AKT – Doctors’ health

Andrew Morrison, aged 43, is a full-time rural GP presenting for a routine health check. He admits to having gained 10kg over the past year, increased alcohol intake to ‘a few beers every night’, and states he is constantly exhausted. He has not taken annual leave for over 2 years. He does not smoke. He mentions ongoing insomnia and irritability, attributing it to ‘just being busy’. BP is 144/92, BMI is 31. Cardiovascular, respiratory and abdominal exams are normal.

What is the MOST appropriate initial management step?

Leah Thompson, aged 35, is a registrar in her third year of training. She presents reluctantly after being advised to seek help by a colleague. She discloses she has been using dexamphetamine prescribed for a sibling to stay alert during night shifts. She has noticed increasing anxiety, tremors and trouble sleeping. She denies suicidal ideation. She fears mandatory reporting and career consequences.

What is the MOST appropriate next step?

Tom D’Souza, aged 59, is a solo GP in a regional town. A local pharmacist contacts you concerned that Tom has been frequently prescribing opioids in his own name. You look up his prescribing history and find recent scripts for oxycodone and diazepam. Tom has been increasingly withdrawn and irritable. You are the only other GP in town.

What is the MOST appropriate action?

Maria Lozano, aged 32, is a junior doctor who presents after fainting in theatre. She reports palpitations and a 5kg weight loss over 3 months, increased anxiety, diarrhoea and heat intolerance. She has also missed her last two periods. Examination reveals a fine tremor, warm hands and HR 112 bpm. ECG confirms sinus tachycardia. She is worried she is not coping with her job.

What is the MOST likely underlying diagnosis?

Dr Samuel Harper, aged 48, is a well-known and respected GP who recently lost his partner in a motor vehicle accident. He has since missed several patient appointments and has been observed arriving late and unkempt. He denies depression but says he’s just ‘tired all the time’. He lives alone and has no family nearby. You are his colleague and friend.

What is the MOST appropriate course of action?

Jessica Tang, aged 27, is a hospital intern who presents requesting a certificate for stress leave. She reports difficulty concentrating, frequent crying spells, and feelings of failure. She has recently been criticised by a consultant for a medication error. She is not sleeping and has lost 3kg in the past fortnight. She denies suicidal thoughts but appears tearful during the consultation.

What is the MOST appropriate initial management?

Dr Rajesh Kumar, aged 41, presents with fatigue, low mood and poor libido. He has recently stopped attending his monthly medical peer group due to ‘being too tired’. On questioning, he reveals he has been drinking a bottle of wine most nights and occasionally taking alprazolam obtained from a colleague. He denies suicidal ideation. Examination is unremarkable. He declines referral to psychology.

What is the MOST appropriate next step?

Tanya Nguyen, aged 38, a GP registrar in her final term, presents with persistent insomnia and anxiety. She fears failing her fellowship exams and says she has been working late and skipping meals. She is tearful and says, ‘I don’t think I can do this anymore’. She denies suicidal ideation but scores high on a K10 assessment. She does not have a regular GP and has never accessed mental health support before.

What is the MOST appropriate next step?

Chris Wallace, aged 65, is a semi-retired GP who presents following a recent fall. On further questioning, he admits to short-term memory lapses and has missed a few patient follow-ups. He insists he is ‘just tired’ but his family has expressed concern about his driving and safety. You are his treating doctor and colleague.

What is the MOST appropriate next step?

Angela Cho, aged 29, is a GP registrar who comes to see you after being involved in a patient suicide. She says she feels responsible and is plagued by guilt. She has trouble sleeping and concentrating. She’s been avoiding friends and social events. Her practice manager has suggested she talk to someone but she’s unsure. She has no suicidal thoughts.

What is the MOST appropriate initial step?

Emily Zhao, aged 33, a GP in a busy suburban clinic, presents reporting chest tightness and shortness of breath during work hours. She worries she may be developing heart disease. She has no past cardiac history, is a non-smoker and exercises regularly. ECG and troponins are normal. On further questioning, symptoms started after a series of difficult patient consultations. She has recently been skipping meals and drinking more coffee than usual.

What is the MOST likely diagnosis?

