Specific Topic(s):

Managing clinical performance of a colleague alongside caring for their health (physical and mental).

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ – Health-care personnel shall at all times act in accordance with relevant international and national law, ethical principles of health care and their conscience.

Geneva Conventions: not applicable

Ethical principles: WMA INTERNATIONAL CODE OF MEDICAL ETHICS at: https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

• A PHYSICIAN SHALL deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception

• A PHYSICIAN SHALL seek appropriate care and attention if he/she suffers from mental or physical illness.

Discussion:

Review of the question: this question examines the responsibilities of a healthcare worker, their colleagues and ‘employers’ to ensure that they are fit and competent for their practice, including recognising physical and mental illness. This can be a very difficult issue for all concerned.

Interpretation of the principles/policy from the references: a healthcare workers’ primary duty is to their patient and to ensure that their clinical practice is competent and safe. This includes reporting unethical or incompetent practice by their colleagues. Those with leadership or managerial responsibilities are responsible for addressing concerns regarding the clinical practice of a member of their team. This also includes addressing health issues of a practitioner. All healthcare workers are also responsible for ensuring that they address any health issues that may affect their professional abilities. These subjects are usually covered by professional guidance – see the links to the UK General Medical Council as an example.

Framework for answering the scenario/question:

• What is your role? – a colleague, a friend, a team leader

• What is the evidence of clinical risk? – personally observed, formally reported, informal anecdote

• Who should raise these concerns with the individual? – you, your leader, a friend

• What are the solutions?

o Reducing clinical risk

o Maintaining a clinical service

o Caring for the individual

• Are there any confidentially issues? – protection: clinical information on patients, personal information on the colleague, medical information on the colleague.

• Should this event prompt a review of the physical and mental health of the remaining members of the team?

Further issues for consideration:

• How should physical and mental health be checked prior to deployment?

• How should any vulnerabilities in the physical and mental health of a team member be addressed prior to deployment, during deployment, on return from deployment?

• This topic links to the responsibilities of ‘employers’ to protect the health of their workforce in the following cards: 2 Hearts, 3 Hearts and Ace Hearts.

General Medical Council (UK). Good Medical Practice. Domain 2: Safety and quality. Respond to risks to safety. At: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-2----safety-and-quality?#paragraph-28 accessed 11 Jun 2020.

General Medical Council (UK). Working with colleagues. At: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/leadership-and-management-for-all-doctors/working-with-colleagues? accessed 11 Jun 2020

Deciding Whether To Refer a Colleague to a Physician Health Program. Boyd J. AMA J Ethics. 2015;888-893. doi: 10.1001/journalofethics.2015.17.10.spec1-1510.