How to approach a colleague who seems to be in cognitive decline

Bad day or something more? How to ask a colleague if it’s time to retire

Dr T is in his late 60s.

He has been finding the demands of work more and more difficult since his cardiac surgery last year. He runs further behind with each consulting session and has struggled to adapt to the new electronic medical record system.

He recently administered the wrong vaccine to a child and when questioned blamed the practice nurse.

His colleagues are increasingly concerned about him and his patients. They are grappling with how to approach him about these sensitive issues.

Sadly, it’s an issue I’ve seen both as a GP and in my role at Avant.

Many of us never really plan or prepare for our retirement, only leaving when we are forced to confront reality.

When is the time to retire?

Australia does not have a legal retirement age for doctors.

Doctors can continue to practise as long as they can do so safely. Age can bring experience and perspective that can be of great benefit to patients and practices.

On the other hand research, Avant’s experience, and feedback from Avant members, suggests that as we age we may become less flexible in our thinking and less able to cope with stresses and changes to the practice environment. Age may also bring physical and cognitive changes that may affect our ability to practise.

But let’s not get ahead of ourselves. Having a bad day, or week, is not necessarily a sign of anything.

After a year of constant stress, readjustment and exhaustion, it’s hardly a surprise that many of us are showing the strain. Many are in need of a good holiday to stop, re-evaluate and take stock.

Whether our colleague is just having a bad day, or there’s something deeper at play, as professionals we do owe it to our colleagues to speak up when we see something wrong. As Professor Michael Myersputs it, if you think a colleague may be in trouble ‘whatever you do, do something’.

The power of a quiet chat

There is considerable evidence about the best way to approach someone when you are concerned about them professionally.

Research on professionalism and patient safety from the Vanderbilt University School of Medicine indicates that we are most receptive to feedback from a peer. The Vanderbilt model starts with a ‘cup of coffee’ chat. As the name suggests – this is simply sitting down with a colleague for a respectful, non-judgmental conversation.

Professor Myers suggests a similar best model for intervening if we’re worried about a colleague. He notes that it’s generally most helpful to use language like ‘I’ve been worried about you, is everything ok?, can I help?”. In these discussions, it’s important to have some examples of your concerns. But if you start by listing these, your colleague may hear this as judgemental and react defensively.

When given an opportunity to reflect, most professionals will respond and recognise the need to take some steps to address the concerns. However, if a colleague is very unwell, or cognitively impaired, they may be unable to act. Professor Myers notes that in his experience doctors often know there’s something wrong but have been overwhelmed by the sheer thought of having to initiate the steps to seek help. In such cases, we may need to make a phone call to their GP, take them to an appointment, or offer some other practical steps.

Being unwell is not a notifiable issue

However, taking action does not necessarily mean mandatory reporting. Avant stresses that, ideally, this isn’t the first place you would go if you have concerns about a colleague.

Practitioners do have an obligation to notify Ahpra if they believe a health practitioner is placing the public at risk of substantial harm by practising with an impairment. But there is no need to report if the potential risk to the public is being effectively managed. That is, if a practitioner who is unwell or impaired seeks treatment, stops practising or modifies their practice so as to manage any potential risk, there is no need to make a report.

Don’t try this alone

It is a difficult dilemma to find yourself in – worried about a colleague, concerned that if you say something you may be harming their career, anxious that if you don’t say anything they may put a patient at risk. But it is not a situation you need to try to manage alone.

To quote Dr Gerald Hickson – ‘It takes courage to speak up. It also takes an infrastructure.’ As leaders and senior practitioners within our practices and institutions, it’s important that we set up the structures so that we notice and can speak up effectively if we see something wrong.

And it is always appropriate to contact your medical defence organisation if you find yourself on either side of this dilemma. Support is available whether you are concerned about a colleague or if a colleague says they’re concerned about you.

How to move forward

As Dr T’s colleagues continue to express concerns, his practice partner decides to intervene.

She meets with Dr T to gently discuss his own health and brings his attention to the concerns about his practice.

Together, they begin to plan for his retirement.

Useful information

Ahpra Taking Care podcast: Dr Gerard Hickson on patient safety and high risk practitioners

Medical Board of Australia - Guidelines for mandatory notifications

This article was originally published in AusDoc. on 14 July 2021.