Patrick O’Neill, aged 56, is a GP who has decided to wind down his practice over the next 12 months. He shares that he’s feeling lost, unsure about what to do next, and is worried about his identity outside of medicine. He denies low mood or suicidality but says he feels ‘flat’ and avoids social events. He is otherwise physically well and takes no medications.

What is the MOST appropriate initial approach?

Shalini Mehta, aged 29, is a second-year hospital resident who has been calling in sick frequently. A colleague mentions she often looks tired and dishevelled, and was seen sleeping in her car during lunch break. She reluctantly agrees to see you and discloses she’s been caring for a parent with advanced cancer and staying up late to study for exams. She denies drug use or suicidal ideation.

What is the MOST appropriate management strategy?

Dr Lisa Harris, aged 44, is a GP who recently returned to work after a prolonged illness. You notice she appears indecisive and confused during a case discussion. She later prescribes an incorrect dose of medication and a nurse expresses concern about her safety to practise. Lisa becomes defensive and says she is just ‘out of practice’.

What is the MOST appropriate next step?

Mohammed Aziz, aged 39, is a GP working in a remote community. He presents during a locum week with insomnia, loss of appetite, and difficulty making decisions. He admits feeling isolated and says he hasn’t had a day off in 3 weeks. He’s worried about confidentiality and doesn’t have a regular GP. There is no suicidal ideation.

What is the MOST appropriate immediate action?

Dr Katherine Price, aged 50, presents for her usual check-up. She discloses recent forgetfulness, including misplacing her car keys multiple times and forgetting appointments. She is concerned about early-onset dementia as her mother was diagnosed at 62. She is still working full time as a GP and has not had any complaints or errors. She sleeps poorly and often skips meals due to a busy schedule.

What is the MOST appropriate initial step?

Dr David Tran, aged 38, presents reluctantly after his partner booked the appointment. He has been withdrawn and irritable for several months, drinks daily, and has lost interest in hobbies. He says work has become ‘pointless’. He denies suicidal ideation but states he wouldn’t care if he didn’t wake up tomorrow. He has never received mental health treatment before.

What is the MOST appropriate initial management?

Anne-Marie Goh, aged 45, is a practice nurse who also works part-time as a GP registrar. She presents with fatigue, tearfulness and irregular periods. She says she is “not coping” and has started avoiding certain patients. She is perimenopausal and uses no medications. She recently started night shifts and says she has no time for exercise or hobbies.

What is the MOST appropriate next step?

James Ellery, aged 31, is a surgical registrar seen for review. He discloses occasional thoughts of self-harm and says he feels ‘trapped’ in his career path but fears disappointing his parents. He works long hours and has poor support at work. He has no plan or intent to self-harm. His mental state is otherwise stable.

What is the MOST appropriate management?

Sophie Delaney, aged 36, a part-time GP and mother of two, presents complaining of poor sleep, fatigue, and constant worry about her children’s wellbeing. She describes feeling overwhelmed with juggling clinical work and home responsibilities. She denies low mood or anhedonia. She has no past psychiatric history and no current medications.

What is the MOST likely diagnosis?

Dr Michael Singh, aged 34, presents for review following a previous consultation where stress leave was certified. He reports improved mood after 2 weeks off but is anxious about returning to work. He is worried he will relapse if faced with the same workload. He denies current depressive symptoms. He has not yet engaged with the psychologist you referred him to.

What is the MOST appropriate next step?

Hannah Mitchell, aged 28, is a GP registrar who presents after being assaulted during a home visit in a rural community. She has bruising and is visibly shaken. She has been unable to sleep, startles easily, and avoids leaving the house. She has no suicidal ideation. This occurred 2 weeks ago and she has not yet returned to work.

What is the MOST likely diagnosis?

Dr Brian Walker, aged 62, presents for his first check-up in years. He appears dishevelled and confused about the date. He says he’s been feeling ‘foggy’ for months and has forgotten to order results for several patients. Staff have noticed he’s become irritable and slower with consultations. He still drives and sees patients alone. He drinks 4-5 glasses of wine most nights.

What is the MOST appropriate immediate action?

Rachel Nguyen, aged 31, is a hospital resident who presents with amenorrhoea for 6 months. She reports exercising daily, often skips meals during shifts, and admits to fear of gaining weight. Her BMI is 17.5 and she has mild bradycardia. She says her performance is important and she must ‘stay in control’.

What is the MOST likely diagnosis?

