Guidance for trainers managing health problems
Background
The impact of health problems on employment
Proactive management
Sickness absence management recommendations
Referral process to Occupational Health
Occupational Health Assessment
Medic Support
FAQs on Disability Discrimination Act 1995 (DDA)
Background
It's known that medical staff don't make good patients, and often invoke their own rules regarding their ill health management. Justification for this approach has included a desire not to let colleagues or patients down, a fear that the entire organisation will collapse without the continuous input of the affected practitioner, and concerns about references.
Doctors are no less vulnerable than others to physical and psychological health problems, including depression, stress, 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 may exist between the appropriate use of the resource that colleagues provide on the one hand and self-diagnosis, investigation and treatment on the other.
The impact of health problems on employment
Although many health problems are minor and self-limiting, the following situations need 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 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 longer than three days is not always enforced.
- Similarly, for absences exceeding seven days a certificate would normally 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, which may inhibit effective and impartial management of such issues (and exceptionally may contribute to them).
- There may be a "culture of collusion" 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 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
- Any absence of more than one programmed activity must be notified by the doctor concerned to the Clinical Director and Medical Staffing.
- Any absence of longer than three days must be supported by a self-certification form (SC1) obtainable from Medical Staffing. It should be submitted in the first instance to the clinical director who will pass it on to medical staffing, and inform the clinical tutor.
- Any absence exceeding seven days must be supported by a doctor's certificate (Med3) obtainable from the staff member's GP. It should be submitted in the first instance to the clinical director who will pass it on to medical staffing.
- In the case of any absence 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 on performance and effectiveness at work. This 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
Discuss reasons for referral with junior doctor and phone to make an appointment. It is important to stress the confidential and independent role of Occupational Health.
Write referral letter to Occupation Health, using the template referral letter as a guide if necessary. 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 could be referred to another Occupational Health Department within the Deanery.
- Where appropriate the Occupational Health Physician will seek consent to obtain medical reports 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 via Medic Support (see details below) or other local services eg 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 Speciality Advisors and/or Post Graduate Dean. This may include referral to the Deanery Career Development Unit.
- 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:
a. Fitness for work
b. If unfit, likely duration of absence
c. Liaison with GP and /or other specialists regarding accessing correct treatment
d. Disability Discrimination Act and associated recommended accommodations
e. Return to work plan, including measures that may need to be considered to support the doctor on his / her return and any other relevant 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.
Doctors rotating between Trusts in the Deanery
It is not uncommon that a junior doctor will need to move to another phase of his/her rotation in the middle of Occupational Health assessment and follow up. In this situation the Occupational Health Physician will request written consent from the doctor to pass on medical details to the next Trust's Occupational Health Department.
Medic Support offers free, confidential staff support to doctors in training in the Oxford Deanery. Doctors can self-refer or be referred by their clinical tutors and others. Medic Support is particularly able to help with a range of emotional or mild mental health problems.
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