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An F2 doctor was halfway through her placement in a paediatric department. A few weeks before, the sudden death of a patient had upset everyone but one of the F1 doctors was hit particularly hard, becoming withdrawn and distracted. The F2 was increasingly worried about her colleague and had covered for him on several occasions when he had been late for his shift. She was reluctant to get him into trouble but one morning she was alarmed to smell alcohol on his breath and called the MDU for urgent advice.
The F2's sympathy for her colleague was understandable but on this occasion her ethical duty was clear. The GMC's guidance states that all doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by their colleagues' practice. This duty overrides any personal or professional loyalties. Raising concerns would also be in the F1's interests as he was risking his own career and might benefit from professional help.
Depending on their professional relationship, the F2 could consider approaching her colleague. She would need to encourage him to leave the shift and talk to his supervisor and/or GP, making it clear she would take action herself if he did nothing. However, she should be prepared for the possibility that he would not take her seriously, react angrily or refuse to accept help.
If she was uncomfortable with the idea of talking to the F1 doctor or had tried to do so unsuccessfully, she would need to follow her hospital's established procedures for raising concerns. This would usually require concerns to be raised in writing but given the situation, it would be better to speak to the designated person in her department straight away. The GMC also expects doctors to keep a record of their concerns and the steps they have taken to resolve them.
The F2 should expect to be updated by her consultant as long as this did not breach her colleague's confidentiality. In the unlikely event that no action was taken and the F1 doctor remained a serious threat to patients, she could escalate her concerns. This would mean contacting a more senior manager within the trust, the postgraduate dean at her Local Education and Training Board or approaching the GMC.
Having acted on her concerns, she should steer clear of any departmental gossip about the doctor: he was entitled to the same degree of sensitivity and confidentiality about his health as any other patient.
After the F2 doctor raised her concerns with the consultant in charge of her team, he spoke to the F1 and arranged for him to take a period of sick leave. The doctor was referred to a counsellor to help him come to terms with the patient's death and reflect on his response. He eventually returned to work within a different department where he was mentored by a senior doctor.
This article originally appeared in the printed edition of wardround April 2014 entitled "A colleague on the edge".
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