Medicolegal aspects of working while unwellBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6721 (Published 10 December 2015) Cite this as: BMJ 2015;351:h6721
Many doctors continue to work when they are not feeling their best and take pride in the fact that in doing so they avoid letting down patients and colleagues. But those who do so when they are seriously unwell can put patients at risk of harm and may further damage their own health and career.
A doctor’s ill health can have a negative effect on performance and team functioning. Concentration and decision making ability may be diminished, increasing the risk of adverse incidents. Doctors can often underestimate the anxiety that their illness will cause them or the impact it will have on their relationships with patients and colleagues. The first sign of an underlying health problem might be an increase in complaints or reports of difficulties at work.
The General Medical Council says in its guidance Good Medical Practice that doctors need to protect their patients and colleagues from any risk posed by their illness. “If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgment or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague,” the guidance states. “You must follow their advice about any changes to your practice they consider necessary,” it continues.
The GMC guidance is clear that doctors must not rely on their own assessment of the risk to patients. It may be tempting for doctors to do so, especially when they regularly advise patients on whether or not they are fit to work, and it may also seem easy to consult a colleague or medical family member or friend. However, the decision about whether or not a doctor with a serious medical condition is fit to work is one that needs independent and objective advice. “You should be registered with a general practitioner outside your family,” the GMC says.
Doctors are entitled to have information about them kept in confidence by their treating doctors. But they must be aware that those doctors have their own professional obligation to protect patients and may need to disclose relevant information to an appropriate person if they are concerned that others may be at risk of serious harm. This may arise if, for example, a doctor continues to work despite being advised not to do so.
Doctors should also be aware that they must let the GMC know if they have a health condition, or a problem with alcohol or drugs, that may affect their ability to care for their patients. The GMC will need to consider whether any steps need to be taken to protect patients, so doctors in this situation should seek advice from their defence organisation at the earliest opportunity.
Cite this as: BMJ 2015;351:h6721
Competing interests: I have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.
● See also on careers.bmj.com Why doctors don’t take sick leave (http://careers.bmj.com/careers/advice/Why_doctors_don%E2%80%99t_take_sick_leave); Why doctors need to resist “presenteeism” (http://careers.bmj.com/careers/advice/Why_doctors_need_to_resist_%E2%80%9Cpresenteeism%E2%80%9D)