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This 48-year-old man has been in a four-person specialty partnership for 16 years. He is increasingly critical of his partners and staff, complaining of poor practice management. Eventually a staff member resigns, claiming through her solicitor that she was 'harassed' by him. When you tackle him gently, he becomes angry and starts to criticise you, citing instances where he thinks you have shown poor clinical judgment.
It transpires that there is a strong family history of depression. He has himself had two major episodes of depression, one at University, and one eight years ago, when he took an overseas 'sabbatical' for several months. His current depression has been manifesting, over several months, as anger and low tolerance of frustration.
This is a difficult situation, partly because of Dr Predictable’s aggressive responses to a respectful enquiry. He may have reached a stage of life when all of his close personal relationships are being re-evaluated. For example, his children may be becoming more independent or he may be in conflict with his partner. Relationship problems are likely to be both a cause and an effect of his depression.
A sensitive history would include questions about financial stress and risk-taking behaviour (including drugs, alcohol and sexual adventurism). Even though this appears intrusive, it is important to enquire with the same level of concern and care as we would with any patient.
Ultimately Dr Predictable needs supportive medical advice. He might choose a known colleague or someone who doesn't know him; these individual preferences are perfectly reasonable and should be respected. The most important goal is to enlist support before his situation worsens.
Dr Predictable is at risk of becoming impaired, possibly through substance abuse (especially alcohol) or through behaviour which could risk his professional reputation. If he fails to respond to your expressions of concern, you might seek advice from the Doctors' Health Advisory Service.
© Doctors Health Advisory Service 2017