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Dilemma: Rumours one partner has an online gambling problem

Question your practice manager’s motives

Dr Bassett - online

It sounds as though relationships in your practice are already becoming strained over a fair distribution of workload, so approach this situation with calm, collected caution.

First, establish whether your partner’s seeing fewer extras is actually problematic. He may be compensating by seeing more complex and challenging patients at a slower pace, for example, or maybe your own consultations (or colleagues’) are inappropriately brief.

However, if his consultation rate is relatively poor then after an informal discussion with your other partners (having perhaps discreetly canvassed senior staff on their views) the best approach would be direct. A gentle conversation between the problem partner and a skilled, sympathetic colleague would be the best place to start.

Also, be circumspect about your practice manager’s motives in floating a potentially damaging and slanderous allegation. If you believe your practice manager’s speculations have any basis, then they need above-board investigation.

One might argue that use of practice time and computer resources to gamble is per se risky behaviour and disreputable (see Harry v GMC [2006] EWHC 3050) and if other pointers of developing dysfunction exist, again, an initial sympathetic enquiry would be advised.

But note that covert access to your partner’s browser history is not only potentially a criminally unauthorised computer access (a probable breach of s1 Computer Misuse Act 1990) but also an intrusion likely to escalate an already evolving dynamic of mutual hostility.

If the gentle approach does not reassure you, and suspicions remain, your clinical governance pathways need to be engaged.

Dr Stephen Bassett is a GP, a barrister, GPC member and a member of the BMA´s´medico-legal committee

Confront the partner and put the rumours to him

Dr Bowden Jones online

Pathological gambling is often described as the ‘hidden addiction’ because it is an illness that is frequently detected only when the problem has started to impact significantly and in a negative way on a person’s life.

In the case of this doctor, his work productivity has dropped and this has impacted on his colleagues, he may be at home gambling online through the night and may be exhausted by the time he arrives for work, or he may be missing days of work due to low mood following significant financial losses.

He may have put his house at risk and may now be suffering alone unable to confess because of the shame and guilt many patients feel about their gambling.

One of the partners could arrange to meet with the doctor and share the concerns about productivity and more importantly about his wellbeing. A direct question then should follow regarding the gambling as we know that unless you ask you are not told. Try: ‘Someone has suggested you may be experiencing problems controlling your gambling. Is this the case?’

A good idea would be to have identified a source of treatment locally so that if the doctor owns up to the addiction a referral can be made jointly to a designated treatment centre thus avoiding a need for further questions later on about whether the doctor did indeed refer himself.

Some 0.9 % of the population is a problem gambler, and there is a significant genetic component in the aetiology of the illness. Doctors can be vulnerable too.

Dr Henrietta Bowden-Jones is a consultant psychiatrist, director and lead clinician at the National Problem Gambling Clinic, London, and a member of UK Government’s Responsible Gambling Strategy Board.

Review your IT policy

Wendy Pugh MDU

There may be an alternative explanation for why the partner is seeing fewer ‘extras’. Does he have more appointments booked because he is a popular GP or has a specialist interest, for example? What evidence does the practice manager have for thinking the GP is gambling online?

If your initial review suggests possible performance-related concerns, you should discuss these with senior colleagues and with the GP in question. This should be done in a non-confrontational and supportive way, as the partner may have health issues. You could explain to him that you wish to look at his web browsing history but much will depend on your IT policy and whether staff have been invited to agree to monitoring.

If he admits to having a problem, you could offer the contact details for support organisations. If you feel the issue is affecting patient safety you will need to consider how to manage any risk while this is resolved. If your partner is resistant to practice advice, consider whether you need to involve the NHS England local area team medical director. Arranging an occupational health review may also be appropriate. If he denies there is a problem, you may need to take his word for it if there is no evidence to the contrary.

You may wish to review your IT policy in light of these events to advise staff clearly about appropriate and inappropriate use of the internet at work and to explain that their use of the system will be monitored.

Dr Wendy Pugh is a medico-legal adviser with the MDU