Health guidance for trainers

Doctors are no less vulnerable than others to physical and psychological health problems, including depression, stress, and alcohol and substance misuse. There are specific issues regarding use and misuse of self medication.

Doctors can frequently obtain prompt, but informal specialist advice from colleagues about specific medical problems. However, a fine line exists between the  appropriate use of the resource that colleagues provide on the one hand, and self diagnosis, investigation and treatment on the other.

'Occupational health advice for educators' is a leaflet produced by Oxford University Hospitals Trust and endorsed by Occupational Health departments throughout the Deanery.

The impact of health problems on employment
Although many health problems are minor and self limiting, the following situations require pro-active management with Occupational Health input:

  • Long term sickness absence
  • Recurrent short term sickness absence
  • Unsatisfactory performance or poor behaviour at work

Proactive management
There is significant evidence that early Occupational Health intervention and proactive management are associated with a greater chance of satisfactory outcome for both the junior doctor and the organisation. Medical staff are more likely to by-pass such active management for a variety of reasons, including:

  • Informal cover arrangements may not be notified to medical staffing (but possibly are to the switchboard)
  • The statutory requirement to submit a self-certification form for an absence of longer than three days  is not always enforced.
  • For absences exceeding seven days, a certificate would usually be required from a doctor. In some instances, medical staff, particularly doctors in training, may have difficulty registering with, or obtaining an appointment with a GP.
  • It may not be entirely clear who is responsible for managing absence. Candidates include: a: The Clinical Director or Lead Consultant; b: The Unit General Manager; c: The Clinical Tutor
  • Doctors may be unhappy about admitting personal, health, and work related problems to colleagues, particularly if they are of a psychological nature.
  • In some directorates, there may be personality clashes between individuals. This may inhibit effective and impartial management of such issues (and exceptionally, may contribute to them).
  • There may be a 'culture of colluision' whereby it is felt that minor problems can be contained within a tight network of mutually supportive colleagues.
  • Misconceptions about the role and independence of Occupational Health.

Sickness and absence management recommendations
It is recommended that the Clinical Director is the most appropriate person to manage these issues.
Sickness Absence, including Long Term Absence

  • Absences of more than one programmed activity must be notified by the doctor concerned to the Clinical Director and Medical Staffing.
  • Absences of longer than three days must be supported by a self-certification form (SC1) obtainable from the medical clinical tutor.
  • Absence exceeding seven days must be supported by a doctor's certificate (Med3Fit Note) obtainable from the staff member's GP. This should submitted in the first instance, to the Clinical Director, who will pass it on to medical staffing.
  • In the case of absences likely to exceed two weeks, the Clinical Director will notify the Occupational Health Department, and will seek advice about whether referral for an Occupational Health opinion is desirable.

Frequent short-term absences

  • It would be appropriate for any doctor who is absent on four or more occasions in any six-month period, to be referred to Occupational Health (or in accordance with local Trust sickness absence management policy)
  • It would be appropriate for any doctor who is absent on two or more occasions, that include out of hours on-call, to be referred to Occupational Health.
  • The purpose of such referral is primarily, to identify any underlying health problem with which the doctor may need assistance. However, if there was any suggestion that an employee was abusing the goodwill of colleagues, it may be a means of sending a message that the absence has not gone unnoticed.

Unsatisfactory behaviour or poor performance at work

  • Occasionally, underlying medical problems such as depression, may have a significant, adverse impact upon performance and effectiveness at work. Tthis in turn may result in a failure to achieve certain standards or competencies within an expected time frame.
  • If unsatisfactory behaviour and / or poor performance are identified in a junior doctor, particularly when this represents a change from previous patterns, it is recommended that they be referred to Occupational Health for assessment.

 Referral process to Occupational Health

  • Reason for the referral should be discussed with the junior doctor and an appointment should be made by telephone. The confidential and independent role of Occupational Health should be stressed.
  • Write a referral letter to Occupational Health. It is recommended that the junior doctor be given a copy of the referral letter.

Occupational Health Assessment

  • The Occupational Health physician (ideally consultant), will see the junior doctor for assessment. If no consultant is available locally, the junior doctor will be referred to another Occupational Health Department within the Deanery.
  • Where appropriate, the Occupational Health physician will seek consent to obtain medical records regarding the junior doctor from their GP, consultant, or allied health care professional.
  • Where appropriate, the Occupational Health physician may liaise with the GP or other specialists, to recommend, or try to expedite treatment.
  • Where appropriate, the Occupational Health physician may recommend counselling, or other local services, for example Staff Physiotherapy, or work related counselling.
  • In some cases, it may be necessary to involve the District Clinical Tutor regarding implications for training, including support of Regional Specialty Advisors, and / or Post Graduate Dean.
  • Recommendations arising from this assessment will be made by letter to the Clinical Director and copied to the junior doctor. These may include advice about:
    • Fitness for work
    • If unfit, likely duration of absence
    • Liaison with GP and / or other specialists regarding accessing correct treatment
    • Equality Act 2010 and associated recommended accommodation
    • Return to work plan, including measures that may need to be considered to support the doctor on his / her return, and any other limitations or restrictions
  • Medical staffing will be informed by letter as to the ongoing length of sickness absence.
  • Where a doctor has a chronic disabling condition, the Consultant Occupational Health physician will liaise with the Clinical Director and a senior representative of the Human Resources department, in order to ensure that appropriate support, in accordance with any governance requirements, is mobilised.
  • The Occupational Health physician may arrange to review the junior doctor for ongoing help and support.