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Troubled partner is making errors

Case history

You have been concerned about your partner Andrew for some time. Two years ago his wife left, taking £30,000 from their joint savings and leaving him with four children. He never complains, but is always having to rush away after surgery or in the middle of meetings to sort out a crisis. He does numerous co-op sessions on top of his full-time work.

Most patients love him. However, he has forgotten to make several referrals and has twice been saved from serious prescription errors. In afternoon surgery you slip into his room to ask his advice and find him fast asleep. What are you going to do?

Dr Claire Cox

'I must be honest about any action I intend to take'

This needs to be addressed urgently, both from the perspective of Andrew's health and patient safety. This is a golden opportunity to set the ball rolling, perhaps with a neutral: 'How are things going?'

There needs to be a strong message of support and understanding. Strategies that could be discussed include how the partnership could help him; reducing his out-of-hours work; taking annual, sick or compassionate leave; seeing his accountant and financial adviser to reduce outgoings; and mentorship. I would try to find out if he was depressed and seeing his own GP or in touch with the sick doctors' helpline.

Problems arise if he refuses to discuss his difficulties or denies these are affecting his safe functioning. I must be honest about any action I take, so I am not seen to be going behind his back. I would say 'I am worried about you and I need to discuss my concerns with . . .' I would choose a partner with whom he has a good relationship. They could then approach him directly.

If he was still resistant, he would need to be confronted with his mistakes and have it made clear the partnership was not happy for him to continue without remedial action.

Dr Patrick Clarke

'Remedying problems now could avert future tragedy'

He sounds like a remarkable man and one I would be proud to have as a partner. Finding him asleep will give me the perfect opportunity to broach the subject. I would start by asking him how he felt he was coping and whether he felt there was a problem. Depending on how he responded, I could offer to cover the rest of his consultations or arrange to meet him after surgery to sort out some help.

The situation cannot continue. He is struggling and it is affecting his family and professional life. I hope I could get him to realise this without going through the errors and by highlighting his positive attributes. If he is not forthcoming, I would gently ask him about his financial and domestic situation. Time spent trying to remedy issues now could help prevent a tragedy in future.

Assuming Andrew has accepted my help, I would suggest he makes a list of all his concerns. A financial adviser may be able to help manage his debts. It may be possible to improve his childcare arrangements or his surgery times. Working harder to cover his shifts or weekends would be possible in the short-term, but I would want to avoid a long-term situation of covering every evening.

I would give him a target of a few weeks to sort himself out. By covering some of his shifts, he will realise I am on his side. I would then want to go back through his list of problems. If there is still no sign of improvement, I would suggest professional help. He may need to see his own GP. His defence union or the BMA may be able to help.

Most of all, Andrew is a friend and I would go out of my way to ensure he gets through this.

Dr Lorna Gold

'I won't take "I'm fine thanks" as an answer'

Show me a GP who claims never to have been tired enough to fall asleep while doing paperwork after lunch, or never to have forgotten to make a referral, and I will show you a GP with a very long nose. Many of the manifestations of Andrew's exhaustion are so familiar that it has been easier to regard each catastrophe as an isolated incident than to acknowledge he is barely coping.

The fact that Andrew has already confided in his colleagues makes it more likely that he will be willing to discuss how he is feeling. I would ask him there and then. An apparently casual inquiry from someone I hope he regards as a friend will be less threatening than putting him on the agenda at a practice meeting. However, I won't take 'I'm fine, thanks' for an answer.

In over a decade as a GP, I have acquired a thick-skinned nosiness which will allow me to ask difficult questions without becoming embarrassed, and timely interference now may head off a partnership crisis.

My priority would be to establish whether Andrew is depressed, physically ill, or misusing drugs or alcohol, in which case he will need help to access appropriate medical services.

Even after two years, Andrew may be so bogged down he cannot see any way out of his muddle, or he may lack the will to tackle issues such as childcare or moving to a smaller house.

He may be unable to manage a domestic budget. I cannot solve his problems for him ­ and Andrew is unlikely to want me raking through his personal finances or his relationship with his ex-wife ­ but I can help him to make contact with agencies that can.

I would be reluctant to ask Andrew to take time off work. His self-esteem is probably being maintained by the positive feedback he gets from his patients. However, I will point out that he has made some uncharacteristic and potentially serious errors and ask him to remember that he is made of mortal flesh and to reduce his out-of-hours sessions.

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