Working with doctors Working for patients

Personal health - case study

Aaron is a second year medical student with an excellent academic record. He enjoyed his first year at medical school, but is starting to worry about the increasing workload.

At the start of his second year, Aaron was stressed about the academic workload and worried he might not be able to keep up. He was also nervous about having more contact with patients.

He didn’t speak to anyone about this, as he thought his fellow students must be feeling the same. He worried they might think he couldn’t cope.

Aaron fell behind with his work as the year progressed. He had trouble sleeping, which affected his concentration. The lack of sleep affected his emotions and energy levels. Some days he couldn’t even get out of bed or leave his flat. He also had relationship problems with his boyfriend, and had fallen into debt. As a result he missed two mandatory teaching sessions in a row.

His medical school tracked student attendance and called him in to see his personal tutor. Aaron went to the meeting, but he did not tell his personal tutor that he was feeling depressed. He was worried the medical school wouldn’t support him.

One of Aaron’s fellow students noticed he didn’t seem to be his normal, confident self and appeared withdrawn and upset. He encouraged Aaron to go and see his GP, but Aaron didn’t want to. He worried the GP would tell his medical school and the problems he was experiencing would go on his record.

Aaron still struggled. He had no appetite and lost some weight. He also stopped seeing his friends and lost interest in the things he used to enjoy doing. He missed more teaching sessions and failed to hand in his work on time on three occasions.

He was referred to his medical school’s professional concerns committee, which is the body that looks at minor lapses in professionalism[5].

What happened next?

At the committee Aaron became upset and admitted he was struggling with his mental health. The committee were sympathetic of Aaron’s situation. They gave him a written warning for missing teaching sessions and, with his consent, referred him to the university’s occupational health service. They also advised him to speak to his personal tutor and his GP to discuss anything he wanted with them[2].

Aaron was worried about seeing the occupational health team, but at the appointment he was relieved to find that they were supportive. They told him they would protect his confidentiality and they would not tell the medical school the details of his problems. They explained the occupational health service would look to see if there were any adjustments to make it easier for him to complete the course. They also encouraged Aaron to see his GP.

The GP formally diagnosed Aaron with depression. With Aaron’s consent, they sent their report to the occupational health service. On seeing the report, occupational health recommended for Aaron to attend cognitive behaviour therapy (CBT) sessions. The medical school rearranged some of Aaron’s teaching sessions so he could attend CBT. They also ensured he was put on placements close to the medical school so he could get to his appointments[8].

Aaron responded well to the treatment prescribed by the GP and the adjustments put in place by his medical school.  With this ongoing support in place, he managed to get back on track and continued with his studies.​

What could Aaron have done?

Carrying on without seeking help was not the best thing to do. Aaron missed the opportunity to see if his medical school had support services that could have helped him earlier in the year. He also risked falling behind with his studies as things didn’t improve.

See what support his medical school can give.

This is the best course of action for Aaron. Some of the things he could look into include:

  • what support services are available, including peer support or counselling

  • whether the medical school has study skills courses that could help him to manage his work load better, and study in a way that suits him

  •  talking to his personal tutor or other staff member about his concerns

Talk to his friends.

It is always good to share problems with friends, but they may not be in the best place to help. They are not experts in the support services available at the medical school.  Even if they are well meaning, they may not appreciate the seriousness of the problem and whether Aaron needs support.

What to take away

  • Students have the same rights to confidentiality as other patients. GPs would only transfer confidential information if it was to protect patients and the public. In this case there is no indication Aaron’s condition is serious enough to impact on patients[1]. There would be no reason for the GP to tell the medical school.
  • Mental health charity MIND states 1 in 4 people in the UK will experience a mental health problem each year. Doctors are as likely to develop mental health problems compared to the general population. Medical schools should create an environment where mental health is discussed openly and have systems in place to support students[7].
  • Students should make sure they register with a local GP when they come to medical school. That way they can have easy access to independent medical advice for anything they need.
  • Students should approach their school for support if they are experiencing academic, financial, social or health issues. All these factors may impact on a student’s ability to excel on the course. Medical schools want their students to do well and will want to help in any way they can[4].
  • Having a health condition is not a fitness to practise concern. How the the student deals with their condition is what's important[3]. It is not in a student’s interest to conceal a serious health problem. If a student understands their condition and seeks appropriate support from a healthcare practitioner and follows their advice, there is no reason for their health to become a fitness to practise concern.

References to the guidance

Achieving good medical practice: guidance for medical students

Domain 2: Safety and Quality

  1. 1. Protect patients and colleagues from any risk posed by your health (paragraphs 29-36)
  2. 2. Getting independent medical advice (paragraphs 37-38)
  3. 3. Practical tip #7: Your health – dos and don’ts
  4. 4. Informing your medical school (paragraphs 39-41)
  5. 5. Annex: Professionalism and fitness to practise processes in medical schools and universities
  6. 6. Monitoring low-level concerns

Professional behaviour and fitness to practise: guidance for medical schools and their students

  1. 7. Considering health and disability issues (paragraphs 33-56)

Other guidance

  1. 8. Supporting students with mental health conditions