Textbook of Maritime Medicine

The port maritime physician should work independently with an appropriate level of competence, evidence based and as a (generalist) general practitioner. The port maritime physician gives a patient-centered and community-oriented comprehensive and integral care that is responsive as well as anticipatory and includes treatment, prevention, health education and promotion and help and assistance where necessary. A characteristic element of general practice that is less present in the port medical practice, is the 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 in fact a very 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. Standards of 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 on the individual seafarer and on the safety of the ship. When the professional circumstances of the patient are of such importance in the medical decision it is obvious that an occupational medical training is almost a condition for a good maritime physician. 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 certainly a necessary element of the work in a port clinic