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Independents' Day

Think about those festive spirits

Christmas is a time for social drinking – and wise GPs should be on their guard, says Dr Catriona James of the MDU

The Christmas and New Year party season is a time when alcohol, while adding to the festive spirit, can also create professional difficulties and dilemmas for GPs.

Partying too hard is, of course, not a problem unique to GPs. A recent survey by the health education charity Developing Patient Partnerships found more than a quarter of the 1,000 people of all ages it questioned said they had sometimes struggled to do their jobs because of hangovers, increasing to a worrying 80 per cent of 18- to-34-year-olds.

It is the time of year, however, when the MDU is most frequently asked for advice about whether it is OK to have a drink while on duty or shortly before going to work.

There is nothing stopping doctors who are not on duty from responsible consumption of alcohol. However, we are aware of

cases where consumption of alcohol has caused medicolegal difficulties and dilemmas for doctors. Here we give two fictional examples of such cases, based on real situations reported to the MDU.

Case one: Emergency situation

A GP who had attended the practice party and consumed several glasses of wine was on his way home by train when a fellow passenger became unwell.

Train staff asked travellers for medical help. The GP – aware of his duty under paragraph 11 of the GMC's Good Medical Practice (2006), which states that 'in an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options of care' – volunteered his services.

He explained to train staff that he was concerned that his abilities might be impaired. The passenger was experiencing severe chest pains and seemed in some distress. Fortunately a nurse who worked in A&E and who had not been drinking came forward to help and the GP was able to step back.

He later rang the MDU to ask if he could be criticised for taking a back seat. The adviser explained that it is usually appropriate, when a doctor has consumed alcohol and someone else with the necessary skills steps forward to help, in this case an A&E nurse, for the doctor to allow that individual to take the lead.

If nobody else had been available, the GP would have been expected to do the best he could in the circumstances. But it would have been advisable to explain the situation to the patient, if possible, before treating them.

It is difficult to see how the GP could be criticised for stepping back in these circumstances, but he was advised to make a note of any treatment he provided and his reasons for stepping back. It was also suggested that he give his details to the train company in case they needed to contact him.

The MDU is not aware of any UK cases of doctors being sued as a result of a Good Samaritan act such as this one, but in any event MDU members are covered by an insurance policy for claims arising out of Good Samaritan acts worldwide, subject only to the terms and conditions of the policy.

But what about drinking at lunchtime or while 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 it would be safe to consume a small amount of alcohol.

Although many doctors feel that to do so does not affect their clinical judgment, difficulties can arise if, as occasionally occurs in clinical practice, a mistake is made and the GP is later found to have consumed alcohol.

In such cases, in the MDU's experience, it may be a lot harder to explain the mistake and to defend the clinical management provided. Some GPs may face complaints even when no clinical error has occurred.

Case two: A drink with lunch

Take the example of a GP who was called out during an afternoon surgery to see an elderly woman in a nursing home who had fallen. He examined her and found no injuries, but the manager of the home later complained to the GMC that she could smell alcohol on the doctor's breath.

The GP responded by saying that although he had had a glass of wine at lunchtime with his meal, an hour before he was called out, this in no way compromised his clinical abilities. The GP also explained this to the GMC and apologised to the complainant if the smell of alcohol caused her concern. The GMC accepted the explanation and did not pursue the complaint.

While there was no question over the GP's clinical judgment in this case, alcohol had resulted in a complaint to the GMC that had caused considerable concern for all involved. In the light of the two examples, it may be safest to consider avoiding mixing

alcohol and clinical practice.

The cases we have shown involve social drinking. Unfortunately, some doctors have genuine problems with alcohol. If you have concerns about your drinking you should seek personal medical advice in line with GMC guidance in Good Medical Practice (paragraphs 77 to 79).

If you have concerns about a colleague's drinking you may wish to share these with them. It may be necessary where your colleague's drinking is adversely affecting patient safety to give an honest explanation of your concerns to your employing or contracting body, following local procedures, or where that is not appropriate to refer the matter to the GMC (Good Medical Practice

paragraphs 43-45).

Your medical defence organisation is also on hand to provide confidential advice if you decide you need to take action.

Catriona James is a medicolegal adviser

with the MDU

what to bear in mind...

• If a GP makes a mistake the MDU says it can be a lot harder to defend the clinical management provided if alcohol has been consumed

• If a patient smells alcohol on a GP's breath, a complaint may be made even if no clinical error has occurred

• It may therefore be best to avoid mixing alcohol and clinical practice at all times

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