I have been waiting for a lot of the responses to come in before I started
responding.
First of all, I stand by all my statements and do not retract anything. I
know thats pretty bold, but I believe in what I said or else I would not have
posted it.
Dr. Thomson, I am not sure, but the last time I checked the only people in
the medical field that could make a diagnosis was a physician. Now that said,
whenever I walk into an E.D., I agree, my experience in the field may triple
or even quadruple the years of experience that ED attending has. But, if I
notice my patient is having a right sided infarct from an MI and has multiple
pressors but has not been given a single drop of fluid what do you think
would happen if I just started shutting off all the drips and started given
the patient fluids as would be the correct tx modality. That would be myself,
as an RN making a diagnoses based on "my field experience". I would love to
be that patients lawyer. For the Critical Care Physician, Critical Care Nurse
team the option is simple. For the medic, nurse team the options are a little
more complex. They either need to, and with great care and etiquette, present
to this ED attending their evidence to support their case that his dx is
wrong or get in touch with their medical director and give their opinion and
in either case they better be right.
As far as the Australian study, you are right, there has been no study in
North America or Canada (and I am not sure why?...anybody know?) This study
was based upon procedures and, again I agree with you, differences in
training may have affected outcome. But remember, this was an aeromedical
study.
Lastly, I believe that there are more reasons why physicians fly on board
aeromedical aircraft other than the 2 you listed...and I will leave it at
that.
