Textbook of Maritime Medicine

The maritime physician needs a good knowledge of the work on board and the tasks the seaman has to do on the ship. He will need this knowledge to be able to estimate the fitness of the man to continue working on board. The approach to the patient must be empathic and open. Seafarers often come to a maritime physician with a problem that has occurred on board and with which they have been alone for several days, thinking and worrying. It may bring them to self-diagnosis and misinterpretations that take time to get them out of their mind (thoughts) again. Make sure to recognize this and send the seaman back on board with good information and instructions on how to eventually continue treatment on board and what to do in follow up. Often the patients will use some kind of self- medication or use medication prescribed from other medical doctors. Due to language barriers the drug may or may not be taken appropriately. Sometimes patients do have chronic conditions, such as hepatitis or diabetes which they will hide from their employer. It is necessary to build a level of trust between the port doctor and the patient so that the seafarer will give information on chronic conditions and self-medication. There was a time when seafarers came to port physicians with vague complaints, minor ailments; in fact one could think often that the seafarer was just looking for some tablets, some reassurance, and the possibility to go to a doctor for free or even to get a free ride into town. Those days are over. Seafarers have complicated tasks to perform in both operational and managerial functions. They are trained people capable of making judgments and aimed at taking decisions themselves. They are today better selected and they are in better condition when they come on board. That, combined with the decreased number of crew on board and shorter stays in port, makes consultation by seafarers less numerous but often more complicated in nature. The cases that maritime physicians get these days are often more complicated, need good documentation and reporting and more parties than before have to be informed. The physician has to keep a more extensive record of cases. So there is more time and energy to be put in each case. It is as if the routine jobs in medicine have declined and the complicated cases grow in number. Is this a indication of a further evolution into a specialization in maritime medicine?