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Managing Doctors in Difficulity

Case Study:

Dr M is a consultant anaesthetist working at a major regional hospital.Until recently, he had an excellent record for attendance and punctuality. However, lately, he has started arriving late for his shifts. Dr M’s colleagues have also noticed some changes in his appearance and he often comes to work looking fatigued. He has always had a reputation for being calm and considered, but these days has become irritable and is disengaging from his colleagues.

Dr S works at the same hospital. She has become concerned about the changes she sees in Dr M and approaches their other colleagues. Dr S finds that their colleagues have also noticed the changes in Dr M and so she decides to approach Dr M with her concerns. Dr S takes Dr M to a quiet area and tells him that she has noticed a deterioration and is worried about his overall well-being. Dr M admits that he has been going through a difficult period in his personal life and that perhaps he needs to take some time off.

Two weeks later, Dr M is still in work and has not taken any time off. Dr S decides that she needs to relay her concerns to their Clinical Director. The Clinical Director has noticed some changes in Dr M too, but was unaware of the extent of the problems being experienced by Dr M. The Clinical Director invites Dr M to a meeting where they arrange for Dr M to take some time off work.

One month later, Dr M returns to work and, although initially he seems to be performing well, over the following weeks his demeanour and appearance again deteriorate. Dr M is forgetful, his communication with his colleagues and patients is often discourteous and he looks exhausted.

The Clinical Director becomes anxious about the situation. He is concerned about the safety of patients, but is also worried about how the matter should be dealt with. He doesn’t want to cause damage to Dr M’s career or reputation and is also worried that he himself might be adversely affected. The signs displayed by Dr M could be associated with anxiety, substance misuse or early onset Alzheimer’s disease.

The Clinical Director needs advice on what actions to take in dealing with his colleague’s difficulties.

NOTE: This case study does not form part of the Guide to Ethics and Professionalism for Registered Medical Practitioners, nor does it constitute clinical or legal advice. It is intended as a helpful illustration of a potential scenario.

What guidance does the Medical Council provide to doctors that could help the Clinical Director in this situation?

If we consult the Ethical Guide, we can find guidance that the Clinical Director should follow. With regard to doctors in management roles, paragraph 60 of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 8th edition states:

63.1.2 As a manager, you share the responsibility for patient safety within your organisation. You should satisfy yourself that clinical audit, handover (see paragraph 23) and confidentiality systems are in place. You should also satisfy yourself that systems are in place to give early warning of any failure or potential failure in the clinical performance of individuals or teams. You should make sure that any failures are dealt with quickly and effectively. You should also make sure that staff understand the importance of these systems and how to use them.

With regard to concerns about a colleague, paragraph 59 of the Guide states:

59.1 If you are concerned about a colleague’s health or professional competence due to the misuse of alcohol or drugs, a physical or psychological disorder or other factors, your primary duty is to protect patients. If there is a risk to patient safety, you must inform the relevant authority of your concerns without delay. If there is no current risk, you should support your colleague by advising them to seek expert professional help or to consider referral to the Medical Council’s Health Committee.

What could Dr S and the Clinical Director do in this situation?

Firstly, Dr S should encourage Dr M to seek help. However, if Dr M did not wish to seek help, it may be necessary for a Clinical Director to intervene. A good starting point for the Clinical Director is to contact The Practitioner Health Matters Programme (formerly known as the ‘Sick Doctor Scheme’). The service offers a strictly confidential assessment with appropriate interventions depending on the needs of the practitioner. These interventions may include referrals to other specialists, counselling or drug and alcohol testing as required.

Patient safety is of paramount importance, and the Clinical Director should bear in mind that taking early action to address this situation is important for protecting both Dr M and his patients.

Individual hospitals or clinics may have different protocols to follow when faced with a situation such as this and you should familiarise yourself with the protocols where you work.

FURTHER RESOURCES:

Practitioner Health Matters Programme
http://practitionerhealth.ie/
The Practitioner Health Matters Programme is a confidential resource that offers support and care to doctors who are under stress or are experiencing a mental health, alcohol or substance misuse issue. They can also offer advice and support to the colleagues of health practitioners who are experiencing problems.

Doctors Health Matters (Medical Council)
www.medicalcouncil.ie/Existing-Registrants-/Health-Sub-Committee/
Doctors can also be referred to the Medical Council’s Health Committee, whose primary role is to monitor and support doctors in maintaining their registration during times of illness/disability. Managers should be vigilant in recognising when a doctor is in difficulty following an adverse event, trauma and when experiencing burnout. Initial support such as RAPID first aid should be offered to doctors who are experiencing mental health difficulties.

Doctors’ Health (ICGP)
http://www.icgp.ie/go/in_the_practice/doctors_health
The ICGP Doctors' Health in Practice Programme was established in March 2000. It aims to promote and support the good physical health, occupational health, psychological health and wellbeing of GPs. It encourages primary health care for doctors' healthcare in the first instance and supports the aim that every GP should have a GP. The healthcare networks and helpline can also be accessed by GPs' families so that GPs can avoid treating their own family members, and the email service can be accessed by practice staff, for example for health and safety issues.

Mental Health First Aid Ireland
www.mhfaireland.ie
Familiarising yourself and your team with mental health first aid procedures can help with early intervention and provide for more open communication within teams. More information can be found at Mental Health First Aid Ireland.

Managing Doctors in Difficulty

Acknowledgement

The Medical Council wishes to thank the Practitioner Health Matters Programme and the Irish Hospital Consultants Association for their help and advice in drafting this vignette.