Your Health
Fears over the regime are deterring vulnerable doctors from seeking help .
DOCTORS ARE HUMAN TOO
Your Health
Professor Leanne Rowe
Mandatory reporting needs reform
MA NDATORY reporting laws — those laws that confront doctors treating their colleagues — have caused harm and require urgent reform .
None of this is the result of malevolence .
The people who put the laws together had the best intentions , even if more thought should have been applied to the implications .
And the people tasked with upholding the rules — those working with the Medical Board of Australia for instance — are not out to destroy doctors who are in need of help .
A deeply confusing debate The harm these laws do is the consequence of a flawed system , and this is why lobby groups , medical defence organisations , mental health groups , lawyers , and most of all doctors themselves are calling for them to be overhauled .
It is important to understand why and make clear what has become a deeply confusing debate .
The national reporting laws were introduced in 2010 through the creation of a national registration system . The media at the time was still buzzing from the so-called ‘ Butcher of Bega ’ scandal , where Sydney obstetrician Graeme Reeves , a man who had depression and a personality disorder , was found guilty of maiming his patients .
It emerged that the concerns around his practice had been well known , not least by the state medical board itself .
The case armed politicians with the conviction that the damage Reeves had inflicted could have
Fears over the regime are deterring vulnerable doctors from seeking help .
PAUL SMITH
been prevented if doctors had been more willing to speak out .
So when AHPRA was created , new laws were brought in that imposed an explicit duty on registered health practitioners to report colleagues who could be putting the public at risk ( see box ).
The laws were passed with little discussion . The one exception was in WA .
Addressing widespread fears In that state , the AMA raised concerns about the laws that are now familiar . They applied to health practitioners treating health practitioners , the AMA said . They ran straight through the heart of the doctor-patient relationship .
Doctors with drug and alcohol problems or mental health issues would be reluctant to seek help because of the fear their names and their problems would end up in a file on a desk at the medical board . WA politicians shared the doctors ’ concerns and so introduced an exemption for treating practitioners to the mandatory reporting laws .
Today there are many stories circulating that as a result WA has become a safe haven of sorts — a place doctors cross state-boundaries to reach , in a desperate bid to access care without fear .
The Medical Board of Australia has tried to address what it says is widespread misunderstanding about how mandatory reporting operates .
It says simply treating an impaired doctor is not sufficient to require a mandatory report .
“[ The reporting laws ] are not about dragging doctors into a complaint process ,” board chair Dr Joanna Flynn told Australian Doctor in an interview two years ago .
“ It is about offering them the support they need so they can continue to practise or return to practice .”
The thresholds for a mandatory report were high , she said .
Another important point is that while WA has its exemptions , treating practitioners still have an ethical duty to make voluntary reports where appropriate .
This could suggest an education campaign for doctors could end the misconceptions and the fear .
But for Avant , the AMA and Beyondblue , the system is flawed and perceptions have become too deeply ingrained .
In 2013 , Beyondblue ’ s survey of 12,250 doctors found 34 % were concerned that seeking healthcare could impact on their registration and right to practice .
Clearly something more than reassurance is needed to ensure
WHAT CONDUCT IS NOTFIABLE TO AHPRA ?
Notifiable conduct is deemed to be when a practitioner has :
• Practised while intoxicated by alcohol or drugs
• Engaged in sexual misconduct in the practice of the profession
• Placed the public at risk of substantial harm because of an impairment ( health issue )
• Placed the public at risk because of a significant departure from accepted professional standards vulnerable doctors seek help .
Change for the better And this seems to be acknowledged by the medical board itself . In her interview , Dr Flynn said the board would “ not stand in the way ” of any reform to the mandatory reporting laws , if that is what health ministers decided .
Sadly , ministers , who will ultimately decide whether change will come , have yet to make that pledge . And all the while , the damage accumulates .
The recent spate of suicides among doctors is tragic by definition . Reform in itself will not change the wider medical culture that demands so much of its practitioners . Lives will still fall apart . But it is something that will make a difference .
And that is why change can only be for the better .
Sources
• ‘ Mandatory reporting of impaired medical practitioners : protecting patients , supporting practitioners ’. Internal Medicine Journal 2014 ; online ( see : bit . ly / 2qecuKi ).
• ‘ National registration scheme at 5 years : not what it promised .’ Australian Health Review 2016 ; online ( see : http :// bit . ly / 2rWXAEL ).
• Avant . ‘ Mandatory reporting for health professionals — WA exemption ’. See : bit . ly / 2ryhhGi
• ‘ Mandatory reporting of health professionals : The case for a WA style exemption for all Australian practitioners .’ Journal of Law and Medicine 2014 ; online ( see : http :// ab . co / 2rBuCOo ).
• Beyondblue . ‘ The Mental Health of Doctors : A Systemic Literature Review 2010 .’ See : bit . ly / 2qUpOSU )
Be kinder to yourself
OVERWORK is often regarded as the sign of a dedicated doctor and those who have driven personalities are often rewarded professionally and financially .
They receive few complaints , rarely make mistakes and are highly conscientious . They complete most of their tasks by the due date , constantly pre-empt problems , manage risks and work long hours to go beyond what is expected of them .
Many of these personality traits are important to get the job done . But when , as doctors , we become slaves to endless to-do lists at the expense of our relationships , we stop enjoying our lives . Ask yourself , are you :
• Irritable when late ? Are you often late because of unexpected emergencies , long consultations and increasing patient demand ?
• Impatient while waiting ? Do you get frustrated that you will run even later if you have to wait for others ?
• A fast eater ? Have you been conditioned to eat quickly or risk not eating at all ?
• Interested in very little outside home and work ? Do you find you have little personal social time because when you ’ re not at work you ’ re making up for lost time with your family ?
• Very competitive and ambitious ? Were you encouraged to compete during student years for rankings and later for postgraduate training positions ?
• Someone who anticipates what others are going to say , and sometimes finish their sentences ?
• Always in a rush ? Do you receive complaints if you keep patients waiting or if your appointments are booked out for weeks ahead ? Do you find it a challenge to accommodate urgent patients , but at the same time feel pressured to make adequate time available for your current patients ?
• Trying to do too many things at once , and at the same time thinking about what you will do next ?
• Constantly pre-empting problems , assessing risks and managing multiple problems , and having to make complex decisions ?
• Seeking to be recognised by others ? Do you find you rarely receive recognition because patients , family and friends expect you to maintain your caring role outside your work and rarely give you positive feedback because they assume you know you are appreciated ?
• Someone who feels guilty when idle ?
• Never really happy ? Do you have a perfectionist , self-critical personality ? Do you think in terms of “ I must ”, “ I should ” or “ I always ”? If you recognise any of these personality traits , then simply try to slow down and practice being kinder to yourself .
Give yourself a break from your harsh inner voice and you may find you are more focused and happier .
Professor Rowe AM is a GP in Melbourne . Her blog on doctors ’ health and self care can be found at : www . medicineisbeautiful . com
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