How do you prove you're a doctor?

[anon-y-mouse]

So I've come across this situation a few times. Someone will offer assistance on an airplane or something, and the flight attendants ask for proof... or in some foreign country, like when I went to Britain, I saw a US doctor trying to write an emergency Rx for himself for some beta blocker, and the pharmacist asked "Do you have a copy of your license?", and eventually dispensed his propranolol. Is there anything out there that "proves" you're somehow licensed? This probably isn't an issue for residents or academic physicians, who can probably flash their hospital ID with "MD" on it. Do you maybe get a card when you apply for a state license? A pocket-size metallic engraved trinket from the NBME for passing step 3??

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[f_w]

So I've come across this situation a few times. Someone will offer assistance on an airplane or something,

Most of my state medical licenses came with
- a big parchment looking thing for the wall
- a small 4x6 computer printout, the actual license
- a wallet-card

The only time I ever had to do the 'if there is a physician on board' thing, they took my word for it. They where happy enough to have someone make a decision for them (cabin altitude switched to 2000ft MSL from 8000ft MSL makes breathing on one lung soo much easier). Niceley enough, they gave me 10k bonus miles for the inconvenience.

 

[core0]

So I've come across this situation a few times. Someone will offer assistance on an airplane or something, and the flight attendants ask for proof... or in some foreign country, like when I went to Britain, I saw a US doctor trying to write an emergency Rx for himself for some beta blocker, and the pharmacist asked "Do you have a copy of your license?", and eventually dispensed his propranolol. Is there anything out there that "proves" you're somehow licensed? This probably isn't an issue for residents or academic physicians, who can probably flash their hospital ID with "MD" on it. Do you maybe get a card when you apply for a state license? A pocket-size metallic engraved trinket from the NBME for passing step 3??

Most BME's don't issue cards anymore. If all you have is a certificate you can copy it down to a reasonable size. You can do the same with your DEA certificate. I put them behind my business card in the middle section of my wallet.

David Carpenter, PA-C

 

[anon-y-mouse]

Most of my state medical licenses came with
- a big parchment looking thing for the wall
- a small 4x6 computer printout, the actual license
- a wallet-card

The only time I ever had to do the 'if there is a physician on board' thing, they took my word for it. They where happy enough to have someone make a decision for them (cabin altitude switched to 2000ft MSL from 8000ft MSL makes breathing on one lung soo much easier). Niceley enough, they gave me 10k bonus miles for the inconvenience.

Thanks! I suppose the wallet-size card will have to do. Out of curiosity, were you able to land soon after? What ended up happening?

 

[anon-y-mouse]

Most BME's don't issue cards anymore. If all you have is a certificate you can copy it down to a reasonable size. You can do the same with your DEA certificate. I put them behind my business card in the middle section of my wallet.

David Carpenter, PA-C

I didn't know what a PA was or what a PA could do before medical school... I assume this is true for the public, esp in other countries... have you ever been in an emergency position to have to justify this? Very interesting.

 

[Apollyon]

I read an article about one of those contract agencies that provides air medical direction (not Mayo, by the way), and one of the guys there (a doc) said that, when the need arises and the call goes out, and a passenger identifies him/herself as a physician, this person on the ground will briefly speak with them by telephone to quickly suss out what kind of doctor they are (not a podiatrist or PhD or whatever), and then authorize them to open the "doc box" on the plane. (There is a separate box beyond the "first aid kit" on planes that has medications and stuff on it.) Also, they can quickly hit the internet and review the credentials (licensed or not, what field).

South Carolina issues a wallet card.

 

[deleted87716]

I have business cards. That's pretty much it.

 

[Bertelman]

I have business cards. That's pretty much it.

Oh snap!


***runs to Office Max to purchase home business card kit suitable for HP deskjet.

 

[mig26x]

this is an interesting question.

 

[core0]

I didn't know what a PA was or what a PA could do before medical school... I assume this is true for the public, esp in other countries... have you ever been in an emergency position to have to justify this? Very interesting.

