Patients have right to know that they’re protected by the various codes and ethics and pieces of legislation that govern the medical profession. These provide them with assurance that the professional treating them is ‘fit to practice’.
And that’s what mandatory reporting is all about. And, there’s no doubt that the protection of patients’ needs to remain at the forefront of legislation – trust and high-standards are paramount.
But with increasing pressure on our health system, more doctors than ever before are becoming stressed and unable to cope with gruelling schedules and long hours. But they don’t speak up for fear of losing their jobs.
The Council of Australian Governments (COAG) recently agreed to review proposed legislation for Mandatory Reporting of Doctors.
At the heart of this, is mental health. Both the Australian Medical Association (AMA) and the General Practice Registrars Australia (GPRA) are heartened that a review is underway – it is long overdue, and needs to take into consideration the stress-related conditions and mental health concerns doctors face — both during their training and into their career, whether they’re GPs, locums, or working in jobs in hospitals. Any doctor, in any setting, at any age or stage of their career, can be at risk.
Currently, in all Australian states except Western Australia, there are mandatory reporting laws, meaning that if a doctor seeks help for a mental health problem, the treating doctor has to report it if they believe it places the public at risk. The result is that few doctors will own up to a mental health issue, let alone see a psychiatrist, because they fear it will jeopardise their career.
We’ve taken huge strides as a society to raise awareness of mental health – it’s spectrum of signs and symptoms and its spectrum of severity. And we know, after much medical research and anecdotal evidence from the brave people who’ve opened up and told their own personal stories – that mental health problems don’t discriminate. We’ve also learned that early intervention is the key to managing the condition or overcoming it completely.
In fact, we’ve done such a good job of taking away the stigma, mental illness is now the number one reason patients will see their GP, accounting for 62 per cent of all consultations.
But for our mental health professionals themselves, it can be a different story. A survey by Beyond Blue in 2010 found one in five medical students and one in 10 doctors had suicidal thoughts in the previous year. These numbers are alarming. What’s even more concerning is that doctors tend not to seek help, or delay treatment for anxiety of depression for two important reasons:
One in three respondents cited “embarrassment” as a barrier to treatment, or a perceived “impact on registration and right to practice”.
Four in 10 believed that “many doctors think less of (other) doctors who have experienced depression or anxiety”.
Suicide in Doctors
In January 2017, the suicide of trainee doctor Chloe Abbot helped to raise awareness of the issue. It’s been reported that two more NSW trainee doctors took their own lives within four months of Chloe, and four died by apparent suicide in Victoria in 2015. It’s been estimated that at least 20 doctors have died since 2007 — but it is likely to be far more, as profession is not always recorded by the coroner.
In hindsight, Chloe’s circumstances led her to be a high-risk for anxiety and depression and potentially suicide. But at the time, no one saw it coming. Her family have since campaigned on her behalf. They say the medical system needs to keep its high standards and expectations, but it does need an overhaul so young doctors like Chloe, who held down as job in hospital between 50-60 hours a week and was studying at least another 30 hours on top of that, don’t need to be under so much pressure.
Addressing the issue
Thanks to her family speaking out, help is on the way. In 2017, NSW Health announced a multimillion-dollar reform plan devised with the state’s junior doctors to better safeguard their health and mental wellbeing, with a particular focus on a reduction in working arrangements for junior doctors to combat fatigue.
That’s a positive step forward, but there is also a dire need to address ‘toxic, competitive, unempathetic’ workplace cultures. Medical professionals need to feel comfortable talking about their struggles without fear of being judged, or jeopardising their careers.
And, with the legislation as it currently stands, it’s a self-perpetuating cycle. Unless we bring this issue out in the open and give Doctors the freedom to face their own personal problems, then it will only continue.
It goes without saying that legislative change is necessary. Finding the right balance though, is the difficult part. Laws need to enable doctors to have the same rights to confidential treatment that patients have, so they can seek treatment without fear of being reported, penalised or losing their jobs. Patients’ rights and overall confidence in the profession need to be upheld in all regards.
In order to achieve this, COAG is currently undertaking a targeted consultation process involving professional bodies representing each registered health profession, consumer groups, National Boards and professional indemnity insurers.
The results of the targeted consultation process will inform a Bill to be presented to the
Queensland Parliament as soon as possible, and if passed, is likely to be adopted by other states and territories, with the exception of Western Australia where the current arrangements are considered adequate and will continue.
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