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Dos and don'ts of travel health under new GMS

In this age of litigation, drinking on or even off duty is an increasingly thorny problem – Dr Matthew Lee of the Medical Defence Union gives advice

Each year the MDU is asked by a number of members for advice on alcohol-related problems ranging from how they should raise concerns about a colleague who is drinking heavily to whether they can have a drink when on duty.

Another common dilemma doctors face is when they are off duty, have had a drink, but are then called on to act as a good Samaritan, as in the following case.

A GP was on a flight to Chicago for a family holiday when a call came over the tannoy asking if there was a doctor on the flight. The flight was well under way and the GP had had a small bottle of wine with each of the two meals that had been served. She volunteered her services, but explained to the air steward her concern that her abilities might be impaired by the alcohol that she had consumed. The emergency in question was a passenger having severe chest pains. Fortunately, another doctor – a specialist registrar in A&E – who had not had a drink came forward to help.

The GMC is clear that doctors have a duty to offer what assistance they can in an emergency, so doing nothing is not an option. If you have had a drink, you may be wise to step back and allow someone else, such as a nurse or another doctor, to take over. If no one else is available, however, you will have to do the best you can. But you would be wise to explain the situation to the patient before treating them if possible.

But what about having a drink at lunchtime or when you are on call? A survey of US doctors in 2002 found that over 14 per cent considered social drinking of alcohol while on call was acceptable and 25 per cent thought that it would be safe to consume a small amount. So, you may ask, is it acceptable to drink a small amount while on duty? It is not the MDU's role to say whether it is acceptable, but we can say that, while some doctors think it does not affect their clinical judgment, our experience is that it can still have adverse medicolegal consequences.

For example, in clinical practice the occasional mistake is inevitable. If a doctor makes a mistake and is later found to have been drinking, it may be significantly more difficult to explain the mistake and defend the clinical management.

Some doctors have had to answer complaints, even when no clinical error has been made. Take the following fictional case, which is based on examples from our files.

A GP was called to examine a child with a temperature, cough, vomiting and general malaise. It was 10 o'clock at night and about an hour earlier the doctor had had a glass of wine with his meal. He examined the child, diagnosed purulent tonsilitis, prescribed antiobiotics and paracetamol and left. The child recovered but the mother complained to the practice and the GMC that she could smell alcohol on the doctor's breath.

The GP responded to the complaint by explaining that he had had a small glass of wine but that it had in no way compromised his clinical abilities. The doctor also explained this to the GMC and apologised to the complainant if the smell of alcohol had caused her concern. The GMC accepted his explanation and did not pursue the complaint.

In this scenario, although there was no question over the GP's clinical judgment, he still had to respond to a complaint to the GMC and that caused him considerable concern.

Very few doctors have a serious alcohol problem that could pose a threat to patient safety. But if you are concerned that a colleague may be abusing alcohol, you must establish the facts of the case, and try to discuss your suspicions with the colleague concerned. If the problem cannot be resolved locally, you have a professional duty to act by informing the appropriate authority or the GMC.

With mandatory breath testing of doctors occasionally mooted as a possibility, drinking alcohol while on duty (or shortly before) appears to be becoming less socially acceptable. If you have such concerns about a colleague then you would be wise to share them with him or her. Your medical defence organisation is also on hand to help you decide if you need to take action.

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