Legal and ethical dilemma

[sunshine080]

My job requires a professional registration in order to perform. My current registration expires shortly and I have been contacted to renew it. In order to renew I have to confirm that I am still fit to practice, and declare that there have been no changes to my health that would impact this. So I have two choices; lie and keep my job (because without a registration, I have no job), or declare my health issues, be unable to renew and lose my job - which subsequently means losing my house, being unable to support my family and child, etc. I am already in a high state of anxiety about this predicament and the closer it gets to the expiration date, the worse it's getting.

WWYD?

I'm confused.

Are you not required, under your current/ongoing registration, to advise restristration authority of any changes to health?

I'm thinking here if someone on the register developed, say, Parkinson's would the registering authority overlook that diagnosis until re-registration rolled round?

By your own admission you do not feel fit to practise - driving on wrong side of road, memory lapses etc.

Why are you still practising? Why are you not already on sick leave and seeking support from OHS, union etc. etc.?

OMG don't let your career be derailed by menopause! Don't take no for an answer - try a different GP, try a menopause specialist! If you are NHS there must be a menopause policy. Take some time off on sick leave and get things sorted. I can't see any organisation sacking you because of your menopausal symptoms, and it would be discriminatory if they did.

The stress of this worry is probably only making your meno symptoms worse. Please be assured that so very many woman suffer like this - your useful life isn't over because of menopause. I can't see that they would deregister you for this. Just take your time, deep breaths, and double checks. You can do it x

There are homeopathic treatments for your problem, but as you are in the UK, I know you will think I am talking through my tin-foil hat. Such a shame.

Ah yes, water that might have had a plant molecule in it at some point in the past. Pro-tip: nothing on earth works better by making it ever-weaker.

OMG no! It's perfectly reasonable and correct to discriminate against a disabled person if their disability affects their ability to work safely.

@VitoCorleoneOfMNMafia Yes that is reasonable when it's the case (as OP feels about herself) but as a disabled person I can assure you that unfortunately discrimination often happens in many ways which are unwarranted.

@sunshine080 A PP(s) made a good point that you could seek some other advice of many kinds. Maybe make a list of all the different avenues you can look into before giving up your registration.

I don't feel HRT will directly help (except maybe via placebo effect) - your doctor would probably have prescribed it nowadays if you were going through menopause and wanted it, as they are less worried about cancer risk etc than they once were.

But if you want to try it there are reputable sites employing UK doctors/pharmacists that you could get it from.

OP said she has previously driven dangerously..I wondered if a Driving instructor or similar?

You really can't drive in that state, innocent people risk being killed.

Go to a different doctor

as a disabled person I can assure you that unfortunately discrimination often happens in many ways which are unwarranted.

As a multiply-disabled person, I'm well aware of that. That doesn't give us the right to withhold a disclosure to an official body that has a right to know. Withholding a disclosure from a professional register or DVLA is not the same as waiting until after I've got a desk job to tell the employer about my autism, migraines, and musculoskeletal problems.

OP see someone privately, it isn’t horrendously expensive, get HRT . It works quickly, if that is the reason.

My DM retired from the NHS aged 43, after being a Nurse her whole adult life. After 7 years, she was actually well enough to work part time, and got her registration updated and worked until she retired at 65. It's definitely an option, but I would certainly push for HRT rather than retiring or quitting in the first instance.

Vito- Yes that is different for sure. At least the DVLA thing (though doctors are pretty lenient with that from what I've heard and don't tend to get people banned from driving often.)

OP I think you are seeing this as too black and white.
i am a HCP and there have been times I’ve been unfit to work due to ill health, on one occasion for 5 months.
the answer was not to deregister but take sick leave whilst working on the problem, being referred to OH and being supported to practice within the scope if my abilities when I returned.
when I read your post I thought I was going to read that you had a serious neurological or mental health issue or drug dependency and not peri menopause symptoms. Whilst I do not doubt you are unwell that does not strike me as warranting relinquishment of your registration.
I would suggest taking a proactive approach here- go to your Gp and say that things are so bad you may have to deregister. If that doesn’t prompt them to investigate or operation then get a private consult- yes it’s expensive but not as expensive as losing your job.
Get signed off for a bit- therefore nothing legally or morally to compromise you.
speak to your Manager and ask for a referral to OH- there will be adjustments they can make to help you function adequately.