Yes. I fly quite a bit and have had the any doctor question twice. I usually lay low til they get to the any medical personell. One presumed MI and one seizure. They actually have a pretty good kit on the plane. Almost anything you need to run a code. Fortunately they also put you in contact with a ER physician. I have ACLS but don't use it much. The funnier item was when we had someone have a seizure on a flight back from the national PA conference. I think the guy that had a seizure was the only one on the plane that wasn't a PA. I let the neurosurgery PA and the neurology PA fight it out over that one.

Also PA's are included in most of the emergency medical provider acts. So if you happen to be somewhere when disaster strikes, you can offer your services.

As far as the frequent flier miles, I turn down any reward. I was told once that if you accept any reward you put yourself outside the good samaritan act. I don't know if thats true but I don't take any chances.

David Carpenter, PA-C

 

[core0]

I read an article about one of those contract agencies that provides air medical direction (not Mayo, by the way), and one of the guys there (a doc) said that, when the need arises and the call goes out, and a passenger identifies him/herself as a physician, this person on the ground will briefly speak with them by telephone to quickly suss out what kind of doctor they are (not a podiatrist or PhD or whatever), and then authorize them to open the "doc box" on the plane. (There is a separate box beyond the "first aid kit" on planes that has medications and stuff on it.) Also, they can quickly hit the internet and review the credentials (licensed or not, what field).

South Carolina issues a wallet card.

I ran into a situation where the guy on the other end of the phone was a physician that I see on a regular basis in the ER when I do consults. It was kind of like Dr. XXXX? Dave??? At least I didn't have to worry about credentialls.

 

[anon-y-mouse]

Yes. I fly quite a bit and have had the any doctor question twice. I usually lay low til they get to the any medical personell.

So they ask for physicians first, then if no bait, they then ask for medical personnel? (I don't travel that often)

I did some googling. Here's the basic first aid kit from British Airways:

http://www.britishairways.com/cms/global/assets/pdfs/health/BASIC_FIRST_AID_KIT_Aug_03.pdf

Here are the drugs available on board, for use with the direction of a physician on board:

http://www.britishairways.com/health/docs/during/Med_Kit_content_list05.pdf

Here's the information about MedLink in Phoenix and how BA interacts with them:
http://www.britishairways.com/travel/healthcare/public/en_gb

 

[dynx]

Most of my state medical licenses came with
- a big parchment looking thing for the wall
- a small 4x6 computer printout, the actual license
- a wallet-card

The only time I ever had to do the 'if there is a physician on board' thing, they took my word for it. They where happy enough to have someone make a decision for them (cabin altitude switched to 2000ft MSL from 8000ft MSL makes breathing on one lung soo much easier). Niceley enough, they gave me 10k bonus miles for the inconvenience.

Bad idea fool...if you ever give help don't take payment of ANY KIND not even a fruit basket. If you do, no protection from a lawsuit for you. And your malpractice aint gonna cover your ass on a flight.

 

[dutchman]

why would you want to prove you are a doctor only to offer free service on an airplane?

 

[Bertelman]

As far as the frequent flier miles, I turn down any reward. I was told once that if you accept any reward you put yourself outside the good samaritan act. I don't know if thats true but I don't take any chances.

I'm not so sure, but of course, I wouldn't be the one wanting to challenge the court's interpretation. Here's the line from my Jurisprudence class..

"In a nutshell, this law absolutely protects doctors who, in good faith, respond to an emergency medical situation (not of their own creation) for somebody who is not their patient and under circumstances where he wouldn’t expect to be paid"

 

[anon-y-mouse]

why would you want to prove you are a doctor only to offer free service on an airplane?

iono, just an example I guess. you have any other opportunities where this might arise? perhaps ones involving bars and picking up random hookups?

 

[f_w]

"In a nutshell, this law absolutely protects doctors who, in good faith, respond to an emergency medical situation (not of their own creation) for somebody who is not their patient and under circumstances where he wouldn't expect to be paid"

The not 'expect to be paid' is the key here. If I recorded the patients name and address and sent him a bill with an E+M code, I would depart from the good samaritan rules. If 3 months later, 10k miles show up in my account and I receive a thank-you note from the airlines medical department, I don't think anyone could turn that into 'expect to be paid' (btw. if frequent flyer miles where considered payment, the goverment would have started to tax us on them 30 years ago).