Alan Sweeney, aged 48, is a practice owner who has been involved in a prolonged legal dispute with a former staff member. He presents with chest tightness, insomnia, and difficulty concentrating. He reports no history of cardiac disease. ECG and examination are normal. He says the stress is consuming all his energy and affecting his clinical work.

What is the MOST appropriate initial management?

Dr Amelia Watts, aged 39, presents with a history of fatigue, muscle aches, and low mood. She has two children under five, works four days a week in general practice, and is also caring for her elderly father with dementia. Blood tests including TSH, iron studies and B12 are normal. She admits she feels emotionally drained and has lost joy in work and home life.

What is the MOST likely diagnosis?

George Riley, aged 58, is a senior emergency physician who presents due to pressure from his partner. She has noticed he has become short-tempered and is drinking more heavily. George says he ‘just wants to be left alone’ and admits to using alcohol to unwind after night shifts. He denies depressive thoughts and says he is functioning well at work.

What is the MOST appropriate next step?

Dr Sonia Kale, aged 32, is a GP registrar who has missed multiple education sessions and appears disorganised in consultations. A colleague reports she is often tearful and leaves early. When approached, she says she’s not sleeping, has lost 4kg, and feels overwhelmed. She recently moved away from her family for training and says she regrets the move.

What is the MOST appropriate initial management?

Liam Kennedy, aged 36, is a rural GP who consults irregularly with patients and has increasingly avoided community events. His nurse reports he often arrives late and seems distracted. In your consultation, he appears guarded but admits feeling hopeless and worthless. He denies suicidal ideation. There is a history of a relationship breakdown 6 months ago.

What is the MOST appropriate next step?

Natasha Blake, aged 29, a junior medical officer, presents after experiencing a panic attack while assisting in theatre. She says she has been feeling overwhelmed and dreads going to work. She has been experiencing chest tightness and nausea before each shift and has started avoiding rosters involving surgery. She denies suicidal ideation and uses no substances.

What is the MOST appropriate diagnosis?

Dr Zoe Randall, aged 47, presents with insomnia and difficulty concentrating. She reports increasingly negative thoughts about her abilities and feels disconnected from patients. She describes herself as emotionally numb and exhausted, despite sleeping 8 hours most nights. She is considering leaving medicine altogether but feels guilty about letting her patients down.

What is the MOST likely diagnosis?

Jacob Irvine, aged 30, is a resident medical officer who presents after an episode of near-syncope during ward rounds. He has been skipping meals, has lost 5kg in the past month, and admits to using stimulant medication obtained online to stay alert for exams. He denies cardiac symptoms. On examination, he has a resting HR of 104 and BP of 100/64 mmHg.

What is the MOST appropriate next step?

Dr Lara Hassan, aged 52, presents with symptoms of low energy, joint aches, and poor concentration. She is peri-menopausal and reports that her symptoms worsen before her period. She has had increasing difficulty maintaining empathy in consults and often feels irritable. She denies depression or suicidal ideation.

What is the MOST appropriate management strategy?

Matthew Klein, aged 37, is a GP registrar seen for follow-up. He has been referred previously for work stress and insomnia. He now reports new onset headaches, difficulty concentrating, and describes hearing his name called when no one is around. He says he is sleeping less than 3 hours a night and feels like he’s ‘falling apart’.

What is the MOST appropriate next step?

Claire Bentley, aged 42, is a part-time GP with a long-standing history of anxiety. She presents due to concern about making a mistake after a recent patient complaint. She has been obsessively checking clinical notes and guidelines, and is having trouble switching off after work. She reports trouble sleeping and tension headaches.

What is the MOST appropriate initial management?

Dr Adrian Parker, aged 55, presents for a check-up after a recent fall. He has a visible tremor and reports occasional difficulty with fine motor tasks such as writing and using a syringe. He has not disclosed this to his colleagues and continues working in procedural general practice. Neurological examination reveals cogwheel rigidity and bradykinesia.

What is the MOST appropriate next step?

Dr Nina Sharma, aged 29, is a hospital-based medical officer who presents with chest pain, fatigue, and shortness of breath on exertion. She reports menorrhagia, poor diet, and frequently misses meals due to workload. She appears pale and has conjunctival pallor. Pulse is 92 and BP 104/62. ECG is normal.

What is the MOST likely diagnosis?

