The maritime physician needs a good knowledge of work on board and the tasks the seafarer has to do on the ship. They will need this knowledge to be able to estimate the fitness of the person 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. This may bring them to self-diagnosis and misinterpretations that take time to get out of their mind (thoughts) again. Be 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 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 see these days are often more complex, need good documentation and reporting and more parties than before have to be informed. The physician has to keep a detailed records,so more time and energy needs to be put in each case. It seems that routine jobs in port maritime medicine have declined and the complicated cases grow in number. Is this an indication of a further evolution into a specialization of maritime medicine?