A colleague's fitness to practise
BackgroundDr Okonkwo is Dr van den Berg’s GP.
Dr van den Berg discloses that he has been drinking heavily during a stressful period at his hospital. Occasionally he’s found it difficult to stop drinking but he never drinks before or during work or when he’s on call.
Dr Okonkwo uses the Alcohol Use Disorder Test to screen for alcohol misuse. Dr van den Berg scores 15 (‘a cause for increasing concern’).
ScenarioDr Okonkwo gives Dr van den Berg some literature and strategies to limit alcohol consumption.
She tells him that she’s worried about the effects of his drinking on his work and urges him to seek assistance from his hospital’s occupational health service.
Dr van den Berg refuses, insisting his work hasn’t suffered and he can handle the situation with her help. He makes clear that, if Dr Okonkwo approaches the hospital directly, he’ll deny there’s any problem.
Dr van den Berg is a patient with the same rights to confidentiality as any other patient. She believes what Dr van den Berg says about not drinking when working. It would breach Dr van den Berg’s trust and likely damage their relationship if she discloses without his consent , which may mean he doesn’t seek help from her in the future.
What the doctor didDr Okonkwo assesses that Dr van den Berg does not currently pose a danger, meaning a disclosure to his employers or the GMC without his consent would not be appropriate. She resolves to keep the situation under review as a decision to raise a concern can be taken quickly and when needed to protect patients.
Dr Okonkwo encourages Dr van den Berg to make contact with the Doctors’ and Dentists’ Group and Alcoholics Anonymous. She discusses the case anonymously with a consultant psychiatrist colleague who specialises in alcohol misuse and is satisfied by his advice that she has taken the right approach.
What the doctor had to consider
- There is a clear public interest in a confidential medical service, which is central to trust between doctors and patients (Confidentiality, paragraph 1).
- The duty of confidentiality is not absolute, and there can be a public interest in disclosing information, e.g. to protect others from risks of serious harm which may be posed by healthcare professionals with health, conduct or performance problems (Confidentiality, paragraphs 63 to 70).
- Doctors must be compassionate towards colleagues who have problems with their performance or health. But they must put patient safety first at all times (Good medical practice, paragraph 51).
- Doctors should be clear, honest and objective about the reason for raising a concern about a colleague’s health, which should usually be addressed to their employing or contracting body’s occupational health service in the first instance (Leadership and management for all doctors, paragraphs 70 to 72).