I’m Worried About My Work Colleague

They are also more susceptible to substance abuse and have a higher suicide rate than the general population.

Dear MDA National medico-legal adviser

Help! I'm very worried about my work colleague. There appears to be something wrong with him. He’s no longer his normal chatty self and is irritable with his colleagues and staff. He seems to be taking longer to do his usual work and other people have noticed this too. What could this mean? What should I do?

Dr W

Warning signs of potential impairment that colleagues (such as Dr W) might notice include:

• out of character behaviour, e.g. social withdrawal, poor focus and concentration, irritability
• decreased empathy for patient's problems
• unexplained work absences
• spending increased hours at work
• making errors
• declining quality of work
• changing appearance, e.g. weight loss, appearing tired, less attention to grooming and appearance.

While Dr W is concerned about his colleague, he is also worried about patient safety and his mandatory reporting requirements.

Depending on the circumstances, it can help if a concerned colleague sat down with the doctor and discussed what has been noticed. Dr W may be a suitable person to talk to the doctor, or he may be able to identify another colleague better suited for this discussion.

Such conversations are often difficult for both parties, and it’s important to explore the underlying cause and assess their insight. In setting up such a discussion, it is advisable to:

• ensure privacy and adequate time
• show care, not judgement
• be open and direct with communication
• demonstrate respect for the other person.

One technique is to use the ‘Four Cs’ to initiate constructive discussion – Caring, Curious, Concerned and Confused:

• You seem very distressed. I care about you and want to help.
• I’m curious about what you said just now – can you tell me more about that?
• I'm really concerned about what might be going on for you at the moment.
• I’m confused by you saying you're fine while you don't seem your usual self. I really want to try to understand what's happening.

Depending on the conversation, Dr W’s level of concern, and the doctor’s level of insight, the doctor could be encouraged to seek medical attention, have some time off work, seek assistance from his MDO, or even make a self-report to AHPRA.

What about mandatory reporting?

Mandatory reporting of AHPRA registered practitioners was introduced in the National Law in 2010. The threshold for mandatory reporting to AHPRA is high. All registered health practitioners are required to report to AHPRA any other registered health practitioner who has behaved in a manner that constitutes ‘notifiable conduct’.

Notifiable conduct is defined in the National Law and means the practitioner has:

(a) practised the practitioner’s profession while intoxicated by alcohol or drugs; or

(b) engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or

(c) placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or

(d) placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards.

Impairment is defined as a person who has ‘a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect the person’s capacity to practise the profession’.

When deciding whether or not to make a mandatory report about a health practitioner’s impairment, two things must be satisfied – the practitioner must place the public at risk of substantial harm in their practice of the profession and that must arise because of the practitioner’s impairment. A practitioner may have an impairment, but if it is not affecting their practice of medicine then a mandatory report is not required.

When deciding whether or not to report, a reasonable belief about the impairment must be formed. This requires direct knowledge and observation of the behaviour – not speculation, rumours or gossip. However conclusive proof is not needed.

A practitioner who fails to make a notification when required to do so under mandatory reporting legislation may be subject to action by the Medical Board. There are some exceptions to this requirement, including treating doctors in WA.¹

These situations can be very difficult and distressing. We encourage you to seek advice before reporting.

For more information on this topic, see the article: The Impaired Doctor.

Dr Jane Deacon
Medico-legal Adviser, MDA National

Reference

1. AHPRA. Guidelines for Mandatory Notifications. March 2014.