Sometimes doctors, like anyone, do get unwell. When a doctor has a physical or mental health problem it may impair their ability to practise medicine safely, endangering patients and public. Delaying intervention, treatment, and assistance for the doctor may result in patient care being affected, and may also affect the doctor professionally and personally. In our experience, early intervention usually enables a doctor with a treatable illness to continue practising while receiving treatment. It is vital that concerns about a doctor's health are raised early and dealt with appropriately. When we are notified of a concern about a doctor's health, our Health Team and Health Committee respond to that concern.
- How do we define the 'ability to perform the functions required to practise medicine'
- Practising certificate health disclosures
- Letting us know about an unwell doctor: notification
- Who manages health notifications?
- Conditions affecting the ability to perform functions required to practise medicine
- More information about health concerns
A practising doctor needs to be able to:
- make safe judgments
- demonstrate the level of skill and knowledge required for safe practice
- behave appropriately
- not risk infecting patients
- not act in ways that adversely impact on patient safety
The HPCAA notes that a 'mental or physical condition means any mental or physical condition or impairment, and includes, without limitation a condition or impairment caused by alcohol or drug abuse'. This supports a lower threshold for referral than that of alcohol or drug dependence.
Important information relating to health disclosures on practising certificates.
Download Practising certificates disclosure
Who must notify us of a health concern?
If you believe a doctor is unwell and may be unable to practise safely, you are required by law to let us know if you are one of the following:
- a doctor - self notification
- the doctor's employer
- any registered health practitioner
- anyone in charge of an organisation that provides health services
- a person in charge of an educational programme or course who believes a student may be unable to practise medicine safely
We understand no one wants to initiate a review of a colleague or doctor. However, every doctor has a responsibility to tell us about a colleague/doctor who is unable to practise safely.
Without help and support, an unfit colleague or doctor puts the community, the profession, and their reputation at risk.
Who may also notify us of a concern?
- any member of the public
Will I be liable if I do not make a notification?
A key ‘threshold’ is that of ‘reasonable belief’, and if you have a reasonable belief that a doctor may be unable to perform the functions required for the practice of medicine, the obligation to notify takes effect.
If the threshold for notifying is reached and you haven’t notified Council, this could be seen to be a breach of professional obligation, and give rise to disciplinary proceedings.
Supporting the obligation to notify, the HPCAA provides protection for those notifying. It states that ‘No civil or disciplinary proceedings lie against any person in respect of a notice given under this section by that person, unless the person has acted in bad faith’.
Threshold for notification
If you are having trouble deciding whether the threshold for notification has been reached the information below may assist you.
Factors that could help you decide are:
- The HPCAA provides for someone who is contemplating referral to seek other professional opinions to help them make their decision to notify us.
- You cannot be liable for making the notification if you act with best intentions.
Factors that could suggest that the threshold for notification is reached include:
- is any suspected condition, or consequent behaviour and conduct, actually impacting on the doctor’s practice, even if that hasn’t necessarily had an adverse impact on patients to date?
- are you concerned that a health problem exists that is not being acknowledged and addressed, and that has the capacity to affect the doctor’s practice without effective intervention?
- have any local interventions failed?
- is the condition the doctor has a relapsing one, and might there be the potential for this to have a greater impact on their capacity to practise in a more independent role, or if they move away from their existing supports?
- should any other workplace know about the doctor’s health problem, and be aware of its potential to impact on their practice?
- is any behaviour or conduct a one-off incident, or is there a pattern emerging that may be attributable to an illness process?
- is there a risk to the doctor themselves? How big is that risk, and how serious would the consequences be for the doctor and their colleagues?
The doctor’s level of insight will always be a critical factor to be taken into account, especially a lack of insight about the capacity for a condition to impact on their ability to practise, or if they have a newly diagnosed condition and they are still learning to integrate this into their everyday life and their practice.
Other factors that may be relevant when deciding whether or not to involve Council
Again, the doctor’s level of insight will be a critical factor, irrespective of whether they have a chronic, relapsing, or progressive illness.
If you are satisfied that:
- the condition is likely to be short lived, and respond quickly to treatment with a full recovery, with any consequent risks to patients be managed during treatment and recovery, for example with sick leave or modified hours or duties for a short period.
- the behaviour or conduct causing concern is likely to be due to personality disorder or dysfunction, which can being managed through the employer’s HR processes
- the doctor has a good understanding of any condition they have, and its capacity to impact on their practice
- there are no concerns about their compliance with, or readiness to access, any treatment required
- they have good supports in place
Things that demonstrate the last three points would include the doctor's acceptance that they have a condition that needs to be managed, their willingness to share information with others as appropriate, how they monitor their own health and responses, and what feedback they seek on these.
Can I discuss my concerns with the Council before making a notification?
A conversation is usually helpful, even if it needs to be hypothetical initially. Options for managing an issue can be discussed, along with the threshold for referral to the Council. You can speak to someone at the Council office by phoning 0800 286 801, and asking to speak to one of Council’s Health Case Managers or to the Health Manager. They can also discuss with you the scope of any report you might need to make, and how that can be submitted.
What external advice can I get?
Under the HPCAA, anyone considering making a notice is entitled to seek medical advice to assist them in forming an opinion, for example, through occupational health, independent doctors, or treating doctors. Any formal notice to the Council made subsequently must state whether such advice has been obtained.
You always have the option of getting advice about a particular situation or concern relating to yourself, or a colleague or doctor, from your medico-legal indemnity insurer. Your insurers have a lot of knowledge and experience on health problems and how they affect a doctor’s practice.
Within a larger practice setting, for example a hospital, or a large general practice, you should also use the clinical governance process, for example talking to the clinical director, the director of training, or the chief medical officer.
Will the doctor be told I notified the Council?
We usually let the doctor know your name and the concerns you have raised with us. We cannot act on anonymous concerns, however you can call us and talk about any concerns you have and how they might be managed.
How would a notification affect what action an employer might want to take?
If a concern is notified or referred to the Council, this doesn’t need to interfere with an employer’s usual HR, clinical governance, or occupation health processes, which can occur simultaneously. Likewise private hospitals can review any current privileges.
How to notify us of a concern
You can use any means from our contact us page.
Health concerns are directed to the Medical Council's Registrar. You may email directly using firstname.lastname@example.org
The Registrar passes the notification to our Health Team, who will speak to the person who made the notification, and then contact the doctor to follow up the concerns.
The Health Committee, which has 4 members of our Council, one of whom is a lay person, then assesses and reviews the concerns and makes decisions on the course of action. It uses an established assessment and rehabilitation process.
Our Health Committee is:
- Dr Jonathan Fox
- Dr Allen Fraser
- Laura Mueller
- Professor Dick Sainsbury
What happens when a potential conflict of interest arises with one of the Health Committee members.
These arise from time to time as New Zealand is a small country, so we are used to managing these. If there is a known conflict of interest with one of the Health Committee members, you need to tell us in the notification, or alert your Health Case Manager. A Health Committee member might be aware of a potential conflict of interest, and we will discuss that with you to get your views.
While that particular member will be aware that you have a current involvement with the Health Committee, they will have no details, and they will not be privy to any discussion, or participate in any decision making.
Conditions that may impair a doctor’s ability to perform those functions include:
- alcohol or drug dependence
- psychiatric problems
- temporary stress reaction
- infection with a transmissible disease
- declining competence due to age related loss of motor skills or the early stages of dementia