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When a new GP thrusts religion on staff and patients

Case history

Your new partner came with glowing references, is diligent, cheerful, computer literate, well-informed and happily does the most irksome visits. About six weeks after her probation period finishes, however, you note that she has organised a series of prayer meetings for staff in the coffee room during their lunch hour, and overrunning by a few minutes. A patient reports that the new doctor has been urging her to marry her lifelong partner and that the word 'sin' was uttered in the consultation. Your partner has stopped some patients' antidepressant medication on the grounds that grace is a more powerful healer than drugs.

Dr Harry Brown

'I'd seek feedback from clinical and non-clinical staff, and her patients'

There are two explanations for this: it is either quite reasonable behaviour and the story that has been transmitted to me has been slightly altered to sound stranger than it is, or indeed, she is exhibiting signs of abnormal behaviour which may put patient

safety at risk. More inquiries must be made, and initially the first port of call should be the new partner herself, to hear her side of the story. I would be honest and upfront with her; there is no other approach. I would want to discuss the specific cases in question, the feedback I have received and also look at the notes. We would examine together how this feedback has arisen.

This should be complemented by feedback from the clinical and non-clinical staff and, most importantly, the patients she has been seeing. The staff attending the prayer meetings are likely to have a good perspective on my partner's mental state. If necessary, a casual inquiry to her training practice may also be useful as well as any of her close family or friends if they are easily accessible.

With all these sources of information readily available I would be able to build up a picture of the true story. Either there are good clinical grounds for her actions with the patients in question and the prayer meetings are quite conventional and acceptable behaviour, or not.

That said, even if her behaviour is acceptable and normal it is important that her personal religious beliefs are not thrust upon staff or patients.

However, if the signs are that some of this behaviour cannot be explained in a rational manner and there may be mental health issues, urgent action must be taken.

Again, time must be spent investigating this issue, specific episodes should be documented, and if indeed an abnormal behavioural pattern emerges suggesting a significant psychiatric illness, action must be taken. The new partner should be told directly of the concerns and her own GP should be invited to take control of any clinical issues.

Advice should be sought from parties like the BMA

and the PCT. If there is a local support group for sick doctors, they may need to be involved. The aim

should be to transform her back to normal health and

her normal duties.

Dr Catherine Laraman

'Has her enthusiasm to be indispensible caused burnout?'

Oh dear, this is all rather worrying. I have two duties here: first, a duty of care to the patients, and second, a duty to look out for my fellow GPs. Patients need competent doctors. Is my new partner behaving competently? My own recollection of becoming a new partner is that life as a principal is very different and often much more stressful than registrar life.

Has her initial enthusiasm to be indispensable caused her to burn out? Is her behaviour an expression of religious devotion, or early signs of an impending psychotic episode? I must admit to being worried about reports of patients being urged to give up their antidepressants; potentially this could have dire consequences.

My first step would be to involve my other partners. Do they have similar concerns? We must decide if immediate steps need to be taken to ensure patient safety. Do we need to review what has gone on in recent consultations and take action?

We must also address the needs of our new partner. This must be done in a supportive and non-threatening manner. Although I may not share her religion (my own 'religion' being a brisk 10km run followed by a hot bath and glass of claret), I would want to respect her style of medicine while keeping in mind what is in a patient's best interests. Although many patients find strength to cope with their illnesses through faith, it is unacceptable for a GP to pass judgment and suggest disease occurs as a result of 'sin'. I hope we would be able to make her feel supported and valued as a partner while encouraging her to refrain from pressing her religious beliefs on others.

She may be need to be persuaded to take time off if she is showing signs of stress or burnout, followed by a gradual re-introduction back to work, along with a revamp of practice workloads. If she was found to have a major mental illness we would need to help her seek appropriate care ­ as GPs we are all fearful of the stigma of mental illness. I would sincerely hope this would not have to involve the Mental Health Act and we could find a way through this and keep our partner.

Dr Nick Imm

'To describe actions as sinful is an abuse of her position'

This needs to be resolved fast. I'm irritated that she's started her prayer meetings at the practice for several reasons. It may appear I condone them when I haven't even been consulted. Not all the staff may want to join in and they may feel pressurised into attending or alienated if they decline.

The fact the meetings run over into the working day is also unacceptable. If my partner wishes to hold prayer meetings and invite the staff she should do so in other premises, in her own time. I also want our practice to be approachable to all, not identified as aligned to a particular religion. The meetings have to stop.

To advise her patients to get married and to describe actions as sinful is judgmental and an abuse of her position as a doctor. I don't think her reported claim that 'grace is a more powerful healer' is from the latest edition of Clinical Evidence. Stopping treatment on this basis is indefensible.

I'd discuss the situation with my other partners and the practice manager and try to corroborate what I've heard. I'd then invite the new partner to give her side of the story to ensure there has been no distortion of the facts. I'd ask about her motives and beliefs and how she feels her religion affects her medical practice.

I'm sure she feels she's doing good but her religious views must not affect either patient care or the running of the practice. What started as religious zeal may well end in a malpractice accusation. Her probation period may have passed but if I'm concerned about patient care a discussion with the GMC may well be on the cards.

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