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Are you concerned about a colleague?
Follow this simple guide on what to do if you are concerned about a medical colleague and their state of physical or mental health.
Introduction
Doctors are just like everyone else, in that they are vulnerable to a wide variety of illnesses.
However doctors may differ from the rest of the population in their tendency to deny or minimise medical problems, and their access to a variety of treatments which can be used to self-medicate.
Doctors tend to deny or minimise their own medical problems.
While many doctors access medical care absolutely appropriately, others fail to do so as a result of personal, attitudinal or professional and cultural barriers.
Doctors experiencing emotional and psychological health problems often find significant barriers to seeking help, particularly in light of a culture within the profession which can encourage doctors to view their own illness as a sign of personal weakness.
But doctors make crucial decisions for their patients during their working day, and it is important that patient safety is not compromised by a doctor continuing to work while too unwell to do so.
Have you recently had a concern about the emotional or psychological health of a colleague? Do you feel you are equipped to take the appropriate action to offer support or guidance?
Worrying signs to look out for
Sometimes it is obvious. A colleague’s physical health could be hampered by a broken limb meaning they would be unlikely to continue their surgical list, and would need to take sick leave or adapt their practice for a period of time.
However some conditions can be more difficult, both to identify and assess. Some of those conditions are highlighted below along with examples.
Signs of depression or other mental ill health
Depression or bipolar disorder are relatively common mental health problems, and occur in doctors like the rest of the population. While the signs may be subtle, for both the individual and their colleagues, the effects on patients may be very significant.
You may notice that your usually efficient registrar seems unable to get through the weekly clinic, and has become irritable and brusque with the clinic staff. You suspect they were tearful when you queried their management of a patient.
A consultant seems to have become over-confident, making rash decisions about patient management which are surprising and not in keeping with their usual calm and considered style.
Signs of addiction
It is difficult to think of a legitimate reason to smell of alcohol at work
Addiction can also occur and may be well hidden in an environment where access to drugs is greater and signs may be skilfully disguised.
It is difficult to think of a legitimate reason to smell of alcohol at work and the picture portrayed is likely to be a much more worrying one. Many people who misuse alcohol lack insight into both the misuse, and the effect of it on others.
A colleague who has been a bit distant with you recently, has now started to be late to teaching sessions and meetings, and seemed to be hiding something in their pocket when you came across them in the anaesthetic room. When you inquire you receive an angry and uninformative response.
Signs of chronic illness
You are worried your colleague may have a chronic problem such as Parkinson’s disease. This could also have very practical implications on their ability to look after patients.
Loss of facial expression may mean that patients misinterpret your colleague’s interactions with them. Tremor may interfere with using the computer accurately, or picking up instruments to use during examination. Minor surgery may already be impossible.
Impact on patients
If there are concerns that a doctor’s health, physical or otherwise, may be affecting their ability to practice, it is vital for the doctor as well as the patients of your practice, that any problems are addressed sooner rather than later.
The worst possible outcome is to fail to take action until harm comes to a patient.
Finding solutions
Doctors who develop health problems can often work safely, as long as they have insight into the limitations it implies for their working life.
Many doctors work for years with serious and chronic conditions. However, limiting their practice, or adapting the way they consult, may be necessary to ensure that patients are not put at risk.
So what action should you take if you are concerned that another doctor’s health is compromising their ability to care for patients?
What to do about your concerns
If you are concerned about the health of a colleague, a first step is often to speak to the individual concerned, to ask how they are and whether they are aware of any health problems.
Sometimes a sympathetic approach will allow a colleague to talk about the difficulties they are experiencing, and may lead the doctor to seek help through occupational health services or their own GP.
Although doctors are notoriously poor at accessing care, specific services for doctors with mental health or addiction problems are available in some areas and have been very effective at providing a service tailored to doctors’ needs. Mutually agreed time off may allow the issues to be explored.
Remember that the individual involved, will be going through a really difficult and distressing time and your support and understanding of this can make all the difference.
If you are a junior trainee
You may not feel you can raise the issues with your colleague. You may be in a junior role, and not in a position to have such a discussion with a senior colleague or your consultant.
Start by raising your query on an anonymous basis with a senior colleague you feel comfortable speaking to about it.
You might be worried about the health of another junior doctor who is about to move on to a different hospital and role. You might raise concerns with the doctor who denies any problems and appears to have no insight into the changes in their own behaviour. You might question your own judgement.
If raising your worries with the doctor themselves has been ineffective or not possible, you will need to consider who else you should speak to.
It would be sensible to start by raising your query, possibly on an anonymous basis, with a senior colleague that you are comfortable to speak to about it. Your colleague can help you assess the significance of your observations.
You should consider ringing your defence organisation, as the adviser you speak to is likely to have dealt with many such cases and be able to advise you in light of the specific issues raised.
