Anaesthetists

(f) Postgraduate Medical Deans, Specialty Advisors,  College

Tutors, Regional Advisors

The role of the Postgraduate Medical Deans is in a transitional

phase  but  within  it  there  may  be  an  opportunity  for

developments  in  ways  which  could  assist  with  some  of  the

problems of stressed and sick doctors.  Postgraduate Deans will

have many points of contact with trainees and  with  all  bodies

affecting trainees and could have a pivotal responsibility in their

welfare.    In  anaesthesia  the  network  of  Specialty  Advisors,

SECTION V - STRESS SUPPORT

21

College Tutors and Regional Advisors have obviously also a close

involvement and liaison with trainees and through them with the

staff of many hospitals.  

These  roles,  while  primarily  involved  with  training,  have

therefore,  considerable  potential  for  helping  with  the  early

identification  of  problems,  in  particular  with  stress  related

disorders in trainees.  It seems clear that the origins  of  stress-

related disorders in doctors often lie in the early  part  of  their

careers.    Postgraduate  Deans  should  check  that  Trusts  do

everything  in  their  power  to  give  doctors  in  training  an

environment  in  which  they  can  learn  successfully,  including

support  in  coping  with  the  stresses  of  their  clinical

responsibilities.

(g) National Counselling Service for Sick Doctors (NCSSD)

The NCSSD was set up in 1986 as an independent body to provide

a  non-coercive  advisory  service  to  any  doctor  in  the  United

Kingdom  who  is  unable,  for  mental  or  physical  reasons  to

perform his work adequately.  Most doctors who fall ill in ways

which impair their fitness to practice are aware of the problem

and take appropriate steps.  A minority, through lack of insight

or for other reasons,  continue  to  work  in  the  face  of  serious

difficulties.    The  primary  aim  of  the  NCSSD  is  to  persuade

doctors in need of help to seek appropriate treatment.

The NCSSD provides a service for all doctors, equivalent to the

Association’s Sick Doctor Scheme for anaesthetists.  If a doctor

is concerned about his health or that of a colleague and wishes to

seek advice from the Counselling service this can be accessed via

a National Contact Point. They are then given the name of a

national  adviser  who  will  be  a  senior  member  of  the  same

specialty as the ‘sick doctor’.  The Adviser verifies the nature of

the problem and may then decide to recruit appropriate help as a

counsellor.  Once a counsellor has taken on the sick doctor, the

Adviser will withdraw and the care of the sick doctor will revert

to  a  normal  confidential  patient/doctor  relationship.    No

permanent  records  are  kept  of  the  transactions.    If  the  sick

doctor  refuses  the  proffered  help  the  referring  colleague  is

informed and the matter, so far as the NCSSD is concerned, is

closed.

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22

Unfortunately the NCSSD is not as widely known as it deserves

and so far the service has not been used as widely as hoped.

(h) General Medical Council

Use of the support mechanisms discussed so far has been largely

dependent on self referral or voluntary utilisation. The list is not

exhaustive or exclusive.  The other very important body and the

one with statutory powers is the General Medical Council.  Most

problems can be resolved without recourse to the  GMC  but  an

understanding of its role is appropriate.

There is evidently a widespread reluctance to refer cases to the

GMC  though  those  familiar  with  the  GMC  believe  that  it

performs  its  statutory  functions  with  skill  and  humanity.

However, the GMC’s association with maintaining standards and

its  disciplinary  role  make  it,  for  the  majority  of  the  medical

profession,  a  remote  and  possibly  somewhat  frightening  body

with the power of depriving doctors of their livelihood.    Thus

doctors may fear that in reporting a colleague to the GMC, this

may endanger their employment.

It is necessary for the GMC to differentiate between the doctor

who is ill and the doctor who is incompetent.  The GMC health

procedures can achieve very satisfactory outcomes, but referrals

to them by colleagues are few.

Medical practitioners are licensed by the GMC under the Medical

Act of 1993.  Under Section 37 of  the  Act,  if  the  fitness  to

practise of any doctor whether fully or provisionally registered or

with limited registration ‘is judged by the Health Committee to be

seriously impaired by reason of his physical or mental condition’,

the GMC can direct the suspension of registration or conditional

registration of the doctor involved.  Doctors may appeal against

directions for erasure, suspension or conditional registration, but

Section 38 (1) provides that the professional conduct and health

committees  have  the  power  to  order  immediate  suspension

pending  appeal  if  the  decision  was  erasure  or  suspension  ‘if

satisfied that to do so is necessary for the protection of members

of the public or would be in the best interests  of  that  person’

(that is the doctor).

