While it remains unusual for a doctor’s health to put a patient in danger, each year the Medical Defence Union (MDU) advises a number of members about concerns related to either their own or a colleague’s health.
If doctors are suffering from alcohol or drug addiction, or another health-related problem, it is vital they feel that they can seek help at an early stage, before it affects their ability to work. Unfortunately, this is not always the case and some doctors will carry on working, believing that their condition or situation will eventually improve.
Gradual health deterioration
It can be difficult to decide when to seek help for a sick colleague, as the deterioration in their health may be gradual. There are, however, warning signs that might suggest when colleagues are suffering from health problems.
Known changes in appearance and behaviour that might indicate problems with a colleague’s health are: dishevelled appearance or signs of self neglect, smelling of alcohol and poor time-keeping. An inability to work with others, poor communication with colleagues and/or patients and poor teamwork may be further signs of an underlying problem.
In a situation where a doctor is providing a deteriorating or poor clinical service, has a negative outlook, shows an uncaring attitude to patients, has poor clinical decision-making and
prescribing, and where there is evidence of inappropriate self-prescriptions, it might be time to blow the whistle.
Duty to care
Doctors have an ethical duty to act if they feel that their health may be endangering patients. Equally, GPs have a responsibility to protect patients if they believe a colleague’s health poses a threat to patients.
The GMC has recently published supplementary guidance, ‘Raising Concerns About Patient Safety’, which sets out a doctor’s responsibilities in a situation where they have good reason to believe that a colleague is endangering patients.
The guidance reiterates that a GP must protect patients from risk or harm posed by another colleague and advises how doctors can comply with this principle.
The GMC acknowledges that doctors may be reluctant to report concerns about their colleagues because it could affect working relationships or have a negative impact on their career. However, the guidance warns doctors to bear in mind that it is their duty to put patients’ interests first, above any existing personal or professional loyalties.
The Public Interest Disclosure Act 1998 provides legal protection against victimisation or dismissal for individuals who disclose information in order to raise genuine concerns and expose malpractice in the workplace.
According to the GMC guidance, you will be able to justify raising a concern — even if it turns out to be groundless — if you have done so honestly, promptly, on the basis of reasonable belief and through appropriate channels.
Raising the alarm
Where possible, doctors should raise their concerns with an appropriate person, which in the GP setting might be the clinical governance lead at the primary care organisation (PCO) or a GP partner. The GMC adds that doctors should be ‘clear, honest and objective about the reasons for their concerns and keep a record of them and the steps taken to try to resolve them’.
If doctors cannot raise their concerns with the responsible person locally because they believe them to be part of the problem, believe there is an immediate risk to patients, or if they have raised their concerns locally but feel they have not been addressed adequately, doctors should then contact an external body such as the GMC or Healthcare Commission.
Doctors may consider making their concerns public when they have done all they can to resolve concerns within the organisation to which they are contracted, or with the appropriate external body, and have good grounds to believe that patients are still at risk of harm. In these circumstances, it is vital that patient confidentiality is not breached. The GMC advises doctors to contact their medical defence organisation, professional association, the GMC or Public Concern at Work — a charity that provides free confidential legal advice, before making their concerns public.
Dr Kirkpatrick is a medico-legal adviser at the MDU
How to identify health problems in colleagues
- Doctors who are suffering from personal problems or ill health but carry on working may be putting patients in danger.
- Changes in a doctor’s appearance and behaviour may be the first warning signs that there is an underlying problem.
- If the doctor is providing a deteriorating or poor clinical service you must consider the danger that patients may be placed in.
- Where possible you should raise your concerns with a practice partner or the PCO. Otherwise you must do so with the GMC or Healthcare Commission.
- If you think the problems have not been resolved, you could raise concerns in public, but patient confidentiality must be maintained at all times.