Research into its devastating effects has sparked a renewed call to scrap the regulations.
The RACGP has used new research highlighting the negative impacts of mandatory reporting on impaired doctors to renew its call for the scrapping of AHPRA’s reporting laws.
The research, published in the Australian Journal of General Practice, interviewed doctor-patients who had undergone the notification process and doctors’ health experts, and concluded that GPs are ideally placed to help their doctor-patients survive the negative consequences of mandatory reporting .
“Enough is enough, mandatory reporting laws must go,” said RACGP president Dr Nicole Higgins in response to the research.
“These notifications place a tremendous strain on GPs, and we know mandatory reporting laws discourage GPs from seeking the healthcare they need,” she said.
“GPs deserve better.”
Last year’s Senate report into the administration of registration and notifications by AHPRA recommended that “the Ministerial Council agrees to remove the current mandatory reporting requirements and align the approach with the Western Australian model”, which does not have mandatory reporting laws.
Earlier this year, findings from a separate study found that 16 practitioners who received notifications from 2018-21 took their own lives.
“GPs are people too, and not immune from health concerns, including mental health issues,” said Dr Higgins.
“Now more than ever, after several very stressful years, it’s vital that GPs take care of themselves and seek help when they need it free of the fear of being reported.
“My message to all GPs if that if you have a health concern – please reach out and book a consult.
“The threshold for reporting a concern has been raised and is now reached when there is a ‘substantial risk of harm’ to the public. The bottom line is that if you need to access healthcare, do so right away.”
The research, led by Dr Owen Bradfield, a medical practitioner and health lawyer, found that fear of mandatory reporting was a significant barrier to help-seeking for unwell doctors, resulting in worse health outcomes, and more complex care requirements when they did seek help from their own GP.
Dr Bradfield and colleagues conducted semi-structured interviews of 21 doctor-patients and four doctors’ health experts with the aim of exploring the events that led to notification, the impact of the regulatory processes on unwell doctors, and the ways in which GPs can “recognise, support and assist doctors with mental health or substance use challenges who are facing regulatory processes”.
The participant doctor-patients were experiencing a range of problems including depression, alcohol and other substance abuse, psychosis, personality disorder and physical health conditions. Predisposing factors they reported included past psychiatric history, family psychiatric history, childhood trauma, low self-esteem, self-medication, teenage recreational drug use, and easy access to drugs.
Events that precipitated their notification included marriage breakdown, family death, vicarious trauma, excessive working hours, patient suicide, and training stressors. Barriers to help-seeking included stigma and fear of suspension, denial, lack of insight and a lack of peer support.
Dr Bradfield and colleagues highlighted three key findings from their work.
“First, most doctor-patients were notified to medical regulators through mandatory reporting,” they wrote. “Many had trouble engaging with, accessing or adhering to voluntary treatment. Doctor-patients feared that disclosing health concerns to treating practitioners may result in mandatory reporting and subsequent regulatory processes.
“This is concerning because fear undermines the trust within the therapeutic alliance that is necessary for optimum health outcomes.
“Second … regulatory processes and poor health do not occur in a vacuum,” they wrote. “We observed recurring patterns of predisposing, precipitating, perpetuating and protective factors within doctor-patients’ personal and professional lives.
“This suggests that doctors experience similar personal risks for mental illness or substance use disorders as does the general population, but that unique work situations can exacerbate those risks.
“Third, we found that regulatory processes resulted in a range of psychological reactions, including acute distress, suicidal ideation, relapse of mental health symptoms, anger, projection and, for some, acceptance and gratitude.
“Regulatory processes also caused financial stress, professional isolation, delayed progress through speciality training, early retirement from medicine and defensive practices.”
The authors said the research underscored the importance of every doctor having their own regular GP.
“GPs are ideally placed to understand the unique pressures, challenges and working environments that predispose some doctors to poor mental health and emotional wellbeing,” they wrote.
“Through open dialogue and engagement, GPs can help overcome the stigma, shame and embarrassment that often prevents doctor-patients with mental illness or substance use challenges from accessing healthcare.
“GPs can play a central coordinating role in the assessment, early intervention and management of doctor-patients.”
Because doctor-patients are so afraid of being reported by accessing treatment, it was critical GPs be alert to “early warning signs or precursors of distress and impairment”, Dr Bradfield and colleagues concluded.
GPs should consider targeted mental health screening of at-risk doctor-patients, particularly those with predisposing factors. Also vital was a complete understanding of their obligations under Sections 140 and 141 of the National Law.
Resources for GPs treating doctor-patients:
- Medical defence organisations
- Drs4Drs
- Hand-n-Hand peer support
Given WA’s non-mandatory reporting laws, Dr Bradfield and colleagues suggested research comparing experiences and outcomes across jurisdictions was “urgently needed”.
