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Managing doctor's health at work

The following is a quote from the Doctors Support Network newsletter March 2004

Appraisal forms may request a signed declaration that the doctor being appraised has no health ongoing problems. This question exposes the GMC?s muddled thinking about health, conduct and performance. Health is distinct from conduct and performance.

An appraiser appraises. S/he is not acting as a general practitioner, nor as an occupational health physician, so it is not
in their remit to decide fitness to work.

Medical confidentiality applies to doctors as well as patients.

Discussing health matters with supervisors, colleagues and appraisers is inappropriate and ill advised. The agreed answer (and that suggested by the GMC helpline) is that if you are able to work, then you do not have health concerns.

 

This distinction becomes easier to understand looking at a relatively simple physical example.

Imagine a GP with an extreme case of athletes foot.  This would not affect their conduct or performance even if they hobble a bit and they could put in a coil just as readily as the next doctor. If assessed by an occupational health team this doctor would be pronounced fit for work.

 

The problem becomes more complex when filling in application forms.

The guidance on these is even less clear - although lying on any form is not to be advised as it is likely to be found out at some point. However, if you have a health problem that will affect your ability to do the work - for example mild contact dermatitis and are applying for a surgical post then although you feel it may prejudice your chance of getting the post it seems it is essential to put this information down on the form. Yet people do get mild eczema from time to time so at what point does one put the skin trouble down to a minor self limiting illness and thus not add it onto a form (you wouldn't put you had a bad cold down) and at what point might this turn into an occupational disease that could seriously affect your ability to do the job. Clearly it is a matter of degree and as doctors are held to be responsible members of society they must to a certain extent weigh up the relative importance for themselves.

Career guidance may have an important role to play here as any surgeon experiencing significant contact dermatitis related to latex or skin cleaning preparations may need at some point to start exploring alternative career options. This approach - even if a change is never needed -  can perhaps also assist in reducing the anxiety provoked by a health problem threatening ones whole livelihood (which in turn might make the condition worse).

At Medical Forum we feel a job selection process should generally happen without reference to age, gender, race, sexual orientation or health. If a person is found to be suitable for the post at interview - the next phase is for occupational health to assess whether that person has any health issues that could prevent them from carrying out the tasks of the job. If the person is disabled or limited by their health problem for example - then there are statutory requirements of employers with more than a certain number of staff to make reasonable amendments to the post. Clearly if the job requires scrubbing up ten times a day with chemicals that exacerbate a dermatitis such amendments are not reasonable and perhaps the job offer should be withdrawn.

The whole thing gets considerably more complex where mental health is concerned. The GMC takes one view, the DSN (representing doctors who have had or are experiencing mental ill health) takes another and doubtless occupational health would take another. There are many interested parties where doctors with ill health are concerned and quite rightly so - but the pendulum seems to have swung almost completely against the doctor. Once again it is a matter of degree. Would we expect a doctor to put down on a form that they were experiencing undiagnosed mild reactive depression or that they were self treating with St John's Wort available OTC as a result of a recent divorce.

However for someone who had been sectioned due to suicide risk in the recent past it might seem different. Yet once again if that person is now assessed by occupational health as fit to work - why should the private and personal life event of illness be hung out to dry on a washing line and perhaps prejudice that doctors chance of resuming their career. Yes - occupational health should be made aware of this episode once the doctor is appointed as some extra monitoring of the person might be indicated and some intervention of OH in the doctors training or workload might be appropriate if signs of strain arise. But sharing of private information between OH and bosses or colleagues is probably illegal.

These issues are a mix between ethical, performance and employment law precedents and as such we don't feel qualified at Medical Forum to give concrete guidance. However if you feel your health is not being handled confidentially or fairly at work then some discussion with an employment law expert or industrial relations officer (eg BMA) might be helpful.