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My colleague is depressed, but won’t see their GP. What should I do?

Three experts advise 

A colleague has admitted that she is not coping well at work and is depressed, possibly suffering from burnout. However, she refuses to see her GP, or seek other professional help. What should I do?

Dr Pipin Singh: Discuss the situation with your colleague

If a GP colleague has openly told you in confidence that they are depressed, then talk to them. You will require time and no interruptions - it cannot be done in a corridor in five minutes. Try and establish what may be causing the problem. It may be work-related and thus the problem may be resolved within the surgery. Be honest with your colleague and share concerns that you have about their wellbeing and the possible impact of not addressing their problem on their own health, their family’s health and patient safety. This in itself could have a detrimental effect on their mood. Try to agree on an appropriate time to meet again and review your colleague’s situation, for example in two weeks. A salaried colleague may require some occupational health support if you are their employer.

It is important not to commit to complete confidentiality as any patient safety concerns will need to be addressed with the remaining partnership and in extreme cases referred to the GMC. This may require advice from your defence union, if felt the colleague was not following the correct procedures and continuing to make mistakes. It is also important to remember that you are not your colleague’s GP thus cannot safely provide an objective assessment of their symptoms or recommendation on treatment. You may wish to recommend some time out of the surgery to allow your colleague to reflect on their problems and take whatever action they need to move things forward.

Establish the reason for their fear of not wanting to see their GP. You may be able to help alleviate any concerns that they may have. If you feel your colleague is not taking the steps to improve their condition and patient safety is a concern, then you have a duty of responsibility to refer your colleague to the GMC.

Dr Pipin Singh is a GP in Wallsend, Tyne and Wear.

Dr Michelle Drage: Contact your LMC

If you become aware that a colleague may be suffering burnout, it is essential to take a supportive empathic approach both as a doctor colleague, and within the context of the workplace. It is equally essential that you are able to balance your role as a GP (perhaps even the colleague’s GP) and as a working colleague. Moreover, you must act professionally in all your dealings. This is a tough call and you will need help and support.

Call your LMC and obtain urgent advice from your LMC secretary or medical director before you take any other action. Your LMC will help you take a whole-practice view, for example, to help you balance the need to support your colleague as an individual with your need to support the practice, to help you avoid referrals at the wrong time and to assess whether patient safety is at risk and whether or not you need to take measures to mitigate against this, such as asking your colleague to take some time out.

You should collate information to enable your LMC secretary to help you look for signs on an individual level (for example stress, fatigue or even cutting corners with record keeping and falling behind with clinical admin), on a partnership level (for example tension between the partners) and on a practice level (for example the practice team not feeling supported, lack of clinical leadership and the staff feeling stressed or unhappy).

Remember that as doctors we set extremely high expectations of ourselves and our colleagues. Be aware that there may be very reasonable reasons as to why a GP colleague may not wish to be seen and supported within in their local health economy. Also, be aware that the LMC secretary or medical director has the authority to ensure that a colleague receives an assessment in safe space where appropriate.

Dr Michelle Drage is chief executive of Londonwide LMCs

Dr Bobby Nicholas: Patients’ interests come first

This is a more common issue that one might imagine. Discussions with a colleague who is not coping can be very difficult and require a sensitive and non-judgmental approach. Your colleague may need support in terms of talking through the issues or help with balancing their workload. You should explore why they won’t seek help from their GP and ensure that they are aware of the other help available such as the NHS Practitioner Health Programme and the BMA’s Doctors for Doctors service.

You must also take into account your professional obligations, particularly around patient safety. The GMC says: ‘if you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or us. If you are still concerned you must report this, in line with our guidance and your workplace policy, and make a record of the steps you have taken.’

The GMC acknowledges that there may be obstacles to reporting concerns; not least that you may be concerned about the problems this could cause for a colleague. However they make clear that your duty is to put patients’ interests first and act to protect them, which overrides personal and professional loyalties. Contact your defence organisation for advice if you are unsure how to deal with the situation.

Dr Bobby Nicholas is Medicolegal Adviser at Medical Protection

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Readers' comments (20)

  • Probably most of us would say - 'I am too, so what the heck, get on'.
    Sorry, just joking but then we are living in tumultuous times and that demarcation between the ability to cope with the workload/stress and depression does tend to get hazy at times!

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  • This comment has been removed by the moderator.

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  • My advice-get a better job rather than the "shitty career" that is general practice!

    "Floundering in faeces" is enough to beat down even the most optimistic and let's be honest I would not wish this life on any other sane person.

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  • In our area in Devon and Cornwall we have a mutual insurance system where any GP who has signed up can self refer for a confidential assessment face to face by an experienced consultant psychiatrist who has assessed more tha 1400 GP over 25 years and access appropropriate skilled therapy support according to need and receive an appropriate support package through making one contact

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  • 3:46 IS BANG ON

    What would probably end up happening is either a colleague will report him to the GMC or a patient or member of the public

    Then the caring GMC would put this poor colleague through a fitness to practice panel where they will be presumed to be a danger to the public and well......... we know the likely outcome for this poor broken doctor.

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  • Self-flagellation...

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  • Like someone already mentioned , GET OUT, IF IT BURNS, LET GO!

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  • We have so many people willing to refer each other to the GMC, that organisation that will look after the doctor concerned, offer him support, make him feel innocent and not at all guility, treat him with respect, get him better and back and up and running. Who needs enemies when your own friends can look after you so well by referring you to the one organisation that has never hurt a doctor in their life, is fair and reflective organisation, take actions to improve their care of the people who pay their fees, is only interested in doctors welfare, does a duty of candour and apologises when the people it victimises on a daily basis come to any harm. Yes I agree, refer the poor soul to the GMC and he will be saved.

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  • It is your duty to refer to GMC. or you could be referred yourself later to the GMC - Guantanamo Medical Centre - where you too can disappear in the system and loose years of your life - while innocent, never charged with any offence, and eventually if you are lucky, be released without any apology, and then be constantly monitored with every step you take.

    People will shun you as there is no smoke without fire, and mud will always stick.

    Yup, that is just what every depressed and burnt out GP needs.

    Watch yourself, your friends will kill you with their kindness, if you did put 1 step out of place, as the GMC will have you hung, drawn and quartered, then burnt on the pyre of patient safety. All paid for by your subscription fees, collected under duress, without which you are unable to ply your hard learnt trade.

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  • The normal rules of mental ill health also apply to GPs who, although pretty resilient, are collectively starting to reach the limit of what they can tolerate at work. We are using 'burnout' as a euphemism for what is likely to be depression and anxiety, but because we're doctors we can't admit it. To have an MI would be so much more acceptable than 'going off with stress and depression'. Loss of autonomy and control, very long working hours, and no obvious resolution to the recruitment/retention problems are taking their toll. PHQ9 and GAD7 can give you an insight, and help doctors get past the widespread blindspot belief that doctors are somehow immune to mental ill health. The stiff upper lip mentality went out with the ark and it is sad that the medical professional still has a tendency towards being a militaristic tyranny.

    Help is out there. Find someone you trust.

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