Cruise Ship Health Care Professionals Qualification

[Ex techie]

Should DCL be required to have a US licenced pediatrician on aboard each of it's ships given extraordinary large number of children aboard in comparison to some other lines?

Not just ACLS and PALS Certification?

[Mbrthelegend]

Absolutely! A ship that CATERS, markets, and embraces families should provide appropriate healthcare providers onboard.

 

 

Sent from my iPhone using Forums

[Ex techie]

I agree, but http://kstp.com/news/stories/S3670845.shtml?cat=1 says there wasn't.

 

Moak claims a pediatrician was not onboard, but a general medicine doctor examined Rosie. A medical services bill from Vanter Cruise Health Services shows Rosie was prescribed Phenergan to calm her nausea. Discharge instructions advised Moak to return to the health center if her daughter's condition worsened.

 

Vanter Cruise Services Requirements are:

Requirements

Medical care onboard is provided by physicians and registered nurses. The Medical Center is an urgent care environment where both crew members and guests are diagnosed and treated. The medical staff encounters health care issues ranging from occupational health, primary care, and urgent/emergency care.

 

Physician

Licensed physician with three years of post-graduate/post-registration clinical practice in general and emergency medicine or board certification in Emergency Medicine or Family Practice or Internal Medicine.

ACLS and PALS Certification

Valid Passport

Prior cruise ship experience is desirable, but not required

Assignments range from 12 - 16 weeks in length

 

Nurse

Licensed in emergency care or critical care

Three to five years nursing experience

ACLS and PALS Certification

Valid Passport

Prior cruise ship experience is desirable, but not required

Assignments 12 - 16 weeks in length

 

http://www.vanterventures.com/node/14

 

http://www.vanterventures.com/Cruise+Line+Overview.htm

 

Ship Physicians and Nurse numbers:

http://www.vanterventures.com/node/19

 

ex techie

Edited January 10, 2015 by Ex techie

[Loonbeam]

I voted no, because in effect they have access to one. All of the lines have access to telemedicine services to talk to specialists in different field, including pediatrics.

 

Now that doesn't mean it wouldn't be a good idea to prioritize ones with pediatric skills when hiring, but shouldn't be a requirement.

 

Secondly, why US licensed? First of all, there is no such thing as a US pediatrics license. States have different requirements, but generally the only thing required to call yourself a pediatrician is a Pediatrics residency and in some cases not even that. You could have done it 20 years ago and still qualify. And your full residency does not have to be pediatrics, can be part of a rotation. Board certification would be closer, but that is not mandatory.

[moki'smommy]

No, it does not make sense to add another physician to the medical staff on the ship. And to then add the qualification of US licensed can largely means that they have to be US trained. The requirements in most states to take the licensing exam are extensive!

 

There is an accredited program in the US that combines internal medicine and peds, but I'm not convinced that it would be any better at meeting the ship's needs than the combination of internal medicine and/or emergency medicine.

 

That said, if the doc finds himself in need of consultation, this is readily available on line or on ship to shore phone. And IF there was there was to be a peds on the ship, logically the docs would work shifts....and we would then be yelling about the fact that someone's 80 year old grandmother was evaluated by a pediatrician.

 

In the incident that probably generated this post, the ship's doc did nothing wrong that I can see. Would a pediatrician be any more comfortable having a potentially ill infant on board? I'm not sure it would have made any difference. The fact is that a young baby can "crash and burn" very quickly--whether on a ship, in a parent's home, or in a US hospital. The issue is what care is available should the child start to deteriorate. And with ANY patient of any age, the doc's choice is to not have an unstable patient on the ship any longer than absolutely necessary.

[BullDawg91]

I say no. A general practitioner is sufficient. If you're going to have a pediatrician, you might as well have a geriatric specialist for the elderly/grandparents. You have to draw the line and t think family practice/general practice is sufficient.

[Ex techie]

I'm glad to see some discussion on this, and grateful to those that have voted and those that have written why.

 

I'm not arguing with anyone, just asking out of curiosity for myself and anyone else that is interested when I reply.

 

I voted no, because in effect they have access to one. All of the lines have access to telemedicine services to talk to specialists in different field, including pediatrics.

 

Now that doesn't mean it wouldn't be a good idea to prioritize ones with pediatric skills when hiring, but shouldn't be a requirement.

