Printout of content from Your Health Matters website

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1 Printout of content from Your Health Matters website

2 Introduction Welcome to Your Health Matters, our website for doctors with health concerns. We understand that medicine is a challenging and stressful profession. While making care for your patient your priority, we appreciate that you can be susceptible to health problems yourself. If you are able to manage a health problem and maintain a good level of care for your patients, there is no need for the GMC to get involved. It is difficult to provide a list of health conditions which we need to know about because our involvement relates, not so much to the health problem itself, as to the effect that the health problem may be having on your ability to care for your patients. This may vary from person to person and will also be affected by what help you are receiving, how much insight you have into your own health problem and the support network you have both at work and at home. If you have a health condition or have a problem with alcohol or drugs that may put patients at risk, you need to let us know so that we can ensure that patients are protected. This site contains a range of advice for those of you with health concerns; help for those who are successfully managing your health conditions, and those who are referred to the GMC for health related reasons. If you have been referred to the GMC you may wish to contact your defence organisation or legal representative. Some content on the site is written by the GMC, while other pages are by doctors who are involved in assessment and support processes. You can also read the story of a doctor who has overcome serious health concerns and returned to work, in his own words. We hope you find the site useful. If you would like to speak to someone about our procedures, please call our contact centre on In our Resources section you can find contact details for a range of organisations which support doctors with health concerns. 2

3 On this site There is a wide range of support available to help you manage your health, so you can continue to practise and provide a good level of care to patients. See our section on managing your health. A small number of doctors are referred to us each year for health reasons and we deal with these as sensitively as we can. If concerns are raised about your health condition putting patients at risk, you may be asked to have a health assessment. Find out more about the health assessment process. A wide range of experts are involved in providing support, advice and carrying out assessments in relation to any risk to patients. Find out who they are and what they do visit People who are involved. In most cases relating purely to health, doctors going through our fitness to practise procedures enter voluntary agreements with us (called undertakings). Once you have agreed undertakings, we will review your progress. A range of guidance and support is available to encourage your rehabilitation while protecting patients. Read more in our section on the supervision and monitoring process. You can view our case studies to see typical outcomes for doctors with health conditions going through our fitness to practise procedures. And you can hear from a doctor who has overcome serious health concerns and returned to work in the doctors experiences section. 3

4 Managing your health Taking care of your patient is the first duty of every doctor, but please do not forget how important your own health and well-being are. We appreciate that it is not always as easy as it sounds and that you may need some help this page provides advice and links to a range of support services. Below is advice on managing your health. In our Resources section you can find contact details for a range of organisations which support doctors with health concerns. Advice and contact details also appear in our leaflet Your Health Matters (pdf) which you can download here. 4

5 Advice on staying well/managing your health The following tips are to help you to manage safely any health problems you may have as a doctor. Make sure you are registered with a GP Trust your GP to give you confidential help Do not be reluctant to seek help early when you are unwell Avoid corridor consultations with colleagues. If you think you need to consult a doctor, then do so, in privacy Other than for minor ailments, avoid self diagnosis and management. Treat yourself as you would expect a patient with the same condition to be treated and have a confidential consultation with a trusted health professional. Note early warning signs of illness and take them seriously. For example, feeling low or irritable, or having poor concentration and low energy may be signs of burnout If you are worried about your drinking or someone close to you has raised concerns, then the chances are you are drinking too much. Get help before your drinking gets out of control. Be sensitive to the needs of your colleagues and encourage them to seek help if you are concerned about their health. Try to maintain a healthy work/life balance. If you develop problems it may help to try sharing them with friends, colleagues and family. 5

