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Competency 4 – Maintaining relationship with patients:Recognise situations where personal health and safety is at risk or

Objective: to ensure the appreciation of the professional position of the OH advisor, employer and employees



Student activity.

John is a good friend of yours. You shared a house as a medical student and you are both now working in the same hospital for your second F1 post. Although John had always been quiet and studious and took life seriously he would always come out for a drink or socialise with the rest of your group. The trouble now is that John seems never to be around. At work he is always rushing from one place to another and has started to look a bit unkempt. He never comes for coffee and seems to be working much later than everyone else. You have started to hear rumours from the nurses that hes become a bit unreliable. He doesn’t seem to answer his bleep. He shouted at one of the ward clerks which was really out of character. You try and find him over a lunch time and find him surrounded by notes and looking dreadful.

For discussion as a group or for individual student reflection:


What are the possible problems John might be encountering?


Consider mental health problems.

1. Stress or anxiety

John might be finding the workload too much or might have personal issues that are interfering with his ability to manage at the moment.

2. Depressive illness

John might have developed an episode of depression. This could be have been precipitated by external influences, such as workload or social influences.

3. Underlying mental health problems.

John might have suffered from mental ill health in the past such as bipolar disorder and his situation has exacerbated his symptoms.

4. Substance abuse

John might be drinking excessively or be using drugs.

5. Physical ill health

John might be suffering from physical disease that as yet has been undiagnosed for example, thyroid disease, diabetes.


Should you talk to John? If you do what might you say?


Yes, as a colleague and friend you should talk to John. He is obviously struggling with his health as well as his performance.

You might want to mention some of the following

  • You are concerned about his well being
  • You have noticed he is struggling
  • You advise he sees his own doctor
  • You advise he sees occupational health
  • You advise he speaks to his supervising consultant

John says very little and you leave him saying you will catch up with him soon.

Two weeks later: (two possible scenarios)

Scenario 1.

You go on to the ward and find John at the nurse’s station staring in to the distance surrounded by paper work and his bleep going off.


What do you do?


The discussion here should relate to:

John’s own health and well being.

Is John now unwell and in need of medical support and advice?

  • He probably is but you still don’t know the underlying reasons.

If he is unwell, how should he access advice?

  • He should go and see his own GP. He should also make an appointment to see occupational health that might be able to support him in work and offer advice.

What should you do?

  • You should try and persuade him to go and see his GP or occupational health
  • If you are very concerned you could suggest he should leave the ward and go and see his supervising consultant or occupational health that day.

The safety of patients and colleagues

Is John now a risk to patient safety?

      • This should be explored with the students. It is possible that he could be. If he is not coping with the workload for what ever reason, he may be putting patients at risk and well as his own health and safety.

Scenario 2.

You go over to John’s house to see how he is. You walk in to his lounge and find lots of empty beer cans and evidence that he has been injecting himself.


What do you do?

This requires discussion around:

1. The ethical issues

  • What responsibilities do you have as a physician in managing such issues?
  • Who should you inform?

See: The GMC guidance notes.

2. John’s health and well being

As discussed in scenario 1. The issues here are similar.

  • What type of support should John initially seek?
  • What specialist support might be available to him?

3. Patient safety

John is now a potential risk to his patients not just from his decreasing reliability and ability to manage his job effectively but also from the risk of exposure to blood borne viruses such as hepatitis B. The risk to patients and colleagues is now much higher than in the previous scenario. Therefore the action required must take this into account.


What is the action you should take?


You should follow the advice in Good Medical Practice, which states: You must support colleagues who have problems with performance, conduct or health.

You should therefore inform John that you are concerned about his behaviour and health and that you will have to discuss this with his supervising consultant because of the seriousness of your concerns.


What might be the action the hospital takes when they become aware of John’s problem?


John would either be placed on sick leave or suspended depending on the situation.