My heart breaks for you. Have you tried the patch? My Mum went on it and it
gutted she battled menopause and switching up antidepressants and doses for years as the patch was the answer for her.

as for the registration, you can explain the nature of your impairment and take the advice of the registering body accordingly. They may put in conditions of practice such as being supervised, this would cover you legally, ethically and ensure your patients and practice are safe all the while keeping you job and salary.

This summarises pretty much what I was going to say.

Re-register and take sick leave if necessary.

I agree with taking leave and buying yourself time to try to sort out what is causing these symptoms. If sick leave isn’t an option, could you take parental leave?

Is there any way you can get a few good nights’ sleep - lean on family members? - just as a one off to see if the lack of sleep is contributing (I bet it is).

I've been back and forth to the GP and keep getting handed amitriptyline or antidepressants.

AMITRIPTYLINE is the work of the DEVIL and from my experience could absolutely be causing everything you describe. I felt dangerous to be even out of bed whilst I took that. Get rid of it. If you need nerve pain remedies there are others such a gabapentin which are not as horrific (different effects on different people of course!) Took me 1 WEEK to get that out of my system - I could not believe the difference it made.

You sound as though you are clinical staff - get yourself some proper advice... from.a different GP!!

Such bullshit. Seriously. OP needs to replace their depleted hormones.

Lie that you are in good health, keep your job, and then take a sabbatical and sort out your health issues.

Go to see a private menopause doctor, they are out there. Can you take a leave of absence while you get it sorted?

Seriously. OP needs to replace their depleted hormones.

@FearMe But presumably her hormone levels are not depleted. That would've shown up in a blood test and then a doctor would probably have prescribed her HRT if she wanted it. They're not prescribing it because she doesn't need it. It'd actually be unethical for them to prescribe it to a woman who doesn't need it and whose symptoms are caused by something else.

In my experience though, private doctors/consultants can be pretty maverick and overzealous if a condition/treatment is their path of choice. So one of them would probably prescribe it despite OP not being in menopause.

On the other hand, I found gabapentin to be horrific, and amitriptyline to be very well tolerated. To the extent that when I no longer needed to be on it for the original reason I asked (and was allowed) to stay on it, as it was also accidentally preventing my migraines.

Can you try and get hrt privately but honestly until then i wouldnt drive you coud kill someone

I have a friend who says exactly rhe same as you... but the symptoms OP described were exactly how I felt on Amytriptyline... so has to be worth looking into!

@TheodoreMortlock impairment by reason of health is still a FTP issue, but is obviously treated differently to misconduct issues. It does still go before a FTP committee if it gets to that stage (and many cases don’t!) as it is a ground of impairment just like misconduct, lack of competence, conviction etc.

OP, I’m a regulatory lawyer. I deal with FTP cases in healthcare every day. Having a health condition, particularly something like menopausal symptoms, is by no means an automatic bar to renewal. But if it’s impacting your day to day life/ practice and you have serious concerns about safety, you do need to be honest about it. When you renew for most healthcare regulators, you have to sign a declaration confirming whether you have health conditions. If you falsely state no, that in itself can become a misconduct FTP matter (should it come to light that you do- although arguably if you don’t have a diagnosed condition it might not).

I would definitely make use of your regulator’s guidance online and advice line (most have them), and talk to your union and employer. If your health was investigated by your regulator the usual process is that you undergo a medical assessment and they give an expert view. They can comment on whether they think it affects your FTP and any adjustments / treatment etc they think is needed. Only in the most serious cases (often severe mental health / addiction issues) do they say the person is completely unfit to practise in any circumstances.

but please don’t write yourself off like this- there is no way you should just accept menopausal symptoms (if that’s what they are) mean the end of your career. I would 100% open an honest and constructive dialogue with your employer and speak to your regulator - they aren’t out to remove people Willy nilly and will want to do what they can to support you.

I’m sorry you are experiencing this. Can you see another GP? You need to keep pushing. Anecdotally I have a few friends who have had brilliant results with HRT and also medication for vitamin D after one was found to be very deficient. They had the same symptoms - brain fog, anger, feeling very down, lack of energy and now feel much more themselves.

Has your company got a Menopause policy (are you NHS?). Approach Occupational Health and if you don’t get any help go off in sick and get signed off while you get sorted. Insist on another GP, don’t be fobbed off with antidepressants which aren’t getting to the root of the problem.