SECTION V - STRESS SUPPORT

23

A  recent  amendment  to  the  Medical  Act  means  that  the

practitioner  may  now  be  referred  to  the  GMC  Performance

Committee which will review practices so far below par as to put

patients’ safety at risk. In the same way, investigations of this

Committee could lead to a doctor’s name being erased from the

register,  suspended  from  the  register  or  registration  being

permitted to continue only on stated conditions.  

The GMC procedure begins with a preliminary screening followed

by an assessment of performance, remedial action, reassessment

and finally referral to the professional performance committee.

A panel of two anaesthetists and one lay person will be involved

in the investigation of the complaint and will make a report after

the assessment of performance.

3.

Conclusion

Doctors have a responsibility to minimise stress in  the  work  place

though the doctor’s health is basically the responsibility of the doctor

himself.  The provision of medical services for sick doctors is a safety

net.  The importance of a good general practitioner is fundamental

and the advice to consult  with  them  and  be  treated  through  them

cannot be overemphasised.  Self treatment and self prescription are

unwise.  Most of the mechanisms which are presented as  providing

support for sick doctors start  from  the  initial  purpose  of  ensuring

patient  safety.    If  all  else  fails,  the  doctor  whose  performance  is

impaired  by  health  and  related  problems  can  be  reported  to  the

appropriate authorities and ultimately referred to the GMC.

The current and continuing structural changes in the NHS make this

advice all the more important.  Doctors still have the opportunity to

be, to some extent, self regulatory.

The behaviour of doctors over many years has largely dictated  the

way in which they respond to the stress which is inherent  in  their

work  and  which  can  lead  to  breakdown  and  ill  health.    It  is

acknowledged that the example and  expectations  of  senior  doctors

must influence the behaviour of their juniors and students  and  that

peer group pressures are of great significance.  In particular, the way

that doctors’ work is organised is a main cause both of stress and of

their ‘denial of sickness’ behaviour.

SECTION V - STRESS SUPPORT

24

There is much less flexibility in the  way  an  anaesthetist’s  work  is

organised than is usually the case for other specialties.  Operating lists

are difficult to rearrange and doctors are conscious that if they take

time  off  because  of  illness  or  any  other  cause,  colleagues  whose

workload is already onerous will have to cover for them.

Ways  of  dealing  with  these  problems  have  to  be  devised.  Some

directorates  manage  this  situation  in  an  exemplary  manner.    The

Association of Anaesthetists of Great Britain and Ireland can provide

confidential guidance in all these matters.

APPENDIX 1 - VOLUNTARY AGENCIES

25

APPENDIX 1 - VOLUNTARY AGENCIES

1.  The Sick Doctor Scheme, Association of Anaesthetists of Great

Britain and Ireland.

Confidential access at:

The Association of Anaesthetists of Great Britain and Ireland,

9 Bedford Square,

LONDON WC1B 3RA.

Tel: [phone] (0900 to 1730).

2.

The National Counselling Service for Sick Doctors

National telephone contact point on 0171 935 5982.

Further information from:

The Chairman, National Management Committee,

National Counselling and Welfare Service for Sick Doctors,

1 Park Square West,

LONDON NW1 4LJ.

3.

Drinkline (National Alcohol Helpline) 0345 320202

4.

Sick  Doctor’s  Trust  (helpline  for  addicted  physicians)  01252

345163

5.

Local services, Church support.

6.

Work based support: Occupational Health Services

7.  Saneline 0171 724 8000

8.  Support for Re-training.  

The General Medical Council aims to work with the co - operation of

doctors, to encourage remedial action and rehabilitation. 0171 915

3642.

9.

British  Medical  Association  Stress  Counselling  Service  for

Doctors.

0645 200169.  This is a 24 hour a day all the year round service.

REFERENCES

26

REFERENCES

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Friedman, M., Roseman, RH.  Type A behaviour pattern: Its

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3.

Caplan, RP.  Stress, Anxiety and Depression in hospital consultants,

general practitioners and senior health service managers.  British

Medical Journal 1994; 304: 1261-1263

4.

Linkman Conference, Association of Anaesthetists of Great Britain

and Ireland 1995, Birmingham.

5.

Dickson, DE.  Stress.  Anaesthesia (Ed) 1996; 51: 523-4.

6.

Seeley, HF., The practice of Anaesthesia - a stressor for the middle

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7.

Neil, HA, Fairer, JG, et al.  Mortality among male anaesthetists in the

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360-2.

8.

Burke, RJ.  Occupational and life stress and family: conceptual

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