6 Health assessment About health assessments If you are referred to the GMC because someone believes your health may be putting patient safety at risk or you come to us yourself - we may ask you to have a health assessment. A health assessment is one part of a wider investigation into your fitness to practise and will help us to understand any health concerns before considering what, if any, measures will be needed to protect patients. The assessment will involve an examination of your physical or mental health by two doctors selected by the GMC. The doctors carrying out the examination will prepare a report covering: a diagnosis using an internationally recognised classification system (ICD10 or DSM4). whether you are fit to practise either generally, on a limited basis, or not at all. any recommendations about the management of your case. Recommendations may include allocating a medical supervisor to report on your progress or attending a support group to deal with substance misuse. Some doctors refuse to have their health assessed or to cooperate with the assessment process. In these circumstances, the case is referred to a fitness to practise panel to consider whether the doctor's fitness to practise is affected and whether action is required to restrict the doctor s practice. Fitness to practise hearings are held at the Medical Practitioners Tribunal Service (MPTS). The MPTS is part of the GMC, but is operationally separate from the GMC s investigation function. International classification systems The World Health Organisation website contains the international statistical classification of diseases and related health problems, 10 th revision - known as ICD 10. 6

7 View ICD 10. (Link to DSM 4 is the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (APA) and includes all currently recognised mental health disorders. The next edition is being consulted on (DSM 5) and is scheduled to be released in 2012 or 13. View the online manual (link to Doctor to doctor FAQs on health assessments Learn more about health assessments from a doctor who conducts health assessments. See our doctor to doctor health assessments section. 7

8 Doctor to doctor health assessments Who will carry out my health assessment? You will be assessed by two health examiners nominated by the GMC. The majority of health concerns relate to mental health or addiction issues, therefore in these cases both examiners will be Consultant Psychiatrists. As a general psychiatrist who has acted as a health assessor for the GMC on several occasions, I have provided the answers below. The GMC will always check that the health examiner has not had any previous connection with you in a social, personal or professional context. If there is any possibility that you know each other, the examiner would not be asked to carry out the assessment. How much information will the health examiner be given about the reason for my referral? I will be given all relevant information received by the GMC, including a copy of the original complaint. Where does the assessment take place? I recognise that doctors will be anxious when arriving for an assessment and we try to be sensitive to this. The assessment usually takes place in the health examiner s normal place of work, which may be a hospital or community resource centre. I try to find somewhere that is discreet so that you don t have to sit in a waiting room where there may be people you know around. To protect your confidentiality I may try to see you outside clinic hours. Will there be a mental examination? The health examiner who is a general psychiatrist (in this case me) will take a case history which covers current symptoms, past history and previous episodes where relevant. I will also take a family and personal history including career, education, personal relationships, hobbies and interests, alcohol and substance misuse. If you are unwell at the time of the examination, we will usually try to get an idea of what you were like before you were unwell. 8

9 Sometimes there might be a mini mental state examination. The examiner will review objective and subjective signs when assessing mental state, and these will be recorded in the report. Will there be a physical examination? You will only have a basic physical examination. One of the examiners may take a blood or hair test to investigate any substances that you might be taking which could have an adverse impact on your health, such as drugs or alcohol. If a more detailed physical examination is required we will write to the GMC to suggest a referral to a specialist. Will you speak to people involved in my treatment? The GMC will request your consent for me to contact anybody else involved in your treatment. After the assessment I will contact your GP and any other treating doctor to discuss your health, your treatment including any medication, any results of relevant investigations and your progress generally. Do the two examiners discuss their findings with each other? No. The GMC asks for two reports which represent the independent views of two experts rather than an amalgamation of different opinions. However, they usually only need one set of blood tests, so we examiners may speak to each other to decide who will make the arrangements for testing. What diagnosis or conclusions should I expect? I will comment on whether or not I believe a doctor has a psychiatric diagnosis within the two international classification systems IC10 or DSM4. If you would like to know more about the classification systems please see the information at the foot of the page About health assessments. The GMC is also interested in any conditions which are in remission but have the potential for relapse. So there are some specific questions we will need to answer about you, for example if there is a mental disorder, how much does it impact on your functioning? Are there any fitness to practise concerns? Are you fit to practise at all? Are you fit to practise with supervision? Although the examiner will have to answer all of these questions, it may be that there are no concerns regarding your ability to practise medicine safely. 9

10 How do you ensure that my personal information is treated in confidence? The report is confidential and details are not disclosed to employers. The report may be used in any subsequent fitness to practise panel hearings but those parts of the hearing which relate to your health are held in private without press or public present. All information about your health is removed from the minutes which are published on the GMC s website and will not be disclosed to enquirers. If I disagree with the assessment can I get a second opinion/arrange my own assessment? You can get your own report and submit it as evidence to the GMC. The GMC will still commission two reports separately from any evidence you may have submitted. All the evidence will be considered before making a decision about your fitness to practise. 10

