Connect
MJA
MJA

Return to work for junior doctors after ill-health

Jillann F Farmer
Med J Aust 2002; 177 (1): S27. || doi: 10.5694/j.1326-5377.2002.tb04629.x
Published online: 1 July 2002
Case histories

The following case histories illustrate the work of the program with doctors recovering from drug misuse and/or mental illness.

Identifying details have been altered in the interests of practitioner confidentiality. However, details pertaining to significant events, milestones, Board intervention and outcomes have been reported as accurately as is compatible with maintaining confidentiality.

Case 1

This young doctor (less than two years after graduation) was rostered to cover ICU alone, with a consultant on remote call. In an endeavour to control stress-related symptoms, he treated himself with benzodiazepines. Their use escalated, as did his symptoms of poor sleep, poor appetite, weight loss and social withdrawal. Recognising that his symptoms were worsening, he sought relief in S8 drugs, which he obtained from the operating theatres (adjacent to ICU). His drug misuse continued (varying in severity) over several years. He was eventually found unconscious in the theatre change rooms.

The Board was notified. His primary and most urgent need was for detoxification because of long-term misuse of benzodiazepines and opiates. Once this had been undertaken, an assessment of his fitness to practise was arranged by the Board.

A minimum of three months off work was needed, but he had no income protection. Showing considerable initiative (particularly given the severity of his illness), he started a dog-grooming business, and managed to support himself through a lengthy period of time out of the medical workforce.

When his medical condition had stabilised, he secured a new medical post with Board support. He was required to fully disclose his medical history to his supervisor, to undergo random urine drug screening (up to 16 tests per month), and was subject to monthly workplace reports from his supervisor to the Board. With the passage of time, reporting and testing requirements have been gradually reduced. He is progressing very well, and there has been no relapse.

Case 2

This intern developed bipolar illness in the intern year. She was absent from work for three months, and then attempted re-entry. She relapsed and, on medical advice, abandoned her internship.

When referred to the Board, she was working in an unskilled, casual position in the hospitality industry. Five years had elapsed and she had been stable for three of those five years.

The Board organised a three-month placement for a training clerkship. The hospital was so impressed they offered her a job. She is now in her Senior House Officer year, and has been receiving excellent reports — "She is the best resident I have ever had". As with most practitioners with bipolar affective disorder managed by the Board, it has been necessary to have a long-term prohibition on night duty.

After so long "in the wilderness", this young woman has so much to contribute. There have been intermittent relapses, but she has the insight to manage these, and appropriately withdraws herself from the workforce.

Case 3

This student developed a psychotic illness in sixth year. He took antipsychotic medications for four months and then withdrew at the beginning of his intern year. He then had a relapse and took nine months off. The hospital was very supportive, but when he started his internship again he received very negative reports.

He tried a new placement with a different employer so he could get a more objective assessment, but the negative reports continued. After six months, he had a meeting with the Director of Clinical Training, the Medical Education Officer and the Consultant. He decided to abandon internship, disclosing a dulling of cognition when taking antipsychotics.

Three weeks later he phoned, relieved and grateful to be off the treadmill. He planned to resume his previous passions for mathematics and languages.

His family needed debriefing, which, although outside the Board's brief, was provided with the doctor's consent. They experienced great difficulty coming to terms with what had happened to their wonderful, talented son.

The Board staff continued to provide support for job seeking (ie, they continued to engage in advocacy with prospective employers and to help him with his curriculum vitae). He found part-time work in a field in which his excellent interpersonal skills were an asset, and is now studying for an alternative career.

Case 4

This intern developed a psychotic illness during internship. She presented as very well after the episode, but subjectively felt very fragile, and was certain she was vulnerable to relapse should she return to work.

Her family, noting the absence of symptoms, and probably fooled by the coping mechanisms adopted by this very able young woman, became quite impatient after she had taken a month away from work, and started demanding that she return. Likewise, her employer, facing staffing problems, was in regular contact, wanting to know when she would be able to resume work.

When she came to the Board's attention, the acute episode had resolved, but she continued to feel vulnerable to relapse. She had not re-established a normal sleep pattern, and continued to feel somewhat dysphoric.

At an initial meeting with Board staff, she outlined a timeline for return to work that she felt she could cope with. Board processes were timetabled to coincide with her timeline, allowing her to refer employer and family to the Board in the event of further disagreement about a return to work.

The timeline proceeded uneventfully and on schedule. No relapses have occurred to date, and she has become a very valued member of the hospital staff. Assessments are consistently in the range "very high" to "excellent".

Case 5

This intern experienced a single episode of psychosis against a background of depression after using cannabis. She voluntarily withdrew herself from the workforce, and resigned from her intern position. When she was again well enough to return to work, she approached the hospital from which she had resigned (Hospital A), but was told that they had a full staff complement.

Another hospital (Hospital B) was approached, and was interested in offering a trial clerkship. This was suddenly cancelled at short notice.

Some weeks later, the Medical Superintendent of Hospital B disclosed that the Medical Superintendent of Hospital A had approached him, and had made several statements about the intern's suitability, which resulted in the withdrawal. By this time, the Medical Superintendent of Hospital A had had no association with the intern for over five months. He was not in possession of any current medical reports and, by any description, the statements he made were inaccurate and frankly defamatory.

A period of protracted unemployment followed. Eventually, a third hospital was persuaded to offer a trial clerkship. They were very impressed, but unable to offer employment on the basis that they had a full staff complement, and no reserve funding. However, because of the positive reports from the placement, the intern successfully competed for a position in a subsequent open-selection process. Reports have been extremely positive, and there has been no recurrence of either depression or psychosis.

  • Jillann F Farmer1

  • Office of Health Practitioner Registration Boards, Brisbane, QLD.


Correspondence: Jillann.Farmer@hic.gov.au

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.