Dr GL is a GP of many years and well regarded by his colleagues. Lately, Dr GL has been having outbursts of anger, often directed at the practice nurse, NA. Last week, after yet another altercation with NA, he smashed her mobile phone on the floor. NA demands of PB, the practice manager, that something be done about Dr GL immediately, otherwise she will resign.
PB discusses the situation with the practice principal, SD. They arrange a meeting with Dr GL. Initially Dr GL denies that he is at fault but then becomes apologetic. He says that he is under a lot of stress and not coping because his marriage is breaking down. He requests time off so that he can get his life in order.
Dr GL returns after three weeks. At first, he appears to be much more settled, but before long the anger outbursts recommence. He is often late for work. There are occasions when he leaves part way through a session, without telling anyone, and doesn’t return. When questioned, he apologises and says that he is experiencing ‘horrendous migraines’. Some of his patients complain that he smells of alcohol and appears very detached. PB and SD are discussing what to do when one of the receptionists interrupts them. She says that there is a very angry woman at the front desk claiming that Dr GL groped her and tried to kiss her. At the same time, she saw Dr GL hurriedly leave the building and she is concerned that he might harm himself. She says that Dr GL has been confiding in her about his marital problems and how life is not worth living.
Observation and questions
This case highlights the importance of looking beyond the behavioural problem and exploring what underlies the behavioural change.
- What should be done now?
- Dr GL has not made any clinical errors. Should he be reported to AHPRA? What are the issues for Dr GL? For the practice?
- What support/assistance might Dr GL need?
- What issues need to be considered, by Dr GL and by the practice, when Dr GL returns to work? What is Dr GL’s responsibility with respect to self-care?
- What would be an appropriate Remediation Plan for Dr GL?
- Could this have been better dealt with earlier? When Dr GL requested time off ‘to get his life in order’, should he have been required to take longer time off?
There are individuals whose behaviour is more ingrained.
- Does that mean that their behaviour can never change and that it shouldn’t be addressed?