Medical Skills of the Port Maritime Physician
The port maritime physician should work independently with an appropriate level of competence, that is evidence based as a (generalist) general practitioner. The port maritime physician gives patient-centered and community-oriented comprehensive and integral care that is responsive as well as anticipatory and includes treatment, prevention, health education and promotion, with help and assistance where necessary. A characteristic element of general practice that is less present in the port medical practice, is continuity of care. Seafarers often use the services on an occasional basis. This requires special attention with regard to reports and follow-up. The port physician has to assist the patient on how and where to seek follow-up. Time is a limiting factor in patient care and this time-pressure becomes a key element in decision-making. The physician working in a port clinic must be skilled in good clinical examination. Very often there is not enough time to make elaborate technical tests. A good knowledge of which kind of test may give the most useful information is essential. Standardised protocols for treatment can be used in most cases. In a maritime environment however, a medical decision will always have to take the specific situation of the seafarer into account. The success of the treatment depends on the conditions on board and the implications such treatment has for the individual seafarer and the safety of the ship. When the working environment of the patient is of such importance in the medical decision it is obvious that an occupational medical training is almost essential for a good maritime physician. They need not only to have an idea about safety and ability to continue work on board, but also to identify aspects of work that may cause injury or disease to a seafarer. Hazard definition and risk management; how to modify work activities and monitoring trends in health are subjects that a port physician should be familiar with. Knowledge of so called tropical pathology, expanded to all kinds of pathology common in other areas of the world but less frequent in the country of the physician, is important. Vaccinations related to work and travel have to be available in the port clinic and travel advice that takes into account the specific characteristic of the ship and voyage is a necessary element of the work in a port clinic
Maritime Knowledge of the Port Maritime Physician
Ideally, a maritime physician should have sailed with a ship. He has to feel, hear and smell life on board. He should see the way seafarers live on board and the way they work. Experience the psychological strain of watch systems, feel the physical strain of some work on board and the monotony in other tasks. The elements that build stress on board, the short passages between ports, the numerous tasks to be done while in port etc.
As a minimum the maritime physician should have a good idea about the different tasks on board ship. He should have insight in the functional demands of each task. A seafarers’ physician must have a profile of each function on board and must know particular hazards for health and wellbeing in each of these jobs.