11 The people who will be involved If you are having health problems that mean we need to investigate your fitness to practise, a wide range of people will be involved in assessing, monitoring, reviewing and generally supporting your recovery. Click to read about these people and the part they play. Doctor himself Role Doctor who has been referred to GMC Description of role You may approach us yourself, or be referred to us if your employer or a member of the public expresses concerns about patient safety. In most criminal conviction cases, for example drink-driving, the police refer the doctor to the GMC. If you are referred to us, you have a duty as set out in Good Medical Practice, to engage and cooperate with our fitness to practise procedures. Health Assessment Role Health assessment team Description of role A member of the Health assessment team, called an Investigation Assistant, is responsible for organising the assessment. The Investigation Assistant will identify two health examiners to undertake the health assessment and let you know that they will be in touch. The Investigation Assistant will try to select health examiners located conveniently for you, but outside your current or previous place of work. The Investigation Assistant is also responsible for ensuring the health assessment is completed within a reasonable time-frame. 11

12 Health examiner You will be assessed by two health examiners. If the issues relate to an addiction or a mental health condition, they will be psychiatrists. In other cases the health examiners will be practitioners with relevant experience. The examination often includes a mini mental state exam. If the assessment is going to include a physical examination the examiner will tell you in advance so you know what to expect. Monitoring Role Case review team Description of role If restrictions are put on your practice such as conditions or undertakings, you will be involved with someone from the case review team. They coordinate and liaise with all parties, for example requesting workplace reports and updates from the medical supervisor. They will also tell you about arrangements for any future hearings. You can telephone the team at any time if there s an aspect of our procedures you don t understand. The case review team is based in our offices, and will maintain regular contact with you through telephone calls, letters and . 12

13 Other people who may be involved with the doctor as a mandatory part of their undertakings/conditions Role Medical supervisor Description of role The medical supervisor is a specialist who reports to us on your progress under treatment. They do not treat you themselves but, with your consent, they will receive information from those who are involved in your treatment, such as a GP or psychiatrist. A medical supervisor may also, where appropriate, directly contact occupational health or any medical practitioner involved in your treatment. You will be provided with copies of any letters sent between the medical supervisor and the people responsible for your care. The medical supervisor will submit reports to the GMC every three to six months. These reports help us to decide if undertakings or conditions are proving effective. They may also help explain to you what you need to do to comply with the standards set out in Good Medical Practice. The medical supervisor is accountable to the GMC for the quality and accuracy of their reports. Further information is provided in Monitoring and supervision process: Dr to Dr FAQs. Workplace reporter The workplace reporter is responsible for reporting on your performance at work. This is usually a senior manager or clinician with practical experience of your workplace. 13

14 They will speak to some of your colleagues to find out how you are getting on in terms of issues such as absenteeism, punctuality, and any other concerns or incidents. They will then complete a standard form which they will send to the GMC on a regular basis. You will be provided with a copy of all workplace reports. The GMC will not disclose any health related information to your workplace reporter, or employers, without your consent. Mentor GP/treating psychiatrist A mentor is someone who will provide you with guidance and confidential support. This can be wide-ranging, covering not just clinical work, but also professional relationships and career plans. The relationship between doctor and mentor is confidential and we do not therefore expect the mentor to provide reports. All we need to know is that a mentoring arrangement has been agreed. All conditions or undertakings will specify that you must be registered with a GP. You may also be required to place yourself under the care of a treating psychiatrist. As for any patient, you make your own arrangements to obtain a GP or treating psychiatrist and are expected to listen to and comply with the advice they give you. 14

