What if a consultant pathologist, working largely single handedly and responsible for reading all the specialised histological slides in a large group of hospitals, had manic depression and was prone to periodic bouts of mania that made him skim through large numbers of slides with only cursory scrutiny of them? Who would recognise that there was a problem? What action would be taken? Where would he be treated? When would the decision be taken that it was safe to allow him to return to work? Should there be continuing supervision, and how should it be organised?

This hypothetical example shows only some of the complex questions posed when doctors become ill or are known to be at risk of illness. Many perspectives can be adopted when the phenomenon of the sick doctor is considered: the need to protect patients, the duty of other doctors to report problems, the responsibility of a good employer to care for its staff, the legitimacy given to some types of chronic illness (for example, rheumatoid arthritis) and not to others (for example, drug and alcohol misuse), and whether doctors should be regarded as special cases or just like other employees.

It has long been recognised that doctors, as an occupational group, experience excess mortality from some causes, particularly suicide and self injury, poisoning, and cirrhosis of the liver.1 Reviews of morbidity among doctors have suggested a relatively high occurrence of psychiatric and stress related disorders as well as drug and alcohol misuse.2, 3

A study carried out under the auspices of the Nuffield Provincial Hospitals Trust set out to explore perceptions of and attitudes to sick doctors as well as the provision of services for them in eight health service localities (p 561). …