28 September 2017

Will mandatory reporting review reduce confusion? 

Medicolegal Mental Health

A long-awaited review by the nation’s health ministers of mandatory reporting rules is under way, albeit in the shadow of exaggerations and mistaken beliefs affecting doctors and the public alike.

Sydney psychiatrist Dr Chanaka Wijeratne says media reports that conflate the issues of mandatory reporting and doctor suicides have added to the burden on unwell doctors and practitioners who treat them.

As an example, Dr Wijeratne, an adjunct associate professor at Notre Dame University, points to an ABC headline from April this year: Doctor suicides prompt calls for overhaul of mandatory reporting laws.

“I think that’s a real problem, because it is clearly telling members of the profession that it’s responsible for doctor suicides,” he said.  “There is no evidence whatsoever that these reporting laws have led to doctor suicides. We don’t know that, even anecdotally.”

National coronial data from 2001-2012 published last year showed 79 medical practitioners had committed suicide in the period, but there was no evidence that mandatory reporting was responsible for any of them, Dr Wijeratne said.

Secondly, the profession has not been well informed about the core objection to mandatory reporting – the rule that says a treating practitioner is obliged to report a health practitioner under their care who may pose a substantial risk to the public because of an impairment.

“People are worried that a doctor with an uncomplicated mental disorder, such as anxiety or depression, would be deterred from seeking care because of concern for their registration, and this would lead to a deterioration in their mental health,” Dr Wijeratne said.

“That is actually counterproductive and counterintuitive, because the more care you seek, the less likely you are to be considered impaired.”

Other notifiable conditions under the rules are: intoxication in a professional setting, sexual misconduct with a patient, and departing from accepted professional standards in way that places the public at risk.

The critical point, Dr Wijeratne said, was that having a disorder such as anxiety or depression did not always equate to impairment.

“If a you have depression, and seek and accept appropriate care – seeing a psychiatrist, a GP or a psychologist – you might be on medication or seeking appropriate counselling, plus you limit or suspend your practice until you are considered well, and you notify AHPRA, you are not going to get in trouble.

“You are not going to be considered impaired. Your registration in no way is in question.”

AHPRA’s reporting guidelines also specified a high reporting threshold. A notification must rely on direct knowledge or observation of behaviour, with a potential risk of substantial harm to the public.

There were also exemptions. A doctor was not obliged to make a notification based on knowledge gained while providing advice at a medical defence organisation or while taking part in a quality assurance committee, he said.

Dr Wijaratne said he was concerned that mandatory reporting was being used as a “scapegoat”, deflecting attention from the long list of problems that cause psychological distress to medical professionals, such as long work hours, bullying and sexism in the workplace.

“I think by focusing on mandatory reporting, we are somehow ignoring the other stuff.”

He noted there were many barriers to doctors seeking help for mental-health issues, ranging from lack of time to embarrassment and worry about career prospects.

The hope shared by most doctors is that unified legislation will be adopted on the lines of the exemption introduced in Western Australia, so that health practitioners treating fellow practitioners will not be obliged to break confidentiality.

Fiona Davies, CEO of AMA NSW, said she hoped at least to see the mention of “impairment” removed from the legislation.

The original intent of mandatory reporting, introduced in NSW in 2008, was to protect the public.  “It was supposed to be a very acute assessment, but it has moved from there,” she said, addressing delegates at the recent Australasian Doctors Health Conference in Sydney.

She said treating doctors should know the rules and seek advice on how to respond in particular circumstances, adding: “People from MDOs will tell you that for most scenarios, there would be a level of complexity.”

In many instances, she believed, reporting a doctor had saved lives. But if a practitioner had merely been “in a bit of a bad place but coming out of it”, that was no basis for reporting.

“What you want to satisfy yourself about first is, is this person going to be OK to go and get help. If you satisfy yourself that they are getting help, really there is no mandatory reporting obligation.

“Hopefully, if you are a good colleague, you will take some extra steps to take care of this doctor.”

Ms Davies also revealed the AMA had worked hard to prevent the mandatory reporting rule being extended to doctors’ spouses. Threats against doctors of disclosure to the Medical Board had become common in domestic disputes, she said.