15 Agreements If we investigate and believe your health is affecting patient safety, we will usually offer you the chance to agree undertakings. These are a voluntary agreement between you and the GMC about your future practice. Examples of undertakings for mental health difficulties may include agreeing to be treated by a psychiatrist (if clinically indicated), or to limit the number of hours you work. Examples of undertakings for substance misuse issues may include agreeing to attend a support network or agreeing to unannounced testing. When to agree undertakings Undertakings can usually be agreed at an early stage in the process, after we have undertaken an investigation and received two health assessment reports. Doing so can help to minimise the stress for everyone involved in the case, and make the process much quicker. If you agree undertakings there will be no need for a hearing to resolve those concerns or for witnesses to give evidence. Before you decide to agree undertakings you may wish to contact your defence organisation or legal representative. Our priority is patient safety and, where possible, we prefer to put arrangements in place that protect the public through mutual cooperation. However, if we cannot come to an agreement with you about what needs to be done to protect patients, your case will be referred to a fitness to practise panel. Depending on the circumstances, it may be possible to agree to undertakings during the hearing. If undertakings are breached As undertakings are an agreement they depend on cooperation. 15

16 Unfortunately on occasions where undertakings are breached, the case may be referred to a fitness to practise hearing. About fitness to practise panels Fitness to practise hearings are held at the Medical Practitioners Tribunal Service (MPTS). The MPTS is part of the GMC, but is operationally separate from the GMC s investigation function. The panels have a range of powers to put arrangements in place to protect the public. These include limiting a doctor s registration (these are called conditions, which work in a similar way to undertakings but are not voluntary). This is more common where there are a number of concerns, some of which do not relate to health. 16

17 Case studies You can use these case studies to see typical outcomes for doctors with different health conditions going through our fitness to practise procedures. Silhouette of doctor A This doctor was convicted for drink driving. The doctor was dependent on alcohol following long term heavy drinking, worsening after problems at home. Silhouette of doctor B This doctor, suffering from bi-polar disorder, was referred to the GMC by his employer, after concerns about his interactions with patients and self prescribing. Silhouette of doctor C This doctor was cautioned for possession of Class B drugs and colleagues noticed he had been performing less well recently. Silhouette of doctor D Doctor D referred himself to the GMC after he was diagnosed with diabetes. Silhouette of doctor E A colleague found this doctor injecting opiates in the hospital toilets. He refused to co-operate with our investigation. Doctor A alcohol problems Doctor A was referred to the GMC after being convicted of drink driving. She was referred to the GMC by the police and had a health assessment as part of the GMC s investigation process. This revealed serious alcohol addiction issues. 17

18 Further investigation revealed that Doctor A had been having domestic problems which led to her increasing her alcohol intake. During a difficult time for her personally, she drove when over the limit. Dr A recognised that she had a problem and agreed to undertakings, which allowed her to continue working and which included a commitment to abstain completely from alcohol and comply with unannounced breath testing. (A medical supervisor will routinely undertake tests during scheduled meetings but sometimes the GMC commissions a private agent to collect samples for analysis at short notice. If a doctor is working this may be conducted by Occupational Health.) She was also required to provide proof of attendance at a support group (Alcoholics Anonymous will provide proof of attendance if asked). After two years, her case was reviewed and it was found that she was fit to practise medicine again without restriction. The undertakings were removed and she returned to unrestricted practice. Doctor B mental health problems Doctor B was referred to the GMC by his employer after concerns that he was inappropriate in his dealings with patients and colleagues and late to work. On one occasion which led to the GMC becoming involved, the doctor shouted at a patient during a consultation and walked out without telling anyone, leaving the distressed patient unaccompanied in the surgery. The doctor had a health assessment and was found to be suffering from bipolar disorder. Decision makers reviewed the report which was produced by the health examiners and found that the doctor had some insight into his health issue. They decided to ask the doctor if he was willing to voluntarily agree to the restrictions on his registration that we felt were necessary to protect the public. The GMC drafted a voluntary agreement (undertakings) for the doctor to consider with his solicitor. After a short period of reflection, the doctor agreed. This meant that he was able to continue working, provided that he 18

