The dilemma
A stressed and anxious foundation doctor was increasingly resorting to several glasses of wine to help her unwind and get to sleep after shifts, although she’d noticed this was starting to affect her performance.
One day, the doctor was asked to prescribe some antibiotics to an elderly inpatient on a general medical ward who had a skin infection at a cannula site. After quickly scanning the drug chart, she wrote a prescription for flucloxacillin. However, before the first dose was administered, a nurse intervened to say the patient was allergic to penicillin.
The doctor was horrified that she hadn’t checked whether the patient had an allergy to penicillin as she would usually have done. She felt the near miss was the result of poor decision-making on her part, as much as information not being logged prominently enough on the drug chart.
Although the patient was unharmed, the doctor was alarmed that her fatigue and drinking had almost led to a dangerous mistake and called the MDU advice line.
MDU advice
The medico-legal adviser warned the doctor not to continue self-medicating and seek immediate help from her GP or occupational health for her stress and drinking. They also suggested the doctor talk to her educational supervisor about her mental health struggles so they could signpost her to local support services.
The doctor shared her fear that her employer might report her to the GMC if she sought help from occupational health. The adviser reassured her this was unlikely and even if it happened, the GMC would usually organise health assessments then ask the doctor to agree 'undertakings' that would include staying under appropriate care. The GMC does not expect doctors to self-refer for health reasons unless there is a risk to patients, and cannot remove a doctor from the register where a concern solely relates to their health.
What is a health assessment?
Health assessments are part of the GMC’s fitness to practise investigations. GMC-appointed assessors are doctors who establish a diagnosis for the doctor’s health condition and provide an opinion about whether the doctor is fit to practise or whether a restriction on practice is recommended.
What are undertakings?
Undertakings are an agreement between the GMC and a doctor about their future practice. Undertakings are offered when the GMC has reason to believe the measures are needed (for a certain period) to protect patients, the public and the doctor. A doctor might agree undertakings, for example, to stay abstinent, to remain under the care of a treating doctor and to allow information sharing about their health.
Here to help
Don’t forget, if you’re contacted by the GMC about health assessments, you can contact your MDO for support.
As well as consulting her GP about her stress, the doctor confided in her educational supervisor, who directed her to a mental health support service for trainee doctors, where she was able to access CBT and peer support to help address her anxiety, rather than turning to alcohol. She also wrote a reflective piece on the incident, explaining how it had motivated her to change her behaviour.
The educational supervisor was satisfied the doctor had shown insight into her behaviour and was seeking help and so presented no risk to patients. As a result, she was allowed to continue her training and it was not thought necessary to involve the GMC.
Take home messages
- Register with a GP in your local area.
- Seek advice early if you have physical or mental health concerns – speak to your GP, educational supervisor or use the resources below.
- Don't self-medicate to alleviate feelings such as exhaustion or anxiety.
- Consult a healthcare professional if your judgement or performance might be impaired by illness (or treatment) – don’t rely on your own assessment of risk to patients.
Additional resources
Taking care of your wellbeing after medical school
Health and wellbeing during the coronavirus outbreak
Health and wellbeing for foundation doctors
The NHS Practitioner Health Programme
Support for doctors
Dr Catherine Wills
Medico-legal adviser
Dr Catherine Wills
Medico-legal adviser
MA(Oxon) MB BS LLM FRCP MFFLM
Catherine joined the MDU in 2004 and is deputy head of the advisory department. Previously, Catherine was a hospital consultant in general medicine, diabetes and endocrinology.
See more by Dr Catherine Wills