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Doctors caring for doctors

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The health of doctors, especially our mental health, has been very topical in recent weeks.

It was a major focus at the AMA National Conference in late May, and it went viral on social media through the Crazy Socks for Docs awareness campaign, which was pioneered by Melbourne cardiologist, Dr Geoffrey Toogood.

Following National Conference, Minister Hunt announced a $47 million suicide prevention initiative, with $1 million set aside specifically to support mental health and reduce suicide in the health workforce. This was most welcome.

I have since written to the Minister about programs for mental health suicide prevention in the medical workforce.

I stressed to the Minister the importance of having the mandatory reporting requirements under the National Law amended, so as to not dissuade medical practitioners from seeking necessary medical treatment or assistance.

It is well known that doctors are at greater risk of suicidal ideation and death by suicide.

So far this year, we have lost several colleagues to suicide–and these are not isolated incidents.

While there is a wide range of factors involved in suicide, we know that early intervention could be critical to avoiding many of these tragic losses.

Unfortunately, the reality is that there are significant barriers, real and perceived, that prevent some doctors from seeking access to formal health care.

The AMA is working to change this situation, and is currently working with the Medical Board of Australia to establish accessible and robust doctors’ health services across the country.

One of the key barriers that the AMA has identified to accessing care is mandatory reporting.

Mandatory reporting for doctors was introduced in NSW in 2008, and then into the National Law for all practitioners in 2010.

The intention of the legislation was to ensure the protection of the public by requiring doctors and other health practitioners to report colleagues under defined circumstances.

The legislation intentionally created a very significant bar for reporting by stating that only matters of grave significance should be reported to the regulator.

One of the requirements for mandatory reporting is to report on health and impairment. This obligation applies to both colleagues and treating doctors.

The AMA, medical colleges, and the medical defence organisations have been concerned for some time that this provision creates a barrier to health professionals in accessing health care, particularly in relation to mental illness.

The lived experience of doctors’ health advisory services across the country confirms these fears.

An extensive study of over 12,000 doctors undertaken by beyondblue in 2013 revealed that one of the most common barriers to seeking treatment for a mental health condition were concerns about the impact of this on medical registration.

The Western Australian Government recognised this concern and after dogged, persistent, and forceful representation from AMA WA over many months, created a provision in their legislation to exempt treating practitioners from the requirements of the Act in WA.

While it has been difficult to collect clear evidence of the impact of the mandatory reporting provisions on doctors seeking treatment, the AMA, doctors’ health services, medical colleges, and the medical defence organisations receive feedback from doctors regarding their fears about seeking medical treatment.

We know anecdotally of cases of doctors travelling to WA for treatment.

Of great concern, it is very clear that some doctors are actively avoiding medical care, where possible, out of fear of the mandatory reporting obligations.

The Western Australian exemption has not made a material difference to the rate of mandatory notifications in that jurisdiction.

The Independent Review of the National Registration and Accreditation Scheme for health professions commissioned by the COAG Health Council in 2014 listened to the concerns of the medical profession and other groups, recommending that the National Law to be amended to reflect the same mandatory notification exemptions for treating practitioners established in the Western Australian law.

As health practitioners, we know the dangers of delaying access to medical treatment or of only providing limited information.

This risk is particularly pronounced with mental illness, where delaying treatment can result in a person ending up with a far greater level of impairment.

As such, we believe the current legislative arrangements are not protecting health practitioners and, equally importantly, they are failing to protect the public.

In my letter to him, I told Minister Hunt it is time for Health Ministers in the seven jurisdictions (excepting WA) to act on the recommendation of the 2014 review report. I am hoping for his support on this most important matter.