19 remained under the care of a treating psychiatrist, took prescribed medication and refrained from self-prescribing. He also agreed to keep his professional commitments under review in accordance with advice from his medical supervisor, and to cease work immediately if advised to do so. Six months later, at a review meeting, the medical supervisor reported that he had heard from the treating psychiatrist that Doctor B was responding well to treatment, and the restrictions on his practice were reduced so that he could take on additional work. Doctor C minor drug problems Doctor C was referred to the GMC after receiving a police caution for possession of class B drugs. During the GMC s investigation it emerged that she occasionally took class B drugs in the evening, then attended work the next day. Colleagues had noticed deterioration in her performance. A health assessment found she was suffering from depression. Because the case involved serious conduct issues (possession and use of an illegal drug) as well as health concerns, the case was referred to a fitness to practise hearing, where conditions were imposed on the doctor s registration. Fitness to practise hearings are held at the Medical Practitioners Tribunal Service (MPTS). The MPTS is part of the GMC, but is operationally separate from the GMC s investigation function. Confidential information relating to the doctor s health was removed from the published public minutes of the hearing. The conditions imposed on Doctor C s registration included a requirement to remain abstinent from illegal drugs, to comply with unannounced testing and to work under the supervision of a consultant/senior colleague. She was also required to attend a support group. It was made clear that any breach of conditions, for example possession of prohibited drugs, may result in an immediate referral back to a fitness to practise hearing. The medical supervisor took into account the views of the doctor and her family, her workplace reporter, GP and a representative from the support group she attended and was satisfied that she had complied fully with the conditions over a two year period. Based on this information, he 19

20 recommended to the review panel that the doctor was fit to return to unrestricted practice. Doctor D diabetes Doctor D referred himself to the GMC after he was diagnosed with diabetes. The doctor was following the advice of his GP on how best to manage his condition. He was also receiving effective support from the occupational health department at his place of work. The GMC decided that there were no concerns about the doctor s ability to practise medicine safely so there was no need for us to take action to protect the public. Doctor E Serious substance misuse Doctor E was referred to the GMC when a colleague reported that she found him injecting opiates in the hospital toilets at the end of his shift. Doctor E had a health assessment and was found to be suffering from opioid dependency. Decision makers at the GMC decided to explore whether the doctor would agree to voluntary undertakings which included complete abstinence from the use of opiates, remaining under the care of a treating psychiatrist, compliance with unannounced testing and attending a support group. During discussions, the doctor rejected the findings of the health assessment and denied the allegations in relation to the incident. In view of this, a voluntary arrangement was not possible and the case was referred for a fitness to practise hearing to establish the evidence in relation to the allegations. Fitness to practise hearings are held at the Medical Practitioners Tribunal Service (MPTS). The MPTS is part of the GMC, but is operationally separate from the GMC s investigation function. Doctor E continued to refuse to co-operate with the GMC s investigation. Shortly after the case was referred for a hearing, a further incident was reported that the doctor had to be sent home as he had appeared intoxicated 20

21 and disorientated during a clinic. In view of the risk to patients, the case was referred to an Interim Orders Panel who suspended the doctor during the course of the investigation. By the time the case came to a hearing, the doctor had still not complied with a health assessment and had been reported by a pharmacist for selfprescribing of opiates. In view of the doctor s serious lack of insight into the concerns about his health and the potential risk to patients, the Fitness to Practise Panel suspended him. 21

22 Monitoring and supervision process About the monitoring and supervision process If you agree to undertakings you will be contacted by someone in our case review team. They co-ordinate and liaise with all parties involved in implementing the agreement. You can telephone or them at any time if there is any aspect of our procedures you don t understand. As part of your undertakings, you will also be given a medical supervisor. The medical supervisor is a specialist who reports to the GMC on your progress under treatment and provides a supportive environment. The same arrangements will also be put in place where conditions are placed on a doctor s registration. If you would like to find out more about what it is like to undergo medical supervision, please see our section on doctor-to-doctor FAQs. For more information about the role of our case review team and medical supervisors please see the section on people who will be involved. 22

