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Fit to practice?
  1. David J Scott
  1. Correspondence to:
    Dr David J Scott
    East Sussex Hospitals NHS Trust, Conquest Hospital, The Ridge, St Leonards-on-Sea, East Sussex, TN37 7RD, UK;

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Hospital medical directors have several duties, one of which is dealing with and offering advice on poor performance. A case study of a paediatric trainee is presented which highlights the dilemmas faced and gives an account of how these were dealt with together with more general advice on dealing with poorly performing doctors.


The medical director has received an email from a staff grade in the accident and emergency (A&E) department complaining that Dr AB, a specialist registrar (SpR) in paediatrics (a one year locum appointment–training (LAT)),1 has upset one of the junior nursing sisters in the department and has been heard shouting at her and being rude to her. The email points out that this is the third time this has happened over a four month period. The medical director is requested to take action to stop this happening again.

The medical director asks the staff grade to put his concerns in writing but he declines as he says he was in another room at the time and could not hear all that was being said. The medical director then asks whether the nursing sister is prepared to provide a written statement outlining what has been happening. She declines as she says nothing ever happens when nurses complain about doctors, and in any case she has got to work with the doctor in the future. In view of this the medical director decides to take no further action.

Three weeks later the medical director is approached by one of his consultant colleagues who tells him that a senior house officer (SHO) in paediatrics, whom she is supervising, has complained that Dr AB has been making derogatory remarks about her. The SHO feels threatened and bullied. At about the same time the staff grade in the A&E department sends …

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