Dr Peter Holmes, aged 60, presents for an annual check-up. He reveals he is considering returning to full-time practice after semi-retirement. He has been working 1 day a week for the past 2 years. He expresses concern about recent difficulty keeping up with new guidelines and digital systems.

What is the MOST appropriate recommendation?

Stephanie Lai, aged 26, is an intern seen after two episodes of crying on the ward. She describes feeling overwhelmed and unsupported, and says she is doubting her ability to be a doctor. She denies any prior mental health history and has no suicidal ideation. She recently rotated into a busy surgical unit with minimal supervision.

What is the MOST appropriate next step?

Dr Mark Rosen, aged 42, a GP in a metropolitan practice, requests help with insomnia. He has been increasingly working late into the night to manage his workload and reports constant rumination about patients. He wakes frequently and feels unrefreshed. He denies low mood or suicidal thoughts. He avoids alcohol, does not take medications, and has no significant medical history.

What is the MOST appropriate first-line management?

Dr Fiona Walsh, aged 36, presents requesting a medical certificate for a conference she is speaking at. During the consultation, she appears anxious and fidgety. She volunteers that she has been relying on modafinil daily to keep up with her work demands and parenting responsibilities. She has not disclosed this to any treating doctor previously.

What is the MOST appropriate next step?

Jonathan Lee, aged 44, a GP in a corporate clinic, presents after a panic attack while driving to work. He reports feeling trapped, frequently ruminating about medicolegal issues and fearing complaints. He avoids taking on complex patients and has become socially withdrawn. He has no prior mental health history. ECG and physical examination are normal.

What is the MOST appropriate next step?

Emily Rosenthal, aged 33, is a surgical registrar who collapsed at work. She is found to have a haemoglobin of 82 g/L and MCV of 72. She admits to heavy menstrual bleeding and iron supplementation ‘when I remember’. She has a history of avoiding doctors. She is pale but haemodynamically stable.

What is the MOST appropriate initial management?

Ahmed Farouk, aged 40, is a full-time ED registrar who presents due to ongoing fatigue and muscle tension. He has been working rotating shifts for years and says he feels like he’s constantly on edge. He avoids caffeine and alcohol and exercises regularly. Blood tests including TSH, iron and cortisol are normal. He is considering reducing his hours but feels guilty about burdening colleagues.

What is the MOST appropriate initial management?

Clare Morrison, aged 49, is a GP who has returned to work after recovering from COVID-19. She reports ongoing brain fog, fatigue, and headaches. She struggles with complex decision-making and is worried about seeing patients safely. She wants to know whether she should take more time off or adjust her role.

What is the MOST appropriate recommendation?

Dr Benjamin Hale, aged 39, is a GP who presents for review of ongoing lower back pain. He has been self-prescribing tramadol and diazepam intermittently for the past 3 months. He says it helps him get through busy clinics but admits he is concerned about becoming dependent. He has not discussed this with any colleagues.

What is the MOST appropriate next step?

Samantha Lu, aged 31, is a paediatric registrar who reports increasing tearfulness, difficulty concentrating, and a fear of harming patients. She has started triple checking medications and avoids ward rounds. She recently made a minor prescribing error which was corrected before causing harm. She denies suicidal ideation but says she is not sleeping well.

What is the MOST appropriate initial management?

Michael Chan, aged 45, a solo GP in a rural town, has been observed by pharmacy staff to appear confused and dishevelled when picking up prescriptions. A community nurse raises concerns about missed follow-ups and documentation errors. You are his only colleague and see him weekly for peer supervision. He denies problems but appears evasive when asked.

What is the MOST appropriate immediate action?

Dr Elise Morton, aged 42, presents after receiving a patient complaint. Since the event, she reports palpitations, poor concentration, and nightmares about work. She avoids checking her inbox and dreads attending the clinic. She denies suicidal ideation. The complaint was dismissed, but she reports ongoing distress and physical symptoms of anxiety.

What is the MOST likely diagnosis?

Andrew Fellows, aged 59, a semi-retired GP, presents due to persistent fatigue and sleepiness. He has been napping during the day and once fell asleep during a telehealth session. His partner reports loud snoring and observed apnoeas. BMI is 35, BP 148/92, and neck circumference is 44 cm. He continues working part-time.

What is the MOST appropriate next step?