Colleagues in difficulty

Healthcare practitioners are not immune to the mental health issues that face many Australians. A cocktail of long working hours and high-pressure situations means healthcare practitioners can potentially be more at risk of experiencing mental health issues.  So how would you handle the challenge of dealing with a colleague in difficulty? Workplace pressures cannot be ignored and there are many signs that can help you recognise if a colleague is experiencing issues that may affect their professional lives.

Some common things to look out for are:

  • Consistent tardiness or often working long hours
  • Skipping lunch breaks
  • Frequently calling in ‘sick’
  • 'Grapevine’ rumours from other staff 
  • History of unwell relatives/recent bereavements/divorce
  • Unrealistic work load – may reflect financial pressure
  • Looking tired and/or untidy
  • Often appearing hungover
  • Any clear shifts in behaviour
  • Changes in mood/disposition eg angry, irritable, emotional
  • Social withdrawal/avoiding social gatherings
  • Changes in work habits 

Issues of incompetence

If you are a supervisor, you have an obligation to raise these issues in the interests of patient and public safety. Workplace performance review and constructive feedback may be necessary to ensure any major issues are addressed in a professional and timely manner.

Remember:

  • If intervention is carried out appropriately and actions managed reasonably, this is not bullying.
  • Personality clashes have the potential to cause workplace conflicts, but if the supervisor remains professional, acts reasonably and focusses on improved competence this is not bullying.
  • Always offer assistance and resources at these difficult times.

Possible course of action

  • Approach the practitioner and ask, ‘Are you okay?’
  • You may need to be respectfully persistent if response is not consistent with observed behaviour
  • Encourage the colleague to seek advice from:
    • Their supervisor/senior colleagues
    • Their GP – ask if they have one
    • Hospital Employee Assistance Program (EAP)
    • MIPS clinico-legal advisers
    • MIPS My Wellness online portal
    • AMA - members have access to the AMA’s Peer Support Service
    • Their ’local’ Doctors Health Advisory Program
    • A range of mutual help organisations
  • If a colleague is senior and unapproachable, speak to someone senior or contact MIPS regarding your concerns 

Self-reporting

In the first instance, MIPS recommends that where there are significant and/or persistent/ long standing and material issues that members  self-report to AHPRA, so they can get in first where possible. You will still need to report, but boards generally consider that a self-reporting practitioner shows considerable insight and in MIPS’ experience this may prevent ‘immediate action’.

Immediate action doesn’t always lead to punitive sanctions. The main aim of the Immediate Action Committee is to ensure the public is protected and there is a reduction of risk to the community and worsening of consequences for the practitioner

Cause for concern

In extreme cases where you believe patient safety is at risk, consider your mandatory notification requirements. The Australasian Doctors’ Health Network sets these out as:

Notifiable conduct

  1. practised the practitioner’s profession while intoxicated by alcohol or drugs; or 
  2. engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or 
  3. placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or 
  4. placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards. 

Regulator’s code

The theme of taking care of yourself and practising only when competent is thoroughly canvassed by AHPRA and your Registration Boards in your code of conduct and your conduct will be judged against this code. Always remember that ignorance of the code is not a defence.

AHPRA’s Code of Conduct

AHPRA assists the medical dental and other health boards in their role of protecting the public by setting and maintaining standards.

AHPRA code - Minimising risk

Doctors’ performance — you and your colleagues
6.3.1 Complying with any statutory reporting
6.3.2 Recognising/minimising the risks of fatigue
6.3.4 Taking steps to protect patients from risk posed by a colleague’s conduct, practice or ill health
6.3.5 Taking appropriate steps to assist your colleague to receive help if you have concerns about their performance or fitness to practise.

AHPRA Code - 9 Ensuring your health

9.2 Your health. Good medical practice involves:
   9.2.1 Having a GP
   9.2.2 Seek independent, objective, medical advice
9.3 Doctors have a responsibility to assist medical colleagues to maintain good health
   9.2.4 Don’t self-diagnose or self-prescribe (or to friends/family) ie Just don’t do it!
9.3Other practitioners’ health

Practitioners have a responsibility to assist their colleagues to maintain good health. When treating a fellow practitioner, you must exercise the same quality of care you provide other patients. It is your professional and statutory responsibility to notify the relevant boards if you are aware that your patient may be impaired and may be placing patients at risk. If you become aware of a colleague whom you are not treating who may be ill or impaired, encourage them to seek help and consider notifying their relevant board, employer or Doctor’s Health Advisory Service (DHAS). If you are in a position to facilitate safe working hours, recognise the impact of fatigue on colleagues and assist where possible. 

Curriculum framework

For junior and prevocational medical practitioners your curriculum includes ‘Professionalism’, where it states, 

Practitioner in difficulty 

  • Identifies the support services available
  • Recognises the signs of a colleague in difficulty
  • Refers appropriately & responds with empathy
  • Some simple tips to help you to look after your own health: 
  • Take responsibility for your own physical and psychological health.
    • Get yourself a GP – establish a continuing therapeutic relationship with a GP and remember to be a patient
    • Avoid self-diagnosis, treatment and prescribing.
  • The support of others is vital – establish a network of colleagues and peers for debriefing, support and mentoring.

"Healthy doctors, healthy patients” or indeed “healthy doctors better medicine” are well-known sayings in the medical profession whereas as the term “Physician, heal thyself”, which has been around since the ancient Greeks must no longer be taken literally. It is important to know your limits when it comes to your own health and ensure you are at the top of your game when  treating your patients.

All healthcare practitioners need to be well themselves to be able to provide high-quality healthcare to their patients and the community and to experience medicine as a rewarding and satisfying career. Research shows that doctors with good personal health practices are more likely to talk positively to their patients and pass on healthy behaviours.

Mandatory reporting

The question we often get asked at MIPS is should the notification come from the hospital, someone else or you personally?
If the hospital or someone else has already made a notification, then the onus may not fall on you. However, we urge you to check your local protocols and make sure you are careful and certain as this is a serious matter. As always, our advice is that you first get advice about this from MIPS.

For more information, see some of the other relevant articles on this page regarding mandatory reporting. 
To get advice, you can contact MIPS 24hr Clinico-Legal Support on 1800 061 113

Colleagues in difficulty

Webinars-Icons-2018If you missed the webinar on Colleagues in difficulty, you can earn one hour CPD and watch the full recorded webinar (RACGP and ACRRM accredited)

Want a second opinion?

Experienced clinico-legal advisers
Call: 1800 061 113
Email: info@mips.com.au

 

 

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