 

Secondly, why US licensed? First of all, there is no such thing as a US pediatrics license. States have different requirements, but generally the only thing required to call yourself a pediatrician is a Pediatrics residency and in some cases not even that. You could have done it 20 years ago and still qualify. And your full residency does not have to be pediatrics, can be part of a rotation. Board certification would be closer, but that is not mandatory.

 

Hi Loombeam,

When searching about Vanter, this site came up about MSC Cruises being the first cruise line to have 24/7 pediactric Telemedicine access:

http://www.msccruisesusa.com/us_en/About-MSC-Cruises/News/MSC-Partnership-With-Giannina-Gaslini-Institute.aspx

 

Hopefully DCL have followed suit and now have access to 24/7 pediatric specialists as well.

 

And I should have proposed the question in a better way by asking if a preference were to a trained US Pediatrician and have offered option of Non US trained Pediatrican.

Obviously I meant that they would keep up their training and qualifications, be assessed on a regular basis etc to keep up with current standards of health care and new best practices.

 

No' date=' it does not make sense to add another physician to the medical staff on the ship. And to then add the qualification of US licensed can largely means that they have to be US trained. The requirements in most states to take the licensing exam are extensive!

 

There is an accredited program in the US that combines internal medicine and peds, but I'm not convinced that it would be any better at meeting the ship's needs than the combination of internal medicine and/or emergency medicine.

 

That said, if the doc finds himself in need of consultation, this is readily available on line or on ship to shore phone. And IF there was there was to be a peds on the ship, logically the docs would work shifts....and we would then be yelling about the fact that someone's 80 year old grandmother was evaluated by a pediatrician.

 

In the incident that probably generated this post, the ship's doc did nothing wrong that I can see. Would a pediatrician be any more comfortable having a potentially ill infant on board? I'm not sure it would have made any difference. The fact is that a young baby can "crash and burn" very quickly--whether on a ship, in a parent's home, or in a US hospital. The issue is what care is available should the child start to deteriorate. And with ANY patient of any age, the doc's choice is to not have an unstable patient on the ship any longer than absolutely necessary.[/quote']

 

Hi moki'smommy,

 

I wasn't advocating an additional physician to the staff, more that one could be trained in pediactrics.

I've apologised above to Loombeam for my poor choice of wording and choices in the poll regarding stating a US Licenced Pediatrician.

And you are right that the Doc's do work shifts. Not 24 cover shifts. Think more 7am-7pm, another 11am-11pm.

Obviously all of the medical team are on call 24/7 should they be needed. They do a rota thing with cover when the ship is in port so that it is fair for all to get time ashore. And they have to stick to the same alcohol restrictions the ship set.

 

I presume, not assume, that a specialist in pediactrics would still have to complete a medical general term in emergency triage and recovery before specializing to be a ped.

Happy to be corrected if I'm wrong.

 

The reason I posted this poll is because kstp.com reported that

a general medicine doctor examined

the child, and allegedly prescribed a medicine to a 4 month old that should not have been given to a child under 2 years.

One would hope that a pediatric doctor would know what meds were safe to give to a small child better than a general practitioner.

 

I absolutely agree that the purpose of the ship board medical team is to treat if possible, or stablize the patient and evacuate them.

 

I say no. A general practitioner is sufficient. If you're going to have a pediatrician, you might as well have a geriatric specialist for the elderly/grandparents. You have to draw the line and t think family practice/general practice is sufficient.

 

H BullDawg91,

 

I was thinking along the lines of the demographic of the ship's Guests.

Obviously they need to cater to the largest and most vulnerable demographic of those that cruise on each and every line and even each ship within that line.

That demographic also has to take into account of the average age of the cruise line crew. Usually <45 years old.

 

I would suspect on a fairly busy cruise on say the Magic class to have around 750 <12 year olds, 350 <13-17's, 250 <30 year olds, 800 30-60 year olds, and maybe 200 >60's.

 

Then add in 840 21-45 year old crew, and say 50 over 45 years old crew.

 

That demographic is skewed very much towards very young, young, 20+ and middle aged. Not the >60's.

 

200 people that may need geriatric specialist care vs 750 under 12 and why general care specialists are still needed for the other 2000+.

These are obviously all estimates.

 

Hope that helps see the reasoning I had to posting the poll the way I did, and please no one take any offence to what I have posted or why I have replied back to you.

