Wednesday, 31 August 2011

Sick Doctors

In June this year an article published in the British Medical Journal reported that in a period of four weeks a third of doctors and nurses have worked when they should have taken sick leave. The authors claimed that, on average, working when sick “nearly halves their working capacity”.
The e-link to an abstract of this article can be found Here
I believe that many of those working in the National Health Service will readily identify with this state of affairs. Why do doctors and nurses do this?
My own experience as a general practitioner is that there is, first and foremost, a desire "not to let the side down" and, of course, a reluctance to inconvenience their patients - or even to attract complaints. For more than once, when I have seen patients of behalf of a sick colleague their comments have been less than sympathetic.
I have myself been fortunate with my health. In more than 40 years of practice I think I have taken no more than seven days off sick. But that is not to say that for considerably more than that I worked when I was feeling more or less wretched. And I saw my colleagues doing the same. Of course, were they having to go to the toilet to vomit between consultations - yes, that has happened - they have been sent home quickly enough. And usually another colleague was called in from her or his half day off to see the abandoned patients.
It may not generally be known that NHS GPs are expected to arrange their own cover for their own absence - be it for sickness, bereavement or any other cause.
But perhaps most concerning is that the doctor who is ill, stressed or grieving is a potentially dangerous doctor. Nevertheless, serious medical errors as a consequence of these episodes are thankfully rare. Yet if they happen, the unfortunate doctor can expect to have the book thrown at him by the General Medical Council (the doctors' professional regulator) and may even be successfully sued. Being unfit for practice for reason of illness, stress, bereavement or fatigue is not considered a mitigating factor.
The General Medical Council (GMC) and successive governments have been at pains to address concerns about "patient safety" and in particular when it is a consequence of a doctor not coming up to the mark, for whatever reason. They have seen the way forward to be the introduction of revalidation, or reaccredidation for doctors at 5 yearly intervals. It is anticipated that this may identify in the region of 2% of doctors who may present a risk to patients.
What I would propose, however, is that doctors attempting to work fatigue and short term illness present a far greater risk to patients than any of the factors that may - or may not - be identified by the revalidation process. Yet this far greater cause for concern has attracted scant attention from those who purport to have the interests of patients at heart. The views of the GMC and the politicians remains that the consequences remain the responsibility of the individual doctor. The sick doctor who makes a mistake can expect not support from them, but censure.

Reference: Dew K, Pressure to work through periods of short term sickness. BMJ 2011;343:218-219 d3446

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