Doctors, like anyone else, can suffer from physical or mental illness, either temporarily or as part of a gradual deterioration with a chronic illness. An illness  may affect a doctor’s ability to care for patients.

The Medical Council (the Council) is the body responsible for protecting the health and safety of the public under the Health Practitioners Competence Assurance Act 2003 (HPCAA). The Council manages doctors with conditions affecting their fitness to practise medicine.  Under the HPCAA it is mandatory for doctors to notify the Council if their own or a colleague’s fitness is in doubt.

A doctor may not be fit to practise if he or she:

• is unable to make safe judgements, or
• is unable to demonstrate the level of skill and knowledge required for safe practice, or
• behaves inappropriately, or
• risks infecting patients with whom she or he comes in contact, or
• acts in ways that impact adversely on patient safety. 

What causes health problems in doctors? 

Most doctors lead healthy and productive lives.  As a group they have lower rates of certain diseases such as cancer.  On the other hand, doctors suffer more from substance abuse and depression.  The stress of medical practice may increase susceptibility to some conditions. 

Many potential disorders may affect a doctor’s practice but common ones are: a temporary stress reaction; a psychiatric problem; physical illness or injury; alcohol or drug abuse or dependence; declining competence due to age-related loss of motor skills or to the early stages of dementia; and infection with a transmissable disease. 

Doctors who face up to a problem and report their difficulty to the Council take the first important step on the road to recovery. Other doctors are not aware they have problems, and resist any offer of support or help.  Some, aware of their shortcomings, go to great efforts to mask their deficiencies.  

If professional help is not sought, it is often only a matter of time before serious problems occur.   

The Medical Council’s experience is that where an illness is treatable, early intervention usually enables doctors to continue practising while receiving treatment. 

For an irreversible illness, on the other hand, it is vital, in the interests of public safety, that the doctor is closely monitored if that is appropriate and safe, or discontinues work if necessary. 

Who must refer a doctor to the Council? 

The requirement to refer a possibly unfit doctor to the Medical Council applies to any doctor or any person in charge of a hospital. It also applies to a medical school dean who believes a graduating student may be unfit to practise.  If an employer alters the clinical duties of a doctor because of perceived ill-health, then the employer must refer that doctor to the Council. 

No one likes to initiate a review of a colleague and it is natural to be cautious.  The HPCAA provides for someone who is contemplating referral to seek other professional opinions to help inform his or her decision. 

Covering up for an unfit colleague is wrong. Without the help and support of the profession, an unfit doctor risks putting the community, the profession and his or her reputation in jeopardy.  Every doctor carries a responsibility to notify the Council Registrar about a colleague in trouble to avoid possible tragic consequences. 

Who may report a doctor?

Any member of the public can voluntarily inform the Council about an unwell doctor. Some people may prefer to contact the local medical officer of health instead. 

What happens when the Council receives information that a doctor may be unfit?

The Council aims both to protect the public and to address doctors’ health problems.

The HPCAA sets out the steps that must be taken when the Council Registrar receives a report.  The Council’s health committee uses an established assessment and rehabilitation procedure.  At any one time the committee is assisting and monitoring about 80 doctors across all ages and branches of medicine. 

The first step – communicating with the doctor 

The health committee acts immediately it receives information.  The health manager will contact the doctor and the committee will then evaluate the concern.  

If necessary, there is provision to protect the public immediately pending a fuller review, either by:

• seeking the doctor’s agreement to limit his or her practice in certain ways; or
• interim suspension for up to ten days by the President of Council following consultation with two members of Council.  In practice this step is rarely used as most doctors willingly withdraw from practice while the issues are being further explored. 

The next steps are: 

• the doctor is assessed by a specialist nominated by the health committee, at the Council’s expense. This examination is compulsory
• the chair of the health committee considers the report and the doctor also receives a copy
• any initial limitations are reviewed  in light of the report
• the health committee considers the doctor’s fitness at its next meeting.  

The health committee may invite the doctor to their meeting.  In any case the doctor is entitled to attend to be heard (with a support person if desired), or make a written submission.

The health committee generally decides on one or more of the following:

• to ask the doctor to conform to limitations on practice relevant to the doctor’s condition
• to recommend or order treatment or counselling
• to recommend to the Council restrictions on the doctor’s registration or practising certificate, or a period of suspension while treatment is carried out
• no further action.

The usual outcome is a negotiated agreement with the doctor, underpinned by an acknowledgement that a breach may result in conditions on practice.  This agreement is the best outcome for everyone because it allows flexibility in how and when conditions can be reviewed and because there is no need for coercion. 

The process is designed to separate health issues from those of conduct and discipline.  The health committee’s approach is non-judgemental with the focus on rehabilitation.  Every effort is made to ensure a non-punitive process.  The assumption is that with treatment the doctor should be able to remain in work safely or return to work as quickly as possible. 

What do agreements consist of?

These vary depending on the nature of the doctor’s health problem and the nature of the doctor’s practice. However a typical agreement might include:

• limiting the doctor’s practice
• supervision of the doctor’s practice
• the doctor nominating a work colleague who can be informed about the relevant health issues
• carrying out random urine and occasional blood tests to check for the presence of drugs or alcohol
• prescribing restrictions
• requiring the doctor to see his or her own general practitioner  regularly
• requiring the doctor to undergo therapy
• requiring the doctor to attend peer support groups such as Alcoholics Anonymous or Narcotics Anonymous
• appointing a senior practitioner as mentor.

How do I notify the Council? 

A concern about a fellow doctor should always be in writing to the Registrar of Council and include details of any other professional opinion sought.  The Registrar will then pass the information promptly to the health committee to consider.

The health committee usually prefers to disclose the identity of the person who has made the referral but will use its discretion.  In the health committee’s experience, when the process is explained, most doctors agree to refer openly in the interest of their colleague.  

Other help available 

The Doctors’ Health Advisory Service (DHAS) assists doctors and their families with personal and health problems. It can be contacted on (04) 471 2654 or 0800 471 2654.  DHAS is partly funded by Council.  

An experienced DHAS counsellor can help with making the decision to refer a doctor.  However notification to DHAS does not remove the legal obligation to notify the Council formally about a doctor whose practice is affected by illness.

The health committee

The health committee is a standing committee of Council and currently consists of three medical members and one public member. The health committee can be contacted through the Council’s health manager, ph (04) 381 6774 or 0800 286 801 ext 774.