 

ex techie

Edited January 11, 2015 by Ex techie

[Loonbeam]

Unfortunately, a pediatrician may not have known unless US trained. I did a little digging, phenergan goes by other names in some countries and may not carry the same warning and labeling depending where sourced.

 

Assuming it was labeled correctly tho, any physician, pediatric or not, should review the dosing instructions before providing.

[Emperor Norton]

Should DCL be required to have a US licenced pediatrician on aboard each of it's ships given extraordinary large number of children aboard in comparison to some other lines?

Not just ACLS and PALS Certification?

 

Legally required, no. However common sense says if 50% or so of your passengers would require a pediatrician you should hedge your bets and have one on board.

[moki'smommy]

One does have to factor in that the group most likely to need serious, complex medical care is the elderly group. These are the people on multiple medications, more apt to get into ongoing health problem issues rather than a chid with an infection, vomiting, etc. which should be able to be managed by a family practitioner or ER doc.

 

MANY medications are labeled "not indicated for children under 2." In most cases this means that they have not been tested in this age group and FDA approval for this group has not been sought by the manufacturer. Pediatricians are often experienced in the use of these same drugs in young children, despite the label warnings. However, in this case it appears that phenergan (typically viewed as a minor, safe medication) has a specific warning regarding small children. This makes me wonder why it was not seen/noted when the doc checked the pediatric dosage. However, no damage was done to the child, whether the result of the low dose given or just luck.

 

Of course, if you read the fine print, it also says this drug can cause seizures in adults--must be pretty rare. I've prescribed a lot of phenergan and never saw a seizure that could be attributed to the drug! The package insert warnings must list everything that happened to anyone during the testing period, whether those things could be specifically attributed to the drug or not, and they don't give any indication of the frequency of these adverse reactions. Obviously, it matters whether something happens in 1 out of 10 people who takes a medication (in which case it is not likely to get approval), 1 out of 10,000, or somewhere in between.

 

FYI, you will have to look long and hard to find a "general practitioner" in practice in the US in current days. This term is typically applied to someone who completed medical school and did a one year "rotating" internship, currently not considered adequate training. A family practitioner has 3 years of post med school residency, spending time in many specialty areas including peds. An internist has 3 years post medical training focused in adult areas (may include a small amount of peds). There is currently a 4 year peds/internal med training program which is essentially adult internal medicine with the additional year spent in peds. An ER doc spends some residency time in various specialty areas including peds and critical care in addition to ER time.

Edited January 11, 2015 by moki'smommy

[gambit57]

One would hope that a pediatric doctor would know what meds were safe to give to a small child better than a general practitioner.

 

You would think, but that's often not the case from what I've seen. Many docs just don't know drugs. Some do, but they're rare. And there's usually a reason why they're "unusually" well informed, such as was a medical advisor to a drug study or something. They know some, but things like contraindications are typically way beyond them. That's why the medical field (in the US anyways) employs pharmacists. They're the "backup" and are supposed to catch those kinds of mistakes because doctors frequently make them.

 

Unfortunately, a pediatrician may not have known unless US trained. I did a little digging, phenergan goes by other names in some countries and may not carry the same warning and labeling depending where sourced.

 

Assuming it was labeled correctly tho, any physician, pediatric or not, should review the dosing instructions before providing.

 

I suppose it's possible, but I've never seen a doctor who routinely reviews dosing instructions before providing. At best, they check how much to write on the prescription, but it's typically a pretty cursory glance because they've usually got their usual dosing amount memorized and then just adjust slightly if the patient is not in the category they are used to prescribing for. In they US anyways, they often write what they're used to and wait to see if a pharmacist calls them if something weird is found.

 

If there's no pharmacist... well, then there's just no backup to check unfortunately. And that's assuming the pharmacist is doing his job and checking.

Edited January 11, 2015 by codex57

[gambit57]

One does have to factor in that the group most likely to need serious' date=' complex medical care is the elderly group. These are the people on multiple medications, more apt to get into ongoing health problem issues rather than a chid with an infection, vomiting, etc. which should be able to be managed by a family practitioner or ER doc.[/quote']

 

That's a good point. On a ship, you've got limited space and resources. While kids often get sick, it's typically nothing serious. So, if you're going to deploy an actual doc, I'd have to agree with moki'smommy and think that the elderly would most likely be the group that uses the onboard doctor the most. Such as the grandparents who often cruise along with the kids.