23 Medical supervisor: Doctor to Doctor What is your role as medical supervisor? As a medical supervisor, I will monitor your progress and keep the GMC updated about it. I will form an opinion on your health, and the progress that you are making under treatment, based on my observations and discussions with your doctor(s) and others. These discussions will include details of any improvements in your health, your current treatment, your prognosis and results of any testing carried out by your doctor or at your workplace. In addition I will seek input from your employer or workplace where possible in order to form a view on your current practice and whether the restrictions placed on your registration are working. This helps me to produce periodic reports for the GMC about your progress, treatment and employment issues. My primary responsibility is to the GMC to generate these reports. I am also responsible for letting the GMC know about any significant problems and/or breaches of undertakings or conditions. What qualifies you for this role? Most supervisors are consultant psychiatrists who have had experience in working with general psychiatry. They may also have specialist experience of forensic psychiatry, occupational health or addictions. In addition I receive training and regular updates from the GMC on matters of policy and new developments. What happens at the first supervision meeting? The first meeting is quite structured and begins with an introduction to the role of the supervisor and the background to your case. We then usually talk through each of the conditions or undertakings and make sure the doctor understands what is expected of them. We also discuss any treatment and workplace concerns. Finally, we will discuss confidentiality issues. 23

24 If substance misuse or dependency is one of the problems the doctor is being treated for, then they may be monitored through toxicology (eg blood, urine or hair tests) in any of their supervision sessions. How often will meetings take place? It depends on your particular health concerns and how you are progressing. It also depends on how aware you are of your health problems and the impact these may have on patient safety. I will stay in contact with you regularly by telephone or and a face-toface meeting at least every couple of months. As you recover, we may discuss appropriate changes to any undertakings or conditions. However, the decision on whether to change your restrictions lies with the GMC and not with me. Can you describe my relationship with you as my supervisor? Whilst my primary responsibility is to advise the GMC on your fitness to practise in the context of your illness, I will also try to support you in your return to, or remaining in, work. I will offer advice about your medical practice and act as a go between for you and your employer if this is helpful. Our relationship is based around regular meetings. Over time I aim to establish a bond of trust between us as your health improves and to provide support tailored to your needs as they change. Can you provide me with treatment? I cannot treat you myself but I can offer support and advice and put you in touch with others who can. What kind of guidance can you give? 24

25 I support and encourage the doctors I work with through their recovery and advise them about the importance of complying with their undertakings or conditions. I can also point you to support groups, facilitate contact with deaneries and medical directors and advise you on any return to work issues. I also help doctors understand the GMC and its procedures. How will you assess whether or not I am making progress? I consider a number of sources of information when assessing how a doctor is progressing. One of these is to ask you how you view your own progress and health. Workplace reports are submitted by doctors and by your workplace reporter. I will also look at feedback from a treating psychiatrist or GP and the results of any tests agreed with a doctor in relation to substance issues. Finally, views of any family members, a partner or others (for example the Doctors and Dentists Group or other support group) that you have agreed to be involved can also be taken into account. Will you be involved in liaising with my employers? I may discuss your progress with your workplace reporter, but details of your health condition will not be discussed without your consent. I may, however, discuss how many hours you should work, your on-call responsibilities, and so on. I would normally also discuss any adjustments that need to be made with you, occupational health and your treating doctors. What information will you need from my workplace? I will agree a main point of contact with your employers, which is usually your workplace reporter. The feedback they give me may include reports about your performance at work including communication and interaction with colleagues and patients, any complaints, sickness absence or other concerns. 25

26 If there are any significant concerns raised then I would normally arrange a meeting or phone call with you. What information will you need from the people involved in my treatment? I will need to confirm that you have attended any planned appointments, continued remission and stability, and any changes in your medication or treatment. I will discuss with them any triggers which may have affected your stability, the results of any monitoring arrangements, and your care plan. We will also be assessing your understanding of your health condition. How will you take into account any views that I have about my treatment? A doctor s own account of their health and views about their treatment are very important. This discussion allows you to demonstrate that you understand your condition and the support network and other plans that have been put in place to maintain remission and prevent relapse. During each meeting, I will ask you about your condition, your compliance with treatment and your insight into it. What information do you share with the GMC? The GMC requests a progress report every three to six months. There is a standard format for the report which asks for an update on your progress in relation to health, employment, compliance with conditions/undertakings, impairment and to give an opinion on your fitness to continue to practise and any changes to undertakings that might be appropriate. Tests results will be copied to the GMC. A copy of each progress report will be provided to you, and there is an opportunity for you to discuss this with your medical supervisor. 26