 

[adismo]

i hang a framed copy of my wall medical license certificate around my neck, much like Flava Flav. Also the stethescope, bluegreen scrubs, trauma shears, pager, and pepsi GMT II rolex go a long way in convincing people.

 

[f_w]

trauma shears,

That is the sign of a newly minted EMT-B.

 

[adismo]

That is the sign of a newly minted EMT-B.

ortho and ER residents too

 

[Hernandez]

Bad idea fool...if you ever give help don't take payment of ANY KIND not even a fruit basket. If you do, no protection from a lawsuit for you. And your malpractice aint gonna cover your ass on a flight.

This isn't so clear cut. A recent article RESPONDING TO MEDICAL EVENTS DURING COMMERCIAL AIRLINE FLIGHTS states that this is not considered compensation. They list this as being part of a law, but i can not find this notation in Public Law 105-137 which they attribute it to.

An important step that reduced physicians' concern
about liability was taken in 1998, when the Aviation
Medical Assistance Act was signed into law.55,56 The
act provides limited "good Samaritan" protection to
any medically qualified passenger who provides medical
assistance aboard an aircraft.55 In addition to being
medically qualified, the assisting passenger must
be a volunteer, render care in good faith, and receive
no monetary compensation. Gifts in the form of travel
vouchers, wine, or seat upgrades are not considered
compensation. The assisting passenger must also render
medical care similar to the care that others with
similar training would provide under such circumstances.
Physicians should be aware of the provisions
of the Aviation Medical Assistance Act and recognize
its limitations.​

and in case anyone cares, this is what is mandated by the government to be aboard airplanes with >30 seats

Stethoscope
Sphygmomanometer
11
Airway Oropharyngeal airway 1 for children, 1 for small adults,
1 for large adults
Intravenous infusion Syringes and needles
Gloves
1 5-ml syringe, 2 10-ml syringes
1 pair
Medication Nitroglycerin (0.4-mg tablet)
Diphenhydramine (50 mg, injectable)
Dextrose (50%, injectable)
Epinephrine (1:1000, injectable)
Required by April 2004 FDA-approved automated external defibrillator
Mask for cardiopulmonary resuscitation
Bag-valve device
Intravenous-infusion kit
Normal saline (0.9%)
Aspirin (325-mg tablet)
Diphenhydramine (25-mg tablet)
Bronchodilator inhaler
Epinephrine (1:10,000, injectable)
Lidocaine (20 mg, injectable)​

 

[Winged Scapula]

As noted above, many states do not issue the wallet card anymore. I have one from PA and the DEA, but not NJ.

But my wallet also has tons of "membership" cards - ie, AMA, ACS, ASCO, ASBS, ASBD, etc. - enough initials to choke a horse.

Then again, my hospital ID is usually in my purse anyway if they wanted some form of picture ID.

If all else fails, Target sells these T-shirts which say, "trust me, I'm a doctor". Perhaps that would help.

 

[OldPsychDoc]

and in case anyone cares, this is what is mandated by the government to be aboard airplanes with >30 seats

Stethoscope
Sphygmomanometer
11
Airway Oropharyngeal airway 1 for children, 1 for small adults,
1 for large adults
Intravenous infusion Syringes and needles
Gloves
1 5-ml syringe, 2 10-ml syringes
1 pair
Medication Nitroglycerin (0.4-mg tablet)
Diphenhydramine (50 mg, injectable)
Dextrose (50%, injectable)
Epinephrine (1:1000, injectable)
Required by April 2004 FDA-approved automated external defibrillator
Mask for cardiopulmonary resuscitation
Bag-valve device
Intravenous-infusion kit
Normal saline (0.9%)
Aspirin (325-mg tablet)
Diphenhydramine (25-mg tablet)
Bronchodilator inhaler
Epinephrine (1:10,000, injectable)
Lidocaine (20 mg, injectable)​

No haldol or ativan???
Damn--I'm not standing up if they call me to subdue a terrorist!

 

[sophiejane]

No haldol or ativan???
Damn--I'm not standing up if they call me to subdue a terrorist!

