It is one of the great ironies that healthcare professionals are, generally, poor at taking care of their own health. Yet it is one of the core set of guidelines in Good Medical Practice that you have a responsibility to look after your health - if not for your own sake, then at least for your patients.
The GMC is clear that “you should be registered with a general practitioner outside your family”. You should refrain from treating yourself. But research by the BMA’s Doctors for Doctors shows that only one in three doctors would see their GP when unwell, despite almost all being registered with one.
The obvious reason is to prevent any illness being passed to your patients. The GMC makes it your duty to ensure you are sufficiently immunised against common serious communicable diseases, and also to report any fears you have about a potentially contagious illness.
Paragraph 28 says: “If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must follow their advice about any changes to your practice they consider necessary. You must not rely on your own assessment of the risk to patients.”
"If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague"
Exposure to illness is not the only way your health impacts on your patients. Stress and anxiety, and alcohol or drug abuse, can leave you in an unfit state to provide care for your patients. Your professionalism is reliant on your ability to perform at an optimum level – anything less is a patient safety risk.
If you feel that conditions at work or interaction with colleagues is affecting your health it may be worthwhile speaking to your employer, to see if any reasonable alterations at work could significantly improve your wellbeing. Similarly, the BMA offers a counselling service for doctors suffering from stress and anxiety.
CASE STUDY: Demon in a bottle
You have probably heard the proverb “physician, heal thyself”. However, GMC guidance is clear that you should not try and assess your own health, or rely on a friendly colleague’s assessment.
Dr A, an anaesthetic SpR, contacted the MPS advice line worried about one of her colleagues, another SpR; she was concerned he might have a habit but did not have any hard evidence to go on. They had only been working together for about 18 months, but she had known him for longer than that. They had always got on well together, but were not close friends.
Lately, he had been moody and abrupt with everybody. It started gradually a few months ago, and she did not think much about it at first, assuming he had some personal problem and needed space. In the last few weeks, though, he had got a lot worse and very changeable – either snapping at people for no reason or being really remote and unapproachable. This was not like him.
One of the most disturbing things was that he had always been a very conscientious doctor – but had become very unreliable, turning up late and sometimes calling in sick at the last minute. And for a previously quite dapper dresser, he had begun to look quite slovenly.
Dr A searched the internet for a list of signs of substance abuse, and thought that her colleague’s recent behaviour ticked a lot of the boxes. She was at a loss at what to do. She was very reluctant to raise her concerns ‘officially’ in case she was wrong, but was concerned that if he was taking narcotics, patients’ lives may be at risk.
MPS advice: Dr A was reassured that she was right to be concerned and that her fears about getting it wrong were understandable. She was reminded that doctors are human, and can become unwell and develop addictions like anyone else. She was told, whilst the easiest thing to do would be to ignore it, that would be wrong. It was explained that the most important issues were the doctor’s health and wellbeing and patient safety.
In addition, in line with the GMC’s Good Medical Practice, Dr A had a responsibility to ensure that any doctor whose health may be affecting their work received the appropriate assistance. Her colleague had a similar obligation to seek help for himself.
It was suggested that in the first instance, Dr A approach a consultant within the department. In turn the consultant would need to report the matter to the head of department. Her colleague should then be referred to an occupational health physician, in order to establish whether he currently had any health problems and/or was abusing drugs or alcohol so that he could receive the appropriate medical treatment. The occupational health physician should also decide if it is necessary to keep the doctor away from the clinical setting to ensure he does not pose a risk to his patients.
In response to Dr A’s concern that the consequences might be punitive for her colleague, she was reassured that although there were formal processes that the hospital and GMC needed to follow, the emphasis would be on ensuring that her colleague received the necessary help and support to overcome his difficulties. Her colleague would, for example, be put in touch with (or if necessary referred to) one or more of the organisations that exist to support doctors in this way (for example, the Practitioner’s Health Programme, the BMA’s Doctors 4 Doctors and the British Doctors and Dentists Group).