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