That's true...they really need ativan. Especially if you've got someone in status epilepticus. Haldol is a great idea as well.

Somebody write a letter!

 

[f_w]

No haldol or ativan???
Damn--I'm not standing up if they call me to subdue a terrorist!

Seat belt extensions and duct-tape ! (anyone see pics of the shoe bomber with his seat being carried of the plane, priceless)

As for sedating someone: Over lunch, I just read through some medicare 'local carrier determinations'. That'll do it. You just start reciting one to an unruly passenger and they'll pass right out (be careful not to overdo it, it can have a respiratory depressive effect).

 

[Mumpu]

I just show them a picture of my BMW.

 

[blanche]

The not 'expect to be paid' is the key here. If I recorded the patients name and address and sent him a bill with an E+M code, I would depart from the good samaritan rules. If 3 months later, 10k miles show up in my account and I receive a thank-you note from the airlines medical department, I don't think anyone could turn that into 'expect to be paid' (btw. if frequent flyer miles where considered payment, the goverment would have started to tax us on them 30 years ago).

just curious, what carrier was this? b/c continental airlines only sends little 'thank you' notes

 

[f_w]

just curious, what carrier was this? b/c continental airlines only sends little 'thank you' notes

That was Northwest.

I don't know whether this was standard procedure. I saved them quite some cash that day and that might have increased their thankfulness (some minor stuff we could do with the passenger using the on-board equipment saved them an unplanned landing and and 220 people missing their connection).

 

[justwondering]

man, i hope after the "are there any doctors" call, they make the "are there any nurses" call too. cause i dont think i could start an iv fast enough (if i can even remember how to do it right) to give D50 or something.

 

[dynx]

That's true...they really need ativan. Especially if you've got someone in status epilepticus. Haldol is a great idea as well.

Somebody write a letter!

If they are in status I would hope that we'd be on or near the ground at that point in time. Patient starts twitching...turn towards closest airport, you got awhile to get there before you start pushing the ativan. Chances are if its real status they've got more of a problem than a siezure anyway and ativan aint gonna solve it.

 

[Tired]

ortho and ER residents too

Never seen a 'pod resident with trauma shears. Bandage scissors yes, trauma shears no.

 

[NinerNiner999]

This is pretty funny because, three weeks ago, I was the physician on a flight who responded to a patient with acute abdominal pain and diaphoresis. Not a big deal, really, most likely a case of acute gastro, but I got to break out the kits and administer care in the first class section.

In case anyone is ever in the situation, I do have a few things I discovered (as I looked through both kits to take a mental inventory of what my options were). The sterhoscope is horrible - there is no way to hear anything with the background noise of the plane. There is a total of 1000cc of normal saline - that is all (2 500cc bags). There are enough cardiac drugs for one round of ACLS, and the only "monitor" available was the AED. There are a total of two IV needles (18g and 20g) and 4 straight needles (18 and 22). the BP cuff if pretty good, but farily useless with said stethoscope.

I was in direct communication with the pilot, who asked me if we needed to divert for an emergency landing (perhaps the reason there is only one round of ACLS meds). I declined, but did suggest we expedite our arrival into Atlanta. They held all circling traffic and we arrived 45 minutes early to meet EMS at the gate.

When it was all over, they upgraded my wife and I to first class for our flight from Atlanta to Baltimore, and credited us each with 10k miles. I asked them if this was considered compensation in any form and they told me it was a way of saying thank you, not compensation...

Pretty cool trip...

Oh - they never asked for my ID until after we landed. I was even allowed to direct where the flight landed without having my credentials checked. They never even asked for my name. Scary.

 

[Bertelman]

Oh - they never asked for my ID until after we landed. I was even allowed to direct where the flight landed without having my credentials checked. They never even asked for my name. Scary.

If you look at all like crazy Bert getting booked in real life, I understand why they didn't ask. I wouldn't ask that guy the time of day.