27 What measures do you take to protect my privacy? Information about your health, including any relevant undertakings or conditions which relate solely to health is strictly confidential. This means that information about your health will not be disclosed to anyone without your consent and will not be disclosed to your employer, workplace supervisor or responsible officer. Only undertakings or conditions which relate to your practice will be published on the GMC s website and disclosed to enquirers. If you have any concerns regarding your privacy and confidentiality, you should tell me (your medical supervisor). What will you do if I am not making progress? Any concern about progress will be discussed with you in the first instance by the person who has raised the issue. If the concerns are not serious, then your medical supervisor will ask those involved in your treatment to review the care plan. If there was a significant crisis, such as sudden and severe deterioration in your health it is likely that I will ask you to stop work until the situation is reviewed. What do you expect from me? At the start of the process I will agree with you a monitoring plan for your conditions or undertakings. You are expected to follow this plan and report any concerns to your supervisor. If any issue arises regarding a relapse of health, change of employment or any new complaints or concerns, you are expected to be proactive in contacting me at the earliest opportunity, outside planned appointments if necessary. You should remain contactable and provide any changes of address, phone numbers and other contact details to me. 27

28 Doctors experiences In this section a real doctor writes about how health concerns affected his working life, talking frankly about the difficulties he experienced and the support he received. Doctor s story A doctor who was referred to a GMC fitness to practise panel hearing after a struggle with drink and drug addiction talks about his road to recovery. I first came to the notice of the GMC in March 2003, when I referred myself, having crashed my car while under the influence of alcohol. It was also discovered, from a random urine test, that I had been taking opiate based analgesics. I did not have to appear before a fitness to practise panel at that time, but was asked to agree to a list of undertakings. These included absolute abstention from drinking alcohol and self medication including over the counter medicines containing opiates. Amongst my list of undertakings was an agreement to provide specimens of breath, urine, blood and hair, whenever required, for testing. I managed to achieve white knuckle abstention from alcohol, but did not embark on any treatment for my addictive illness (at that time, I did not recognise that I had an illness, and thought like everyone else it seemed, that I must simply be weak, wicked and wilful). I thought that my drug taking was secondary to my alcohol dependence. I used opiates to treat the unpleasant symptoms of alcohol withdrawal. My attitude to life did not change, and I began to take codeine again, this time as a substitute for alcohol, to make myself feel better. I began to write myself prescriptions using patient names and I very quickly became hopelessly addicted to codeine. Road to recovery When this was discovered I went into a residential treatment centre for health care professionals in Derbyshire; Birdsgrove House (now sadly closed) 28

29 where I underwent detox and began on the road to recovery from my addiction. My case was referred to a fitness to practise panel in summer 2004 and that began a five year involvement with the GMC s fitness to practise procedures. Throughout the process I was supported by a medico-legal expert and solicitor appointed by the Medical Protection Society whose professional and non judgmental advice made this as humane as possible. I was also supported by my mentor, a retired GP, who had previous experience of Local Medical Committee and GMC procedures involving doctors with health problems including alcohol and drug dependence. He provided regular, weekly meetings at a time when it appeared that no one else was willing to talk to me and which in retrospect kept up my morale when at times I felt that all was hopeless. Respect The GMC treated me, throughout, fairly and with respect. For some reason I was not expecting this and thought that I would be looked upon as a criminal. I found this attitude extremely reassuring. Conditions were imposed upon my practice and, subject to these, I was allowed to continue to work, safely, as a GP. Unfortunately my PCT decided to suspend me from their Performers List and I subsequently lost my job as a principal in General Practice. It was to be about 18 months before I would work again. It was quite possible that I would never be able to resume earning a living and supporting my family by practising my profession. This is an aspect of the process which undoubtedly causes the greatest distress to doctors who find themselves in a position similar to mine. Compassion and commitment I count myself extremely fortunate in having good local supportive surveillance from my GMC supervisor, a consultant psychiatrist from the regional Drug and Alcohol Unit. She managed to combine her strict GMC surveillance role with compassion and careful advice (often looking beyond 29

