In the ten years since its inception, has had considerable success both directly and indirectly in getting members of every discipline in the profession into treatment programmes for substance abuse. Much more, however, could and needs to be done to reach them before they have done irreparable damage to themselves, their families, their practices and ultimately their patients.
How does the scheme work?
The Scheme has two arms as it were; an active Committee and a financing arm which is its Trust Fund. The Committee consists of two representatives from each of the following medical bodies; the Irish Medical Organisation, the Irish College of General Practitioners, the General Practitioners Wives Association and the Irish College of Psychiatrists. The first three also have one trustee each who are responsible for the Trust Fund which is registered charity with the Revenue Commissioners and to whom an annual audit is submitted. Absolute confidentiality is maintained and in the great majority of cases only the member who has been approached and the chairman will be aware of the doctor's name. The fund is used to give interest free loans to enable a Sick Doctor to go for treatment. In cases where finance has been provided for locum cover, a colleague nominated by the doctor will be asked to supervise the locum and sometimes the practitioner when he resumes duty. I am happy to report that with the exception of two cases, all interest free loans have been repaid. This is a measure of the accuracy of the assessments carried out by the trustee responsible and of the integrity of the doctors concerned. By "rolling over" the fund in this way, it can help far more people than if it were simply disbursed as an inducement or donation which might be seen as "enabling" an addict.
The fund was launched by generous private donations at the outset, but now its major source of funding is the proceeds of the christmas card sales of the GP Wives Association. No expenses are sought or paid to any member of the Committee. For readers who wish to know more about the scheme the Committee had a 30 minute video made entitled Into the Light, a copy of which should be available in every Irish hospital with a compliment of ten or more NCHDs.
So what's next?
Every year we are increasingly getting requests from doctors and their colleagues for help where the problem is not due to substance abuse or where the doctor is no longer actively in practice. These are the two criteria which must be met by the Deeds of Trust of the Sick Doctor Fund before we can help financially. Last year for every two doctors whose problems met the above criteria, we had three doctors in difficulties who did not. We were also limited in the amount of help we could provide in these cases. Some examples include; an elderly doctor suffering from brain damage unable or unwilling to give up the practice; illegal behaviour, e.g. prescribing controlled drugs to addicts; psychotic illness resulting in risks to patient care; doctors sent home or removed from medical registers abroad for whatever reason. It is clear to us as a voluntary committee that we cannot undertake commitments to doctors who have equally severe, and sometimes far more serious problems than the ones we were set up to help. The reasons for this are that the needs are greater in terms of time, expense commitment and a broader base of administrative and legal expertise. Furthermore, the legal indemnity needed to protect the committee's actions against legal threats is far greater as is the long term financial support these doctors may require.
Structure of new scheme
How should we deal with the problem of the increasing numbers of doctors who do not comply with the terms of reference of the Sick Doctor Scheme but need help just as urgently?
In my view, assistance can be provided by a scheme based on ours (in which confidentiality is paramount and financial help, on an ongoing and perhaps permanent supplement basis, can be provided to enable the doctor stay off work - permanently if necessary) yet with some reorganisation. It will need some limited statutory recognition so that doctors can be referred to it as in the case of the Health Committee of the GMC in England. It will also need a much broader base than we have to date and perhaps with a representative of each medical discipline and, certainly, technical assistance such as legal, administrative and counselling services. It will need legal indemnity for its members' activities. The skewed thinking of a sick doctor may result in allegations of breach of confidentiality, loss of earnings or professional/career damage against those who are trying to help. This was an aspect of our work which has left us very exposed and often unable to intervene. Furthermore, we were not able to acquire this support for our members despite numerous meetings with the Department of Health and successive Ministers. Lastly, it will need to be put on a secure financial footing with a regular income - preferably by way of a levy on every member of the profession who is actively in practice. Perhaps too our Medical Defence Organisations (who could be saved expensive legal actions as these doctors are very vulnerable) and the medical employers should contribute?
Who should take on this commitment? Obviously medical members of bodies involved in regulating the profession, medical organisations who represent the interests of the different disciplines, our Medical Schools and our Medical Defence Organisations should form the nucleus. It is a big but increasingly necessary undertaking.
Sick Doctor Scheme,
c/o Irish Medical Organisation,
10 Fitzwilliam Place,