My message to all junior doctors and medical students is that it’s ok to go see your doctor if you are struggling with emotional problems or think you may have mental illness and that despite comments made in a recent news piece you are actually protected under the law if you do so.
The recent reports of a spate of young doctors’ suicides have created genuine concern in the medical community, including us here at onthewards.
It’s understandable in such situations to want to do something, to take actions that make it easier for our young colleagues to seek help when they need it and to also change a culture where too often work comes at the expense of family and social life.
But we also have to be careful and not do anything that might make the situation worse.
That is why I was shocked to read comments suggesting that if doctors disclose drug addiction or mental health problems then it is mandatory for treating doctors to report this to AHPRA (the Australian Health Practitioner Regulation Authority).
To be fair, in a subsequent comment on Twitter, one of the commentators qualified that he should have said he was only referring to doctors who were impaired as a result of mental illness.
But regardless, the original statement is a plainly wrong statement of the facts which could have been easily checked by going to the AHPRA website and reviewing the Guidelines for mandatory notifications. I think it’s important to note what is said there:
Section 140 of the National Law defines ‘notifiable conduct’ as when a practitioner has:
practised the practitioner’s profession while intoxicated by alcohol or drugs; or
engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or
placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or
placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards.
The guidelines then go on to provide decision-making trees that assist practitioners in determining if a mandatory notification is required. In a lot of circumstances, the answer is NO.
So to those junior doctors reading this post. Please seek help if you think you need it. There is no requirement for anyone to notify anyone who seeks help. If you are seeking help for yourself its highly unlikely you will ever need to discuss this with AHPRA and you will be doing yourself a favour.
Because it makes an already bad situation worse by creating further confusion in the minds of doctors about what happens when you tell another doctor that you might have a problem with issues like depression or substance abuse.
I can understand the viewpoint that perhaps the possibility of mandatory notification is an impediment to some doctors coming forward and I can maybe understand how a review of the legislation and process around notification might be useful. But on the other hand, I don’t think any serious commentator would be in favour of significant changes to the criteria as listed above, as they are clearly aimed at providing sufficient protection to the public whilst giving practitioners the appropriate space and time to recover and practice safely.
As a colleague of mine commented it’s probably the fear by doctors about what may happen under the law that is the problem, rather than the actual law itself.
Now perhaps you are struggling to believe me. “Sure”, you say. “That may all be fine in theory but in practice”. So, let me share my own experience with this issue.
I have treated several health practitioners in my time. Never in one of these occasions have I had to make a mandatory notification in relation to a colleague*. On some occasions, the individual themselves decided to self-notify, which is something we strongly encourage. In all the other situations it just wasn’t necessary, sometimes it was just a matter of taking some time off work in others it was possible to keep working while undertaking treatment and recovery.
So to those junior doctors reading this post. Please seek help if you think you need it. There is no requirement for anyone to notify anyone who seeks help. If you are seeking help for yourself its highly unlikely you will ever need to discuss this with AHPRA and you will most likely be doing yourself and your patients a favour.
Links:
Doctor’s Health Advisory Service
Beyond Blue
NSW Health JMO Support Line (if you are experiencing bullying and harassment at work)
LifeLine
*(I have had to make mandatory notifications as a manager)
Its all lip service
April 15, 2017 at 8:35 amI would like to know what the fallout of self reporting is! A doctor I worked with on a transient basis told me that he had been strongly encouraged to self report an episode of depression for which he was allowed time off work during internship by his hospital. He self reported this episode, and felt that this was what had ruined his medical career- 6 years later he was still having to prove his fitness to work to AHPRA and was a significant impediment to any offer of a training job.
John Sammut
April 27, 2017 at 10:15 amThanks for the comment.
The diagnosis of a mental illness or any other form of impairment in and of itself does not require mandatory reporting, but rather the combination of an impairment coupled with a belief this impairment placed the public at risk of substantial harm in the practitioner’s practice of the profession. It is a very common myth circulating at the moment that practitioner’s should be wary of seeing someone for their impairment: eg: OCD, high anxiety, depression because the mere fact they are seeking help for their impairment constitutes mandatory reporting: It’s important to remember – it does not.
If there was a requirement to prove fitness for work when changing jobs, it would be on the basis of an ongoing impairment for which notification was required and on the basis of which, conditions would have been placed upon a practitioner’s
registration/work. These conditions are reviewed regularly and lifted when the impairment allows for such a change without placing the public at risk.
Vicky Dawes
April 16, 2017 at 11:57 pmThis is true but it is worth highlighting that medics seeking help for mental health issues may find it negatively impacts their ability to get insurance cover. https://www.beyondblue.org.au/about-us/about-our-work/discrimination-in-insurance
Jill Orford
July 14, 2017 at 7:52 amMental health is serious, we shouldn’t ignore it. “It’s okay to tell your doctor that you are not okay.”