30 my professional life into relevant pastoral areas). This proved to be an exceptionally important factor in my professional and personal recovery and rehabilitation. The GMC fitness to practise procedures are time consuming, involving a huge commitment from GMC staff, panel members and specialist advisors. I honestly regret the cost and trouble that I have been responsible for through my dealings with the GMC, but if one of the aims is to return safe and healthy doctors to appropriate medical practice, thus avoiding the waste of invaluable training, experience and talent, then economically and humanely, it is enormously important and worthwhile. Sustained recovery I am now enjoying a sustained recovery from my addictive illness. Following advice and support from the Deanery and a three month period of supervised practice in a sympathetic training practice, coupled with on-going voluntary professional mentoring, I returned to GP locum work in This has led to a permanent part-time salaried partnership in the same practice in which I underwent my period of supervised practice, which I have enjoyed for the last three years. I have also trained as a GP mentor and I am involved in running a charitable support group for doctors and dentists with alcohol issues. In June 2009, I received a letter from my investigating officer at the GMC informing me that the conditions placed on my registration had been removed and that further GMC supervision would cease. I have come a long way since being called in front of the GMC seven years ago and my life, both personally and professionally, has never been happier or more fulfilling. The GMC process (which is not something that I would wish to repeat!) drove my early recovery from my addictive illness, but I continue to pursue recovery because I love the way I now feel and the quality of my new life. Support I have been extremely lucky to find sympathetic and non-judgmental colleagues who have helped me regain my feet and get back to work in a job 30

31 that I love. I am also extremely indebted to my wife and family, who I have dragged through all of this, and who also suffered in the wake of my active illness, and who have stuck by me. Contact us Phone: gmc@gmc-uk.org Organisations which can help you If you need to talk about your health, the following organisations support doctors in difficulty in the UK. Association of Anaesthetists of Great Britain and Ireland Contact from members about any health and well-being issue is welcomed. wellbeing@aagbi.org Website: Telephone: British Doctors and Dentists Group Website: Telephone: British Medical Association In times of difficulty or distress call 24/7: BMA Counselling and Doctor Adviser Service Telephone: Website: British International Doctors Association Address: ODA House, 316A Buxton Road, Great Moor, Stockport, SK2 7DD. Telephone:

32 Doctors' Support Network Peer support group for doctors with a wide range of mental health problems. info@dsn.org.uk Website: Telephone: Doctors Support Line Helpline dealing with any problem from career and family to mental health problems. Staffed by doctors and fully confidential. Telephone: The Medical Defence Union (MDU) Ireland advisory@the-mdu.com The Medical and Dental Defence Union of Scotland (MDDUS) advice@mddus.com The Medical Protection Society (MPS) querydoc@mps.org.uk Medical Royal Colleges Medical Royal Colleges may have their own support services for members - check the College websites for details. NHS Practitioner health programme Free and confidential services for doctors with a mental health, addiction or physical health problem affecting their work. Patients outside London area will be dealt with on a case by case basis and maybe required to seek 32

33 funding for inpatient or specialist case if required. Website: Telephone: Primary Care Support Service The Primary Care Support Service is a direct access, confidential counselling, support and educational service for GPs (doctors), general dental practitioners and community pharmacists working in Wales. It is funded by the Welsh Assembly Government but is run as an independent service with co-ordinator input in each of the three Welsh regions. pcssinformation@wales.nhs.uk Phone : Psychiatrists' Support Service A free, confidential support and advice service for members, trainee members and associates of the Royal College of Psychiatrists who find themselves in difficulty. psychiatristssupportservice@rpsych.ac.uk Telephone: Royal Medical Benevolent Fund RMBF offers support to members of the medical profession and their dependants who, through illness or misfortune, find themselves in financial hardship. The website also provides a wide range of other sources of help and support. enquiries@rmbf.org Website: Telephone: Fax: Royal Medical Foundation The Royal Medical Foundation exists to support doctors and their dependants who find themselves in financial hardship. caseworker@royalmedicalfoundation.org Telephone:

34 Fax: Samaritans Confidential emotional support 24 hours a day. jo@samaritans.org Website: Telephone: Sick Doctors Trust 24 hour confidential telephone helpline for doctors with drug and alcohol problems. Website: Telephone: