Health concerns about a doctor
Doctors get sick too, and when they do it's important that their illness doesn't interfere with their ability to practise medicine safely. A doctor must always be able to practise medicine without putting patients or the public at risk.
Introduction
If a doctor has a treatable illness they can often continue practising while being treated, if they are treated swiftly. Any delay could affect patient care, and could also affect the doctor professionally and personally.
If you're concerned about a doctor's physical or mental health, it's important that you let us know as soon as possible - our Health Team and Health Committee will deal with the situation appropriately.
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'.
How we define the 'ability to perform the functions required to practise medicine'
Whether a doctor is in good health or has a health problem, a practising doctor must always 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.
Conditions affecting a doctor's ability to perform
These may prevent a doctor practising medicine safely:
- alcohol or drug dependence
- any impairment that occurs as a result of drug or alcohol abuse
- psychiatric problems
- temporary stress reaction
- infection with a transmissible disease
- medical conditions affecting motor skills or cognition.
Practising certificate health disclosures
Important information relating to health disclosures on practising certificates.
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This guide provides important information relating to health disclosures on practising certificates.
Letting us know about an unwell doctor: notification
If you are a member of the public :
- please notify us using via our contact us page, or you can email the Registrar directly using health@mcnz.org.nz.
However, if you are:
- a doctor
- the doctor's employer
- any registered health practitioner
- anyone in charge of an organisation that a provides health services
- a person in charge of an educational programme or course who believes a student may be unable to practise medicine safely,
you must (by law) notify us of your concerns.
We understand it's difficult to raise concerns about a colleague or doctor in these circumstances. However, every doctor has a responsibility to tell us about a colleague/doctor who may be unable to practise safely. Without help and support, an unfit colleague or doctor puts the community, the profession, and their reputation at risk.
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Tell us who you are so we can better direct your enquiry
What happens if I do not notify the Council of my concerns?
If you have reasonable belief that a doctor may be unable to perform the functions required for the practise of medicine, you must notify the Council. If you have reasonable belief and don't notify us, you may be in breach of your professional obligation, and you could face disciplinary proceedings.
However, when you do notify us, the HPCAA provides protection for you, as long as you have acted in good faith. 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’.
How do I decide whether my concerns are sufficient to notify the Council?
Sometimes it's hard to decide whether your concerns constitute 'reasonable belief'. If you're not sure, the information below may help you decide.
- Do you believe that the doctor's suspected condition, or consequent behaviour and conduct, is affecting the doctor’s practice, even if it hasn’t necessarily affected any patients yet?
- Do you believe that the doctor has a health problem which, without effective intervention, may affect their practice?
- Have any local interventions failed?
- Is the condition the doctor has a relapsing one, and could this affect their ability to practise independently if they had no support?
- Should any other workplace know about the doctor’s health problem and its potential to impact on their practice?
- Is the doctor's behaviour or conduct a one-off incident, or is there a pattern emerging that may be due to an illness?
- Is there a risk to the doctor? How big is that risk, and how serious would the consequences be for the doctor and their colleagues?
It's critical to assess the doctor’s own awareness too: particularly if they seem unaware their condition may affect their ability to practise. Consider too, is this a newly diagnosed condition which they are still learning to integrate into their everyday life and practice?
Other things to consider before you notify the Council
- Is the condition likely to be short lived and respond quickly to treatment; would the doctor fully recover?
- Can any risks to patients be managed during treatment and recovery, for example with sick leave or modified hours?
- Is the behaviour or conduct causing concern likely due to a personality disorder or dysfunction, could that be managed through the doctor's employer HR processes?
- Does the doctor accept they have a condition that needs to be managed and are they willing to discuss it?
- Does the doctor have a good understanding of their condition and its potential impact on their practice?
- Are you concerned about the doctor's readiness to accept or comply with any treatment that may be required?
- Does the doctor have good support in place?
Again, the doctor’s level of insight will be a critical factor, irrespective of whether they have a chronic, relapsing, or progressive illness.
Always bear in mind:
- the HPCAA allows you to seek other professional opinions before you decide whether to notify us
- if you act in good faith, you cannot be liable for making a notification.
Can I discuss my concerns with the Council before making a notification?
Yes. Great idea. It's always good to talk and it's usually helpful even if the conversation is hypothetical at first. We can discuss your 'reasonable belief', as well as various options for managing an issue. Call the Council office on 0800 286 801, and ask to speak to one of our Health Case Managers or the Health Manager. They will also talk to you about any reports you might need to submit.
What external advice can I get?
If you are considering making a notification, under the HPCAA you can seek medical advice to help you decide. You may want advice from occupational health, independent doctors, or treating doctors for example. If you then formally notify the Council, you must let us know that you obtained this advice.
You can also get advice 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.
In a larger practice setting, such as a hospital, or a large general practice, you should also talk to the clinical director, the director of training, or the chief medical officer, or occupational health if that is available.
Will the doctor be told I notified the Council?
Usually. Our aim is to work openly with doctors, so we will almost always give the doctor a copy of your concerns (with your personal contact details redacted if necessary). We cannot act on anonymous concerns, but you can call us and talk about any concerns you have and how they might be managed.
Does a notification affect what action an employer or private hospital might want to take?
Not necessarily. If the Council receives notification about a concern, an employer can still follow their usual HR, clinical governance, or occupation health processes.
How can I notify the Council of my 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 health@mcnz.org.nz.
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Tell us who you are so we can better direct your enquiry
Notification management: what happens
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 on the concerns.
The Health Committee then assesses and reviews the concerns and decides on the course of action following an established assessment and rehabilitation process.
The Health Committee is typically made up of five members of our Council, two of whom are lay people. Our current Health Committee is:
- Dr Stephen Child
- Dr Ainsley Goodman (Chairperson)
- Dr Charles Hornabrook
- Dr David Ivory
- Simon Watt
- Dr Rachelle Love, Council Chair, is an ex-officio member of the Committee.
What if there's a potential conflict of interest with one of the Health Committee members?
This does happen from time to time as New Zealand is a small country. If you know of a potential conflict of interest with one of the Health Committee members you must tell us in the notification, or alert your Health Case Manager.
That Committee member will know that you have a current involvement with the Health Committee, but they will have no details, and they will not be privy to any discussion, or participate in any decision making.
More information about health concerns
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If a doctor has an issue with their own health, wherever possible we try to help them to remain in practice while it is being resolved. That said, our primary objective is to protect the health and safety of the public - which may mean that the doctor will be unable to practise safely, or will be limited in what they can do, until they are well enough to fully resume practice.
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A notification around concerns about your health is different from one about conduct, and our approach to dealing with it it is non-judgmental and focuses on your rehabilitation and the safety of patients and people you come into contact with.