Good medical practice: guidance for occupational physicians.

Following a catalogue of serious, highly publicized medical misdemeanours, the General Medical Council (GMC) has introduced plans for a new system of medical licensing in the UK called 'revalidation'. Under this, the onus will fall on individual doctors, including occupational physicians, to demonstrate their continuing fitness to practice. Doctors will need to show that they meet basic minimum standards in terms of the care they provide, their own continuing professional development, and other aspects of professional life like probity and ethical behaviour. As part of the process, the Faculty of Occupational Medicine, Royal College of Physicians, has produced its own guidance on good medical practice for occupational physicians, following an extensive consultation exercise. This paper summarizes the background to the initiative, the development process and the standards that have been recommended to aid professional accountability.

Medical repatriation of British diplomats resident overseas.

BACKGROUND: The aim of this study was to analyse medical evacuations and short tours (collectively known as medevacs) in British Foreign and Commonwealth Office (FCO) staff and dependents residing overseas. Further aims were to look for groups with a disproportionate number of medical evacuations/short tours, and to identify events which may have been predictable in retrospect. For the purposes of this study, a medical evacuation was defined as a journey to the UK or an appropriate regional referral center for medical treatment or review, and a medical short tour was an early termination of posting for medical reasons. METHOD: The medical records of all staff and dependents who had been medically evacuated/short toured in 1995 were retrospectively analysed. Information collected included demographic details, whether the medevac was an emergency or a predicted necessity, why the medevac was required, the diagnosis, and the time from medical clearance to medevac. RESULTS: In 1995, 160 medevacs involving 137 individuals were authorized. This represented 3.08% of individuals overseas, with only 0.4% of individuals posted overseas being evacuated with new medical events within 1 year of medical clearance. The proportion of medevacs for staff was significantly higher than for dependents (spouses and children), and staff in their 20s and fast-stream diplomats (young "high-flyers" with a university education) were over-represented in the evacuee group. Non-physical problems were predominant in the latter groups. The main reason for evacuation (70%) was that medical facilities were considered unsuitable, and just over half of the medevacs (51%) were considered by the investigating team to have been unpredictable. CONCLUSIONS: Only a small percent of individuals posted overseas required medevac. The likelihood of evacuation was significantly higher in staff when compared to dependents, and certain grades/age groups appeared to be over-represented in the evacuee group. These groups are possibly more vulnerable, particularly to non-physical problems, and this is a potential area for future research. A prospective study of medical events overseas is proposed to see if these results are reproduced. If these findings are confirmed, medical clearance and FCO posting procedures may need to be altered for groups which are identified as being vulnerable.

Burnout and psychiatric disorder among cancer clinicians.

The prevalence and causes of 'burnout' and psychiatric disorder among senior oncologists and palliative care specialists have been measured in a national questionnaire-based survey. All consultant non-surgical oncologists in the UK were asked to participate. Sources of work-related stress and satisfaction were measured using study-specific questions which were aggregated into factors. Psychiatric disorder was estimated using the 12-item General Health Questionnaire. The three components of 'burnout'--emotional exhaustion, depersonalisation and low personal accomplishment--were assessed using the Maslach Burnout Inventory. Three hundred and ninety-three out of 476 (83%) consultants returned their questionnaires. The estimated prevalence of psychiatric disorder in cancer clinicians was 28%, and this is similar to the rate among British junior house officers. The study group had equivalent levels of emotional exhaustion and low personal accomplishment to those found in American doctors and nurses, but lower levels of depersonalisation. Among cancer clinicians, 'burnout' was more prevalent among clinical oncologists than among medical oncologists and palliative care specialists. Psychiatric disorder was independently associated with the stress of feeling overloaded (P < 0.0001), dealing with treatment toxicity/errors (P < 0.004) and deriving little satisfaction from professional status/esteem (P = 0.002). 'Burnout' was also related to these factors, and in addition was associated with high stress and low satisfaction from dealing with patients, and with low satisfaction from having adequate resources (each at a level of P < or = 0.002). Clinicians who felt insufficiently trained in communication and management skills had significantly higher levels of distress than those who felt sufficiently trained. If 'burnout' and psychiatric disorder among cancer clinicians are to be reduced, increased resources will be required to lessen overload and to improve training in communication and management skills.