About mandatory notifications

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.

The law

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.

Why are these comments unfortunate?

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.

The reality

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.

Conclusion

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)