Health and the International Experience

The true prevalence of illness, including alcohol and substance misuse amongst Irish doctors is unknown.  Whilst mental illness and substance abuse are the most common conditions affecting doctors and the care of patients, it must be remembered that there are many other conditions which may affect the care of patients and which are not necessarily seen as problematic by doctors themselves. 

Internationally the health of doctors is the subject of much interest  and research especially in areas such as doctor’s own personal characteristics, the  health environment  in which we practice,  the relationship between our own health behaviour and its impact on  the care of patients, and  results of various interventions  targeted at  burnout and  ill health amongst doctors.  Such research is essential for the understanding of doctors’ health, and correct approaches to it in the future.

Currently 50% of doctors attending the Health Committee have alcohol-related problems and 50% are drug misuse-related.  The figures for the UK are similar, where General Medical Council health restrictions in place for substance misuse are 47% and mental illness rates are at 39%.

One must take care when extrapolating statistics regarding doctors’ health from other jurisdictions, as health care systems and cultures can be very different.  In New Zealand, there is mandatory notification of mental and physical conditions affecting fitness to practise.  It is estimated there, that between 1% and 2% of a population of practicing doctors may be performing poorly due to illness.  In 2008, the New Zealand Council health committee was monitoring 172 doctors, and had 66 new referrals in the year. 

In the UK, the National Clinical Assessment Service report 2009 (NCAS: eight-year review 2009) suggests a figure of 25% of doctors assessed for poor performance have a related underlying health issue.

It would appear that at present, the cases currently coming to the attention of the Council and the Health Committee represent the more severe end of the spectrum of doctor’s ill health, the remainder being managed without reference to the Council.

It is likely however, that the introduction of Professional Competence procedures will lead to an increase in doctors either self-referring and or being referred to the Council with identified health related issues.  Amongst the issues for training bodies and employers, will be the development of pro-active educational modules on health issues whilst in training, in addition to the development of rehabilitation structures required to support doctors who have been ill, in their return to active practice where possible.