Letters to the editor

OVERVIEW

Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

A national support service

Editor – Your editorial (Clin Med 2015;15:219–20) covers two points about the health of doctors; the first from the report Work and wellbeing in the NHS; why staff health matters to patient care¹ highlights that working in the NHS at present is extremely challenging, and some doctors are suffering ill health as a consequence of the demands placed upon them. The report unfortunately does not mention the Royal College of Physicians (RCP) and Faculty accreditation scheme for occupational health services, Safe, Effective, Quality Occupational Health Service (SEQOHS; www.seqohs.org). The Boorman Report called for access to quality-assured occupational health services, and SEQOHS accredited occupational health services bring higher confidence in the efficacy of interventions. The actions identified in the report are very sensible and occupational physicians welcome them.

The second point in the editorial mentions the recent General Medical Council (GMC) report Doctors who commit suicide while under GMC fitness to practise investigations.² The report relates the significant challenges some doctors present when they are unwell. It is well known that some doctors ignore, or minimise symptoms, and are reluctant to seek help from their normal medical advisers and seek informal advice from colleagues.

Despite good treatment pathways for these illnesses, some doctors choose not to access them. There may be specific reasons why doctors need confidence in routes of care they take; nevertheless where their illnesses may impinge on patient safety, specialised occupational health support is needed to protect doctors and their patients. Rapid access to treatment and occupational health advice should be routine, professional practice. This requires improved access for doctors to trusted occupational health services to be accompanied by changes in culture and behaviour. All parties with an interest in healthy doctors and healthy patient decisions, including the GMC, Royal Colleges, the Academy of Medical Royal Colleges, medical indemnity organisations, British Medical Association, medical directors and human resource managers, should work together to make such pathways and behaviours the expected norm for all health professionals.

The provision of a national support service itself or in isolation from an occupational health service has the potential to actively work against any preventative steps needed to encourage doctors to continue to declare illnesses and seek support early in the course of an illness. Doctors need their GP to be the lynchpin of their care just like any other member of the public, and without careful planning, a national support service may cause them to circumvent their GP, if and when they think they need to.

Doctors who have an illness which might affect their performance should be able to seek confidential advice from a consultant occupational physician, who will give advice on any adjustments to allow the doctor to continue in practice, and advise on whether they should refrain from work during treatment or rehabilitation. The RCP could lead on encouraging members and fellows to deal with their own health professionally and access specialist health services in the same fashion as the rest of the population. They should also be advised to seek help from occupational physicians. When medical advice is followed early in the course of many illnesses, prognosis tends to improve. If all doctors who are unwell have trusted access to appropriate diagnostic and therapeutic advice from clinicians, accompanied by trusted advice on fitness for work, their medical problems can be managed in a timely manner and patient safety is not compromised.