Simon Calder: The Man Who Pays His Way

The doctor was on her rounds when I met her: she was walking round and round the economy class section of an Air China Airbus, somewhere over Siberia. This Hampshire GP takes plenty of in-flight exercise to minimise the risk of deep-vein thrombosis, and to enhance her general well-being upon arrival. Well, she does almost all the right things: "I like to have the odd drink". Nothing, though, that would cloud her judgment - for which passengers on a flight from Auckland to Singapore had good reason to be grateful.

The doctor was on her rounds when I met her: she was walking round and round the economy class section of an Air China Airbus, somewhere over Siberia. This Hampshire GP takes plenty of in-flight exercise to minimise the risk of deep-vein thrombosis, and to enhance her general well-being upon arrival. Well, she does almost all the right things: "I like to have the odd drink". Nothing, though, that would cloud her judgment - for which passengers on a flight from Auckland to Singapore had good reason to be grateful.

Medical emergencies are deeply worrying for the individuals concerned and their families; when you are seven miles above the Great Siberian Plain, help can seem a very long way away.

Health scares are also extremely disruptive and expensive for airlines. In the summer, a Continental Airlines jet from Newark to Gatwick was obliged to land at Gander in Newfoundland when a passenger felt unwell. The cost in extra fuel, landing fees and disruption to everyone's schedules was exacerbated when take-off from Gander was delayed by said passenger. He insisted he felt much better and wanted to continue to Britain rather than getting checked out at a Canadian hospital and taking an extremely circuitous route home.

Passengers aboard a recent British Airways flight BA59 bound from Heathrow to Cape Town fared even worse. A medical emergency about an hour into what was supposed to be an overnight flight resulted in a diversion to Barcelona. This extra stop would have extended the crew's working hours beyond legal limits, so the decision was made to stop for the night. Unfortunately, Barcelona's chronic accommodation shortage meant that hotel rooms could not be found for the 400 passengers on board. Everyone was obliged to fly back to square one - landing around midnight at Heathrow, where sufficient beds were available.

The flight eventually arrived in South Africa nearly 24 hours late, after having burned an extra 10,000 gallons of fuel. British Airways also had to pay out at least £100,000 for hotel rooms and meals (for passengers at both ends of the route - a Jumbo-load of people was waiting at Cape Town, too), plus extra landing charges and its staff's wages. There is also the hard-to-quantify effect on BA's reputation. Although no airline can be held responsible for the effects of a medical emergency, this event was one of a sequence of disruptions to the Cape Town flight. Last month, BA59 encountered a technical problem, forcing passengers to stay overnight at Heathrow; shortly afterwards, another flight to the same destination was cancelled "for operational reasons".

Back on board Air China, everyone seemed in fine fettle. But the stresses of 21st-century air travel can trigger serious conditions that require immediate medical attention. Happily for we passengers - and the airlines - the chances of a doctor being aboard a wide-bodied aircraft are reasonably good. Like other middle-class professionals, they tend to travel a lot.

Singapore Airlines has reason to be grateful that my new GP friend travelled on one of its flights from Auckland to Singapore. When, over central Australia, the call went out for a doctor, she responded immediately.

A passenger in business class was having breathing difficulties, which could signal heart problems or merely a panic attack. The captain asked her to decide whether to divert the aircraft to Alice Springs - at a cost of tens of thousands of pounds and hundreds of missed connections - or to continue as normal.

The lowest-risk strategy was to divert. Bravely, however, the Hampshire doctor concluded that the life of the ailing passenger was not under threat and that the aircraft could fly on. She was proved right, and everyone made their connections - including the patient, who had recovered by the end of the journey.

As Richard Quest reported two weeks ago, Singapore Airlines operates the longest flight in the world, between New York and Singapore. The cost of a diversion to this 18-hour flight would be enormous. So you might imagine that the carrier is scrupulous about thanking doctors who respond to calls for help. How, I wondered, did the airline reward her for her help: a free flight to anywhere Singapore Airlines flies, or just an upgrade to business class for her onward flight to London? Neither of the above. "They gave me a gin and tonic." Even this was not as generous as it might appear, since all drinks are free on board the flight anyway.

In response, the airline issued a statement saying it "recognises the invaluable role of doctors who assist with medical emergencies in-flight". If a doctor responds to an emergency request on board, says Singapore Airlines, "We always thank them personally afterwards and will send them a small token of our appreciation". The airline points out that if no doctor is present, it has a "tele-medical service, which puts the cabin crew in touch with fully qualified doctors on the ground in Singapore, who advise them on the best course of action".