Features: Supporting ill doctors
26 January 2009
Having your registration restricted due to ill health can be traumatic - but a doctor explains the GMC's procedures can offer support and advice too.
Read one doctor's experiences of the GMC’s procedures and the support and advice that is on offer.
Interview with a doctor
I first came into contact with the GMC in 2001 following a conviction for being drunk in charge of a vehicle while in my second house officer post. I was surprised as the police had told me when arrested that the GMC would not find out. I was shocked, frightened and too ashamed to tell anyone, especially my family, friends and work colleagues.
I was subsequently examined by two psychiatrists and placed under the supervision of a medical supervisor, who was supportive. I was deep in addiction to alcohol, with little insight into my condition, and being treated for depression. I never drank at work, but got drunk to unconsciousness almost every night, turning up to work the following day still drunk and smelling of alcohol.
My undertakings stated I should abstain from alcohol. I did not manage to abstain for more than a day, but my liver function tests were normal and I lied to my medical supervisor and clinical tutor about my alcohol use. I thought I could continue to get away with it and remained in denial of the damage to my mental health, my patients and my career.
The following year on rotation I was found to be drunk at work. My workplace supervisor, who had until then believed me to be abstinent, reported this to the GMC, and I was suspended from work. My mother had recently died and I used this as an excuse to continue drinking which became out of control.
The GMC wrote to me in terms which I found unhelpful and hard to understand at the time. I no longer have these letters, but they were worded in strong terms with bold letters and emphasis on how I was in breach of my undertakings. I was seriously unwell, with alcohol the only way I knew to silence the suicidal thoughts. I didn’t know who to ask for help.
I was lucky. My hospital provided funds for a treatment centre, although after six weeks on discharge I relapsed and was once again charged with drink-driving. After two more months I went back into treatment and following this stayed sober. I remember being afraid of both the impending court case and the GMC hearing. However, in treatment I felt safe.
After six months of agreeing not to work (but not suspended), I appeared before the Panel for the first time. My medical defence union would not provide legal services as my membership had expired, so the GMC provided me with a contact for legal representation.
I borrowed the money for a solicitor. To my surprise I was given conditional registration. The hearing was very formal but I felt elated with the outcome. I went back to work, and stayed sober.
Over the next three years I appeared annually at GMC hearings, which became easier and felt less formal the longer I stayed sober. I felt comfortable enough not to have legal representation. I began to see the GMC as less threatening and punitive as I began to accept I had a mental condition and that the GMC has a duty to protect patients. It became less uncomfortable for the Panel to discuss my mental health with me, and whilst it was hard for me to take afternoons off work to see my supervisor and treating psychiatrist I made the time to do so.
I have found the most difficult and shaming aspect of all this has been to inform future employers of my registration status, although nearly all my employers have reacted with support.
After three years, I started missing appointments and stopped attending AA meetings. I stopped taking my antidepressants, and soon became dependent on opiates. After a year of this I was admitted to a psychiatric ward.
Three weeks after discharge I appeared at a further hearing at the GMC, and this time my dad came with me. I recall feeling for the first time that they acknowledged I was a person with an illness, and they weren’t there to punish me. I was suspended for six months, although I expected longer. At the next hearing I was given conditional registration. I have now returned to work and have remained clean and sober for 21 months.
Over the last two years, my experience with the GMC has been very different from 2001. I have been quite touched by supportive remarks in correspondence, and no longer fear hearings, resent drug testing or seeing my supervisor.
All healthcare professionals need somewhere to go and get help without fear, otherwise they get more unwell, putting patients more and more at risk.
It must be enormously difficult to protect the public from a doctor who is incapable of working due to mental illness, but also supporting the doctor who, after all, is a person who needs help and support in a job of sometimes enormous pressure.
A new pilot Service
A new service is being piloted in London to redress the lack of specific services for doctors (and dentists) who have mental or physical health concerns or addiction problems of any severity.
When it comes to mental health or addiction problems, doctors sometimes suffer in silence which can have catastrophic consequences for both the doctor and their patient. Feelings of guilt, fear of jeopardising their career or simple embarrassment at having to adopt the ‘sick role’ have been given as reasons for doctors not approaching health services for help. An additional factor is that doctors may feel embarrassment on treating a fellow practitioner, tending to approach a consultation like a clinical discussion, rather than allowing the sick doctor to be a patient.
The Practitioner Health Programme is a new, free, independent and confidential service supported by a multi-professional team of doctors, specialist nurses and counsellors. The programme began taking referrals in September 2008 and to date PHP has had a steady stream of practitioner -patients requiring help, support, treatment and onward referral.
The GMC has agreed a Memorandum of Understanding with the PHP which confirms the principle of the confidential service provided by the PHP and the protection, as far as possible, of confidential health information about individual doctors, subject to the GMC’s statutory duty to protect patient safety.
Dr Clare Gerada, a general practitioner with mental health and addiction expertise, is the programme’s Medical Director. She told GMCtoday: ‘Research has shown that doctors have higher rates of addiction and mental health problems than a matched population, with certain specialities (such as psychiatrists) being at even greater risk. Doctors are prone to self-diagnosis and treatment or to asking colleagues in corridor conversations “can I just ask your opinion on…”.’
Dr Gerada added: ‘We can offer assessment, treatment and ongoing management for a range of mental health, addiction and physical health problems affecting work. The programme should be seen as complementary to existing services and with your consent we endeavour to communicate with any other health professional you might be in contact with.’
In time, it is hoped that the service will be extended to other areas of the country. For now, the service is based in the south London transport hub of Vauxhall, so is accessible by bus, tube, train, boat, foot and bicycle.
For more information visit www.php.nhs.uk. For a confidential discussion about yourself or anyone you are concerned about please ring on 020 3049 4505.
GMC comment
As with other aspects of our fitness to practise function, our health-related work in this area has developed considerably over the last five years. In particular:
- We now routinely seek feedback from employers on doctors under supervision and often engage with occupational health departments.
- We have developed a policy on the use of chemical tests as special investigatory tools, and we use unannounced testing where it is appropriate to do so.
- We have more clearly defined the roles and responsibilities of the medical examiner, medical supervisor and workplace supervisor.
- We engage with a variety of organisations that support doctors who may be unwell in order that those doctors have access to informed advice regarding the operation of our fitness to practise procedures.
- No doctor will be erased for disciplinary reasons where their impairment relates purely to their ill health. In addition, we will not disclose details of any doctor's ill health to any person outside the GMC without that doctor's consent.
- We have also fully reviewed the content, style and tone of our correspondence to doctors and patients.
Other sources of support
The British Doctors’ and Dentists’ Group has been in existence for 34 years. The group provides venues for doctors and dentists recovering from substance abuse to meet for mutual and entirely confidential support and encouragement. Tel: 0870 444 5163
The Medical Council on Alcoholism: 020 7487 4445
Sick Doctors Trust: 0870 444 5163
BMA Drs for Drs: for help, counselling and personal support call: 08459 200 169 www.bma.org.uk (click on health and well being)
MedNet: provides confidential consultations and emotional support on a range of issues. Email: mednet@tavi-port.nhs.uk; tel: 020 8938 2411
Doctors’ Support Network: 0870 321 0642
Doctors’ Support Line: 0870 765 0001
Royal Benevolent Fund: tel: 020 8540 9194; visit: www.rmbf.org.