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Dr Everlasting lacks insight

This 72-year-old woman is running a solo practice and your practice covers for her on the rare occasions she takes leave. On her first visit as a patient, she tells you of arthritis in both knees, particularly the right.  She believes that she needs a knee replacement and she comes armed with the name of her preferred orthopaedic surgeon. When you enquire into how she is managing her workload she replies that her youngest dependent son is still at university. You persuade her to have some routine tests, which show a significantly elevated gamma GT and a haemoglobin of 9.9. You discover that she is self-prescribing Panadeine Forte and NSAIDS for her pain, along with Stilnox to sleep.

Comment

Dr Everlasting has signs suggesting impairment. As is common in older patients, she has several medical problems, but it transpires that she has other problems as well - she has not submitted a tax return for six years ('I don't have time for that nonsense. The patient's needs have to come first'). Your further history reveals the possibility of emotional abuse as part of a dysfunctional relationship with her son. You have good reason for concern regarding her clinical competence, even though she cares a great deal about her patients.

You can explain to Dr Everlasting that the Medical Benevolent Association can assist distressed doctors, particularly those with financial problems. Whatever you decide to do, a rapid intervention is needed to avert a potential physical or psychosocial disaster.

Despite allowing you to be her 'treating doctor', if Dr Everlasting refuses to alter her practice or other behaviours, you may decide to seek advice from the DHAS. Ultimately this may be a case for notification to the Medical Board, since Dr Everlasting appears to lack insight. This would provide you with an opportunity to discuss her situation (even if you choose to do this anonymously) with the only body with the legislative authority to enforce an intervention..