Depression and bipolar disorder are relatively common mental health problems and occur among doctors just like the rest of the population. While the signs may be subtle, for both the individual and their colleagues, the effects on patients may be very significant. For example:
You may notice that your, usually efficient, registrar seems unable to get through the weekly clinic, and has become irritable and brusque with clinic staff. You suspect they were tearful when you queried their management of a patient.
A consultant seems to have become over-confident, making rash decisions about patient management, which are surprising, and not in keeping with their usual calm and considered style.
Signs of addiction
It is difficult to think of a legitimate reason to smell alcohol at work, and the situation here is likely to be a much more worrying one. Many people who misuse alcohol lack insight into both the misuse and the effect of it on others. Drug addiction can also occur and may be well-hidden in an environment where access to drugs is greater and signs may be skilfully disguised. For example:
A colleague, who has been a bit distant with you recently, has now started to be late to teaching sessions and meetings, and seemed to be hiding something in their pocket when you came across them in the anaesthetic room. When you enquire, you receive an angry and uninformative response.
Signs of chronic illness
You are worried your colleague may have a chronic problem, such as Parkinson’s disease. This could also have very practical implications on their ability to look after patients – loss of facial expression may mean that patients misinterpret your colleague’s interactions with them, tremor may interfere with using the computer accurately or picking up instruments to use during examination and minor surgery may already be impossible.
Impact on patients
If there are concerns that a doctor’s health, physical or otherwise, may be affecting their ability to practice, it is vital for the doctor, as well as their patients, that any problems are addressed sooner rather than later; the worst possible outcome is to fail to take action until harm comes to a patient.
Finding solutions
Doctors who develop health problems can often work safely as long as they have insight into the limitations it implies for their working life. Many doctors work for years with serious and chronic conditions; however, limiting their practice, or adapting the way they consult, may be necessary to ensure that patients are not put at risk.
So, what action should you take if you are concerned that another doctor’s health is compromising their ability to care for patients?
What to do about your concerns
If you are concerned about the health of a colleague, a first step is often to speak to the individual concerned to ask how they are and whether they are aware of any health problems. Sometimes a sympathetic approach will allow a colleague to talk about the difficulties they are experiencing and may lead the doctor to seek help through occupational health services, or their own GP.
Although doctors are notoriously poor at accessing care for themselves, specific services for doctors with mental health or addiction problems are available in some areas, and have been very effective at providing a service tailored to doctors’ needs. Mutually agreed time off may allow the issues to be explored.
Remember that the individual involved will be going through a really difficult and distressing time, and your support and understanding of this can make all the difference.
If you are a GP
It is very important that GPs are registered with a GP outside their own practice.
If you are a junior doctor
You may not feel you can raise the issues with your colleague. You may be in a junior role, and not in a position to have such a discussion with a senior colleague or your consultant.
Start by raising your query on an anonymous basis with a senior colleague you feel comfortable speaking to them about it.
You might be worried about the health of another junior doctor who is about to move on to a different hospital and role. You might raise concerns with the doctor, who denies any problems and appears to have no insight into the changes in their own behaviour; you might question your own judgement.
If raising your worries with the doctor themselves has been ineffective, or not possible, you will need to consider who else you should speak to. It would be sensible to start by raising your query, possibly on an anonymous basis, with a senior colleague that you are comfortable to speak to about it; this colleague can help you assess the significance of your observations.
You should consider ringing your defence organisation, as the adviser you speak to is likely to have dealt with many such cases and may be able to advise you in light of the specific issues raised.
If you are in a senior role
Having considered the options, through your discussion, you may then need to go back to the doctor you are concerned about, to talk again about the sources of help available for them, and how they might seek their own advice. If this is unsuccessful you should consider raising your concerns with those with some responsibility for the doctor concerned.
In the case of a trainee, their educational supervisor will be following their progress and may be a good place to start. Programme directors may also be helpful in such situations.
If the doctor is an associate specialist or consultant, a clinician with a managerial role, such as the clinical or medical director, is likely to be appropriate.
Next steps to take
When discussing your concerns you should make clear the nature of your worry and the reasons for it; specific examples are helpful to illustrate the reasons for your view that health may be the problem.
Although the process can be very difficult and stressful for a doctor, if there are serious health concerns it is better for everyone concerned – particularly the doctor – that the concerns are picked up and dealt with appropriately as soon as possible. Waiting until an adverse event occurs, or a patient is harmed, can be very damaging for both the doctor and the patients in their care.
Who to talk to
Once you have brought your concerns to the attention of an appropriate person, such as the educational supervisor or the clinical director, the matter should be looked into by the trust, deanery or local education and training board (LETB) in a sympathetic but structured way, to determine whether the concerns raised reflect a health problem serious enough to impact on the doctor’s work.
This is likely to include referral to the occupational health department and, possibly, a request for information from the doctor’s GP or other specialists; it may involve temporary exclusion from the workplace before sick leave is arranged.
If all else fails
If the doctor is moving to another area, and/or unwilling to co-operate with the advice either from occupational health or the trust, deanery or LETB, they may have to be reported to the GMC. If this happens, the GMC are likely to initiate a fitness to practice investigation and arrange health assessments for the doctor in question.
Most trusts, deaneries or LETBs and the GMC are reasonably sympathetic to doctors with health problems – although the processes may be prolonged, and can lead to feelings of isolation for the doctors involved, particularly if they are temporarily excluded or on sick leave.
Keeping in touch with colleagues who are unwell, and letting them know that their colleagues are concerned about them, can be vital to reassure doctors in this position that they have support.
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