiz:

    1. (1) Half the boat are upchucking and groaning in their cabins with gastroenteritis. The “fully comprehensive medical kit” advertised in the brochure is being pulled apart for antibiotics, “intestinal cleansers,” and motility inhibitors. Do you (a) deliver a pious sermon on the merits of oral rehydration therapy; (b) get on with your own dive, since they will ignore your advice anyway; or (c) sell your personal supply of ciprofloxacin to the highest bidder?

    2. A diver has sustained a deep laceration from a coral cut. The medical kit contains stitches and a pair of gloves but no instruments or local anaesthetic. Having boiled up a pair of mechanic's pliers and someone's eyebrow tweezers, do you then (a) attempt acupuncture using a book of Chinese medicine you found on the book-swap shelf; (b) relabel the emergency oxygen cylinder “Entonox” and hope for a strong placebo effect; or (c) make creative use of the superglue which someone has brought along to repair their fins with?

    3. Passenger A has failed to drink adequately and is now writhing with probable renal colic, unresponsive to the available analgesics. Passengers B to Q have paid a substantial sum for their trip and expect the tour company to deliver on the itinerary. Do you (a) authorise a return to shore and risk being lynched by your fellow passengers; (b) administer the only injectable analgesic available, whose name you do not recognise and whose package insert, in an unknown eastern European language, includes the word “anaphylaxis”; (c) require all passengers to hand over their personal medication in the hope that you might rustle up the ingredients for a Brompton cocktail?

    Answers on the website, please.

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