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
www. australiandoctor. com. au 2 June 2017 | Australian Doctor | 5