If you are in a senior role
Having considered the options, through your discussion, you may then need to go back to the doctor you are concerned about, to talk again about the sources of help available for them and how they might seek their own advice.
If this is unsuccessful, you should consider raising your concerns with those with some responsibility for the doctor concerned.
In the case of a trainee, their mentor will be following their progress and may be a good place to start.
If the doctor is a resident specialist or consultant, a clinician with a managerial role, such as the clinical director, is likely to be appropriate.
Next steps to take
When discussing your concerns, you should make clear the nature of your worry and the reasons for it. Specific examples are helpful to illustrate the reasons for your view that health may be the problem.
Although the process can be very difficult and stressful for a doctor, if there are serious health concerns it is better for everyone concerned, particularly the doctor, that the concerns are picked up and dealt with appropriately as soon as possible. Waiting until an adverse event occurs or a patient is harmed can be very damaging for both the doctor and the patients under their care.
Who to talk to
Ideally any concerns raised should be dealt with at a local level.
The process can be difficult and stressful for a doctor but it is better for everyone, particularly the doctor, that the concerns are dealt with appropriately.
Once you have brought your concerns to the attention of an appropriate person such as the mentor or the clinical director, the matter should be dealt with in a sympathetic but structured way, to determine whether the concerns reflect a health problem serious enough to impact on the doctor’s work.
This is likely to include referral to the Psychology department, and possibly a request for information from the doctor’s GP or other specialists, and may involve temporary exclusion from the workplace before sick leave is arranged.
Some resources are available to assist doctors with mental health concerns or addiction, and these should be highlighted to the doctor.
Keeping in touch with colleagues who are unwell, and letting them know that their colleagues are concerned about them, can be vital to reassure doctors in this position that they have support.
Coming back to work
Many doctors returning to work after a substantial period of sick leave will have a phased and supervised return. Again, colleague support during the return to work is crucial and can make the difference between a difficult and stigmatising experience, and a positive and constructive return to full clinical practice.
Sources of help
Psychology Department, Mater Dei Hospital
Location:
The Psychology Department is located on the first floor, Outpatients block.
Opening Hours:
The department is open from Monday to Friday between 7.30 am till 2.30 pm.
Contacts:
Staff may be contacted on telephone number +356 2545 6900, +356 2545 6901
Staff Support Service:
In this department there are 4 Psychologists and 2 Psychology Assistants who are led by Mr. Paul Sciberras, Managing Psychologist.
Staff support is a service aimed at all Mater Dei hospital employees. The objective is to offer psychological and emotional support to staff members experiencing personal or professional issues which affect one’s well-being as well as work-performance issues. This service is based on the premise that it is a healthy practice and sign of strength to seek help and /or counsel, when needed.
This is an autonomous service that functions independently of MDH administration. This implies that personal data and information shared in the session(s) will NOT be passed on to third parties outside the service.
The service is based on self-referrals in which confidentiality and safety are key.
Appointments
Appointments are made on a self-referral basis. Apart from an acute emergency situation, staff are required to fill in the appropriate self referral form which may be obtained from the Psychology department or downloaded from KURA.
The completed signed form can either
- Be brought personally to the Psychology Department
- Scanned and sent electronically to Mr Paul Sciberras, via email at
- By external/internal mail to the Psychology Department, Mater Dei Hospital.
Once received, a psychologist will contact you as soon as possible to fix an appointment.
The service is free of charge
Employee Support Programme ( www.esp.gov.mt )
The Employee Support Programme (ESP) aims to identify and respond to the needs of public employees experiencing personal, emotional and/or behavioural problems which are interfering with their work-life balance. This is necessary to enable them to be healthier, more productive, able to contribute better to their place of work and to assist the general public. The Unit is designed to deal with a broad range of difficulties such as work-related stress, mental health difficulties and emotional stress, marital and family concerns, bereavement and terminal illness, addictive behaviour and disability issues. The ESP Unit provides confidential, short-term, psychological support.
The Programme plays a critical role in meeting the operational goal of strengthening the capacity of the institution and administration. Its aim is to provide the required support to public employees with the objective of strengthening their effectiveness and efficiency at their place of work. The Unit encourages and assists employees to assume responsibility for their personal health and wellness in order to contribute towards a healthier work environment.
Apart from direct support to public service employees, the ESP Unit provides training to employees in managerial positions on issues related to well-being at the workplace, why it is important and how it can be implemented at work. This can be done in the form of talks, seminars and discussions organised by the Unit itself. The ESP Unit also regularly organises initiatives to raise awareness on the importance of employee well-being and better mental health.
Contact details: https://publicservice.gov.mt/en/people/ESP/Pages/Contact-Details.aspx
Most of the data provided was borrowed from the British Medical Association