 

MANY medications are labeled "not indicated for children under 2." In most cases this means that they have not been tested in this age group and FDA approval for this group has not been sought by the manufacturer. Pediatricians are often experienced in the use of these same drugs in young children, despite the label warnings. However, in this case it appears that phenergan (typically viewed as a minor, safe medication) has a specific warning regarding small children. This makes me wonder why it was not seen/noted when the doc checked the pediatric dosage. However, no damage was done to the child, whether the result of the low dose given or just luck.

 

Of course, if you read the fine print, it also says this drug can cause seizures in adults--must be pretty rare. I've prescribed a lot of phenergan and never saw a seizure that could be attributed to the drug! The package insert warnings must list everything that happened to anyone during the testing period, whether those things could be specifically attributed to the drug or not, and they don't give any indication of the frequency of these adverse reactions. Obviously, it matters whether something happens in 1 out of 10 people who takes a medication (in which case it is not likely to get approval), 1 out of 10,000, or somewhere in between.

 

FYI, you will have to look long and hard to find a "general practitioner" in practice in the US in current days. This term is typically applied to someone who completed medical school and did a one year "rotating" internship, currently not considered adequate training. A family practitioner has 3 years of post med school residency, spending time in many specialty areas including peds. An internist has 3 years post medical training focused in adult areas (may include a small amount of peds). There is currently a 4 year peds/internal med training program which is essentially adult internal medicine with the additional year spent in peds. An ER doc spends some residency time in various specialty areas including peds and critical care in addition to ER time.

 

Yeah, off label usage is a whole 'nother ball of wax. It's common for some drugs, and uncommon for others. I don't know anything about phernergan, so I wonder if anyone out there has a lot of experience with this drug and is aware of it's off label uses. Or see if common off label uses are listed in Lexi Comp or some drug handbook?

[Loonbeam]

When my doc administers meds in office she is not familiar with, she always checks the dosage. but yeah, not so much ones she knows, then again she knows them.

 

I am thinking that if the doc was not familiar enough with the drug to know about the restrictions, they should have checked.

 

 

 

 

I suppose it's possible, but I've never seen a doctor who routinely reviews dosing instructions before providing. At best, they check how much to write on the prescription, but it's typically a pretty cursory glance because they've usually got their usual dosing amount memorized and then just adjust slightly if the patient is not in the category they are used to prescribing for. In they US anyways, they often write what they're used to and wait to see if a pharmacist calls them if something weird is found.

 

If there's no pharmacist... well, then there's just no backup to check unfortunately. And that's assuming the pharmacist is doing his job and checking.

[gambit57]

If you've got a good doc, hang onto them if at all possible.

 

Back to the question of US licensed docs, maybe it's cuz of my job and personal experience, but I've seen too many US docs that just don't know their stuff enough (in my opinion). The medical boards often are extremely reluctant to act against those super rare killer docs. There's no chance they'd act against a doc who just should know better. Plus, often times, I can understand why they are. In the US, the way payments and insurance works, it doesn't give them time to be. The backup that other med professionals like nurses and pharmacists give them also allow them to not know as much as they probably should or have mistakes covered.

 

On a ship, that's totally different.

 

And I've got relatives and clients who are docs licensed in other countries. Just like the US, you get good ones and bad ones. Being US licensed isn't going to magically ensure you get a competent doc. Similarly, some DOs are far better doctors than MDs. And some are far worse. Shoot, some NPs are far better docs than some MDs/DOs.

 

I just don't think requiring US licensure would ensure anything. In general, I don't like how in the US we're kind of conditioned to say, "it's not my fault, I can be as naive and clueless as I want because other people are supposed to watch out for me. Everyone else is negligent, but not me." Yes, I'm very anti-plaintiff's bar and I'm not even a defense attorney. lol

[Ex techie]

Greats pro's and cons being offered at opinions!

And thanks for that!

 

Very Very surprised the No votes are at 75%! Thought it would have been other other way!

 

ex techie

[Lerin]

We don't use a pedi for our kids on land, have a wonderful general doctor that the entire family sees. A cruise is no different, can't think of some special cold only a kid is going to get on vacation that a general MD can't take care of.