Stay Well Plans in GMC Cases

How Doctors Can Demonstrate Effective Personal Management of Ill-Health Vulnerabilities

 

Where a doctor has suffered from mental or physical ill-health or both, there will be an expectation that the doctor will take personal responsibility for staying well in the future. 

Having a written Stay Well Plan is an important step in assuring regulators and employers that all that can be done will be done to stay well. A doctor who fails to identify strategies to stay well is more likely to have ongoing and intrusive regulatory intervention.

Where to start:

If a doctor is in denial that they have a medical condition there might be limits to what they are prepared to do. However, even where a doctor does not accept all allegations or findings off ill-health, they can still take steps to evidence how they will ensure that they stay well.

For those doctors who fully accept that that have a health condition, they will be in a stronger position to evidence how they have been staying well, and how they will stay well in the future. A doctor should look at our general advice on Showing Insight, which is a useful tool to analyse the history, before going on to detail how they will stay well in the future.

Write a Chronology of the History of Ill-Health

Setting out a clear chronology, and identifying the triggers for the past ill-health is a good starting point. This will help to identify future vulnerabilities, and assist in the organisation of a management plan.

Physical & Mental Wellbeing and Resilience

These terms are often bandied about as though they are some kind of panacea for a doctor’s health condition and personal risk management. Some health conditions may go into periods of remission, while others might be permanent.

There are courses on mindfulness, stress relief, managing pain or anxiety, resilience, which a doctor might attend, and evidence that they have attended and reflected on same – especially how it relates to their own circumstances.

Taking Time Off

Taking time off from work can be a useful think to de-stress, or to focus on staying or becoming well. Working with an employer (and their Occupational Health department) will be an important step to managing ill-health.

Identifying Causes 

A doctor needs to look at the causes of their illness. Some illnesses are organic in origin, some might be as a consequence of or related to the use of alcohol and drugs (or self-medication with prescription only medicine), others might be an inherited diseases, or a condition relating to physical ill-health.

Identifying and Recognising Signs and Symptoms of Illness

This is not always easy. Some illnesses are more obvious than others. Some psychological illnesses might require trusted others to act as a support and friendly face, who can be trusted to bring matters of concern to the attention of the doctor who is suffering with mental ill-health.

Managing Illness

Where an illness causes mental impairment, with risks to others, a doctor will need to ensure that they work with their own clinicians to be able to engage and identify the therapies that work. Some conditions will be chronic and permanent, while others might be intermittent and sporadic/ Either way, strategies to manage the illness will be important.

Medication and Therapies

The GMC code of conduct, Good Medical Practice, holds that doctors should not treat themselves, save for in exceptional circumstances. This means that a doctor should consult their GP or specialist.

Denial of Illness

Some doctors deny that they suffer from a physical or mental health condition. Without insight into one’s illness a doctor is unlikely to be able to manage their illness or prevent relapse, or even engage with treating clinicians to help them stay well. Where this happens, the regulators will often suspend doctors from the register or heavily restrict the doctor’s practice by way of conditions of practice.

Relapse Prevention

It is the doctor who has primary responsibility to prevent relapse, if they are to continue to practise as a doctor, or return to practise as a doctor in the future. Relapse would be the return of symptoms, or (increasingly) unmanaged symptoms.

Therapies and Clinician Support

Identify what steps need to be taken over time. Liaise with your GP, specialist, consultant. Involve them in planning therapies and treatment over time.

Assessing Risk of Impact on Self or Others of the Health Condition

A doctor who fails to engage in managing their own illness will be considered unlikely to be able to work at reducing the risks of such illness impacting on themselves or others. 

For those doctors who have good insight into their own illness and the risks of it impacting on others, they will be more likely to devise ways to stay well, looking at their own medical history, the prognosis and risk factors that increase the likelihood of an acute period of unwell ness, or a worsening condition, or relapse.

By its nature, this article is written in generic terms but if a doctor works though this article, bearing in mind that factors that are set out, they will be able to begin to devise a stay well plan.

Content of a stay Well Plan

A doctor needs to record their history of illness, identifying the periods where they were well, or where they managed their ill-health well, and factors that led to difficulties, relapse or the development of their condition.

Personalised Stay Well Strategies

It is important that a doctor personalises their own stay well strategy, as most people who are suffering from a mental or physical health condition will often experience unique symptoms, that they must learn to manage and ameliorate, where possible. A bespoke Stay Well plan will often incorporate generic ideas, but that alone is unlikely to lead to a plan that will work.

Evolution of Stay Well Plans

Stay well plans need to be reviewed every so often. They may need tweaking, and lessen over time, or require increased intervention and vigilance. Set a review date. Keep to it. And then when you have reviewed the plan, set another review date. Some stay well plans must be in place for the  professional’s working lifetime.

Have Faith in the Regulatory Process

All of the above may come across as soft law, but these are matters that the GMC and MPTS tribunals will look for. A doctor who does not give thought to the above matters is less likely to be successful in achieving an outcome that they seek.

DDS

If you are a doctor who is tasked with evidencing that you have overcome a medical or mental health condition or that you are working on doing so, and you seek legal advice on how to evidence matters by way of a Stay Well Plan, give Doctors Defence Service a call on 0800 10 88 739