Modules

Mental health

Depression in a colleague

The following conversation takes place in the staff room of a family practice clinic.

  • (there is a knock on the door)

    Tom: Dennis, can I see you for a minute?

    Dennis: Yeah.

    Tom: You weren’t in again this morning. Is everything okay?

    Dennis: Yeah, uh, I just, uh, couldn’t make it.

    Tom: You know, we’ve had to cover a lot for you lately, uh, and this just isn’t like you.

    Dennis: Uh, sorry about that.

    Tom: Did you get the message from the pharmacist?

    Dennis: No, I haven’t checked my messages.

    Tom: Well, it seems that you wrote a prescription for triple the dose for one of your patients. You know, we’re really all concerned for you.

    (Dennis sighs)

    You’ve been making a lot of mistakes lately.

    (Dennis sighs again)

    Dennis …

    Dennis: Ah, I’m okay, I’m okay.

    Tom: Have you seen anyone about how you’ve been feeling lately?

    Dennis: No.

    Tom: Well, I don’t want to pry, but like, how are things going at home?

    Dennis: Uh, I don’t know, I, I just can’t get going. You know, nothing seems important. Sheila’s had enough. I … I just uh …

    Tom: I understand.

    (Dennis sighs)

    Tom: You know, I’m really concerned that you’re depressed. You know, we’re all concerned for you, eh. I’ve got to ask you, like have you ever thought about ending your life.

    Dennis: Well, sometimes I wonder what the point is, you know. Sometimes I just think it would be better if I didn’t wake up.

    Tom: Well, when you say sometimes you think it would be better if I just didn’t wake up, have you made a plan of ending your life?

    Dennis: No, nothing like that.

    Tom: You know Dennis, you just can’t carry on like this. You wouldn’t want your patients to see you when you’re in this kind of condition. You know, I … I … you’ve got to see someone.

    Dennis: I can’t see someone. Who am I going to see? Everybody knows me.

    Tom: Dennis there is nothing to be embarrassed about. As you know, this is an illness. If one of your patients came in to see you and uh, they were feeling like this, you would certainly insist that they get help.

    (Dennis sighs)

    Tom: Dennis, you know, you just can’t work while you are in this condition. I’m sorry, my friend. Are you okay?

    Dennis: Yeah, I’m okay.

Commentary on: Depression in a colleague

In this scenario a physician is clinically depressed and unable to function.

  • What is the responsibility of the impaired physician?
    • To himself?
    • To his patients?
  • What is the responsibility of his concerned colleague?
    • To his colleague?
    • To his colleague’s patients?
  • Does his behaviour constitute professional misconduct?
  • To whom should his colleague speak about the situation?
  • How might the situation differ if he was practicing solo?
  • What support services are available for impaired physicians?

Dealing with an impaired or incompetent colleague is extremely difficult. There is a general impression that physicians consider themselves invulnerable to the ills of other human beings. Thus, they may fail to recognize deficiencies in their professional conduct due to ill health, age or substance abuse. Even if the problem is recognized, pride may prevent the physician from seeking help, as in this case.

As a self-regulating professional, the physician has the duty to his patients to provide the highest quality care. If he cannot do this due to ill health, he has an ethical duty to see that his patients are properly cared for by others, until he is capable again.

It is also generally believed that physicians tend not to report colleagues who are possibly incapacitated or incompetent: “After all, it could be me next. That really wasn’t incompetence; he just made a mistake.”

However, as a self-regulating professional with a duty to society, the concerned colleague, Tom, behaves appropriately in discussing the situation with Dennis. Tom indicates that he feels that Dennis is unable to practice until treated for his depression. Does the concerned colleague have any responsibility to his colleague’s patients? Yes, but only in the sense of general accountability to society as a member of the profession. He has no fiduciary relationship to his colleague’s patients.

What should he do if his depressed friend refuses to stop practicing and seek help? (Reporting requirements vary among provinces and territories. Consult your medical regulatory authority guidelines for more information.) Clearly, in this instance, Dennis’ colleagues have been aware of the situation and have been covering for the incapacitated physician. This code of silence cannot be maintained indefinitely. Are there more senior heads of programs or institutional administrators who should be aware of the situation and who might be able to intervene?

Most provinces and territories have a physician health program in place where support services for impaired physicians are available.


 

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