 

[tibor75]

Most of my state medical licenses came with
- a big parchment looking thing for the wall
- a small 4x6 computer printout, the actual license
- a wallet-card

The only time I ever had to do the 'if there is a physician on board' thing, they took my word for it. They where happy enough to have someone make a decision for them (cabin altitude switched to 2000ft MSL from 8000ft MSL makes breathing on one lung soo much easier). Niceley enough, they gave me 10k bonus miles for the inconvenience.

I got upgraded to first class on my return trip! (Delta)

It's amazing how little you can do on a plane. Other than taking somebody's BP or shocking for VT (2 extremes), you can't do much other than say, "Land this plane!"

As an Indian-American, I assume most people would assume I'm a doctorb anyway, so I don't feel like I need to carry any proof.

 

[f_w]

As an Indian-American, I assume most people would assume I'm a doctorb anyway, so I don't feel like I need to carry any proof.

Actually, people would assume you are an internist

On the plane, the airline cares less about what you can DO, more about the decisions you can make. If they don't have to divert, it saves them lots of dough (due to the cascading delay that even a 45min detour would create). The gastroenteritis that can wait until Atlanta or my pneumonectomy patient who made it to his hospice that day would otherwise required a diversion.

 

[ms. a]

We need to start flying the airlines you guys fly!! My husband has responded to the "doctor on-board" request a couple of times (he's an ER doc), and never once has there been any kind of upgrade, frequent flier bonus or anything!

 

[Bertelman]

We need to start flying the airlines you guys fly!! My husband has responded to the "doctor on-board" request a couple of times (he's an ER doc), and never once has there been any kind of upgrade, frequent flier bonus or anything!

Maybe they weren't satisfied with the services he rendered.

 

[f_w]

We need to start flying the airlines you guys fly!! My husband has responded to the "doctor on-board" request a couple of times (he's an ER doc), and never once has there been any kind of upgrade, frequent flier bonus or anything!

There might be a difference between the 'legacy' airlines and the discount carriers.

 

[toxic-megacolon]

Northwest airlines gave me 10,000 miles and upgraded the next leg of my flight.

 

[Dunce]

Bad idea fool...if you ever give help don't take payment of ANY KIND not even a fruit basket. If you do, no protection from a lawsuit for you. And your malpractice aint gonna cover your ass on a flight.

and the lawyers win again

 

[Blade28]

As far as the frequent flier miles, I turn down any reward. I was told once that if you accept any reward you put yourself outside the good samaritan act. I don't know if thats true but I don't take any chances.

Hmmm...never realized this. Good point.

 

[Discobolus]

One needs the wallet size medical license so they can be like Tom Cruise in Eyes Wide Shut constantly going around saying "I'm a doctor" and flashing the wallet size license.

 

[ms. a]

There might be a difference between the 'legacy' airlines and the discount carriers.

It was Continental and United. I'm pretty sure they would qualify as 'legacy' airlines. Oh well.

 

[f_w]

It was Continental and United. I'm pretty sure they would qualify as 'legacy' airlines. Oh well.

Someone else here mentioned that all they got was a _$*%& postcard from Continental.

And I am not suprised about United. They detest their customers to start with. Why would they want to do anything like that (I was hoping for them to get chopped up during bankrupcy, but somehow scum allways floats to the top).

 

[blanche]

yeah continental only sent a little note but you know? now i think about it, i guess it doesn't matter, they are a great airline and i think the general pleasantness of flying w/them makes up for that (let's compare/contrast w/ united, usscareways...)

 

[tibor75]

Bad idea fool...if you ever give help don't take payment of ANY KIND not even a fruit basket. If you do, no protection from a lawsuit for you. And your malpractice aint gonna cover your ass on a flight.

Uh, WRONG. FF miles aren't payment.

 

[dynx]

Uh, WRONG. FF miles aren't payment.

Ok *******, when you provide a service I'll be happy to be the expert witness against you...even if its not malpractice cause then I can get paid by the lawyers and not risk being sued.

