Practice dilemma - A colleague confides he has hepatitis C

The Dilemma: The GP registrar at your practice has just been diagnosed with hepatitis C infection. He did some blood tests as he was feeling more tired than usual. These showed abnormal LFTs so he then arranged hepatitis serology testing.

He confides in you over lunch one day. He insists on his infection being kept confidential; he does not want his GP trainer to be informed. He says he is taking blood, suturing minor superficial wounds and performing vaginal and rectal examinations. What should you do as a fellow GP in the practice?

A GP's response - Dr Alison Glenesk is a GP trainer in Aberdeen
This is a very tricky situation. I need to reconcile two seemingly conflicting courses of action - supporting my young colleague and discharging my duty to the wider practice community.

I would wonder why the GP registrar has chosen to confide in me at this time. As a trainee studying for exams, he will be well aware of his own obligations, and mine.

Could it be that the whole thing has become too much for him to cope with? I would encourage him to tell me about this huge problem, which is threatening his health and career. There is also the issue of where he has contracted hepatitis C and whether he has put anyone else at risk, which will need sensitive handling. He needs support and a non-judgmental attitude.

I would stress the need for him to confide in his trainer, and offer to help him with this. There may be an interpersonal problem between them. The registrar must also stop performing all procedures that might put anyone at risk, and contact occupational health for further advice. His defence union should also offer assistance and the BMA runs a helpline for sick doctors.

If I can't persuade the registrar to do any of the above, I would have to act in accordance with the GMC's Good Medical Practice (paragraph 43).

If I suspect a colleague's health problem is putting patients at risk, I must take immediate action, either by informing the appropriate person at my local NHS Board or trust, or seeking advice from my own defence union or the GMC. This would be my last resort, but is clearly my own duty as a doctor.

A medico-legal opinion - Dr Pallavi Bradshaw is a medico-legal adviser at the Medical Protection Society
You have clearly been placed in a very awkward position by your colleague. It is likely that you feel torn by the loyalty to your colleague who has confided in you, empathy for his situation and concern about your professional obligation.

As a fellow GP you have a responsibility for the welfare of the GP registrar, but above all to your patients.

As the GP registrar appears to trust you, it would seem advisable to counsel the trainee of his own professional responsibilities.

You should encourage him to seek independent medical advice to manage the condition for his own benefit and to seek an occupational health/infectious diseases opinion to assess the risk he poses to his patients and how that risk can best be managed.

You should have an open and frank discussion with the registrar about your concerns and the need for him to inform his trainer and restrict his practice while awaiting occupational health assessment.

You must also be clear that if he refuses to do so you are obliged to raise this issue with his trainer with or without his consent and take immediate steps within the practice to manage the risk he poses and consult with occupational health.

As a health professional one must always be alert to the fact that disclosure of personal sensitive information about a colleague may be warranted in the interests of patient safety.

A patient's response - Elizabeth Brain is a member of the RCGP patient partnership group
Your advice to your colleague should be that you most earnestly disagree with his wish that the matter remain confidential. However, you should express this with due understanding and sensitivity and be empathetic to the dilemma that he is in.

There is no question that his duty to his patients must override the complexities that this information could bring to his career and this is a message that has to be expressed very clearly.

However large or small the risks, patient safety is paramount. You should explain that a prompt disclosure to his colleagues, and to the medical authorities, can only enhance their regard for his professional integrity.

Immediate disclosure will minimise the risk to his patients and his career opportunities and prospects.

Some boundaries may have to be drawn as to what procedures can and cannot be performed as part of his daily work and what additional precautions have to be taken.

You should emphasise that this may only affect a small proportion of what he is currently doing and that there is still a vast field of medicine that will be unaffected.

The fact that he is infected does not, in itself, affect his skills and ability to make a significant contribution to medicine in general and to his patients in particular. Finally, be very supportive as he journeys through this.

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