Here's the law in texas:
The Texas Good Samaritan Law limits the civil liability of persons administering emergency care in good faith at the scene of an emergency or in a health care facility. This law limits the civil liability of these persons unless their actions are wilfully and wantonly negligent. This protection does not apply to care administered for or in expectation of remuneration, or by a person who was at the scene of the emergency because he or a person he represents as an agent was soliciting business or seeking to perform a service for remuneration. Also, the limited civil liability is not available for a person whose negligence was a producing cause of the emergency for which care is being administered.[35]

Emergency medical service personnel who are not licensed in the healing arts who administer emergency care in good faith are not liable in civil damages for an act performed in administering the care unless the act is wilfully or wantonly negligent. This limit of liability applies regardless of whether the care is provided for or in expectation of remuneration.[36]

The limited civil liability provided by the Good Samaritan law is an affirmative defense. This means that after a lawsuit is filed, the physician must prove that the law provides protection

Doesn't say jack about frequent flier miles not being remuneration. And it does say a lawyer can sue your ass and YOU must prove you are covered by the law...if you like those odds against a jury of your "peers" then be my guest.

I can also show you the law in a couple other states, all of them say the same thing. But you know...."uh. Wrong" is a compeling legal argument so I can see why you would be so certain.

 

[Bertelman]

Ok *******, when you provide a service I'll be happy to be the expert witness against you...even if its not malpractice cause then I can get paid by the lawyers and not risk being sued.

This was discussed above with f_w. The way I see it, the defense lies in the expectation. Aside from reading this thread, I would have never expected to be remunerated for anything, most certainly with miles, if I provided some meager level of care on an airplane.

Now, if you respond and preface any delivery of care with, "I'm getting some miles and an upgrade for this, right?" then you will probably be in trouble.

Where the heck is Law2Doc when you need him?

 

[dpmd]

The good samaritan laws protect you from liability, but they don't mean you can't get sued regardless of whether any money, reward, or whatever changed hands. They way many of the people who got something for being the doc on the plane received the reward makes me think the person on the receiving end of the care would never really know about it (thank you card sent later indicating x amount of miles, or being pulled aside after the flight and given the miles). If you were to say "gee, I saved the airline x amount of dollars by not having to land the plane-how much of that are you going to give me", that would demonstrate an expectation of remuneration and cause you trouble. However, just accepting something offered to you after the fact would probably be more easily defendable in court. If you are so concerned about the potential for a lawsuit that you feel you should decline the miles (or free drinks, or invitation to join the mile high club from a grateful flight attendant), you should probably not get involved at all. That is the only way to completely avoid a lawsuit in this type of situation (although not true in other countries, where a duty to help is explicit in the law).

 

[tibor75]

Ok *******, when you provide a service I'll be happy to be the expert witness against you...even if its not malpractice cause then I can get paid by the lawyers and not risk being sued.

Here's the law in texas:
The Texas Good Samaritan Law limits the civil liability of persons administering emergency care in good faith at the scene of an emergency or in a health care facility. This law limits the civil liability of these persons unless their actions are wilfully and wantonly negligent. This protection does not apply to care administered for or in expectation of remuneration, or by a person who was at the scene of the emergency because he or a person he represents as an agent was soliciting business or seeking to perform a service for remuneration. Also, the limited civil liability is not available for a person whose negligence was a producing cause of the emergency for which care is being administered.[35]

Emergency medical service personnel who are not licensed in the healing arts who administer emergency care in good faith are not liable in civil damages for an act performed in administering the care unless the act is wilfully or wantonly negligent. This limit of liability applies regardless of whether the care is provided for or in expectation of remuneration.[36]

The limited civil liability provided by the Good Samaritan law is an affirmative defense. This means that after a lawsuit is filed, the physician must prove that the law provides protection

Doesn't say jack about frequent flier miles not being remuneration. And it does say a lawyer can sue your ass and YOU must prove you are covered by the law...if you like those odds against a jury of your "peers" then be my guest.

I can also show you the law in a couple other states, all of them say the same thing. But you know...."uh. Wrong" is a compeling legal argument so I can see why you would be so certain.

Who rewards FF miles? Is it the person you "saved?" No, it's the airline. Payment would be if the person you saved gave you something of numerical value. They are not. The airline is giving you something for the inconvenience you had to undergo while on their flight.

Gee, hard to imagine this would be sooo hard to understand. And YOU called me the *******. Don't get all bitter because you foolishly gave up free FF miles. Hilarious...