Mandatory reporting: Changing attitudes within the profession

Paul Hayes

16/03/2018 11:43:20 AM

Altering existing mandatory reporting laws would help to foster a new message about the philosophy of the medical profession and its approach to the mental health of its practitioners, the President of the Australian Medical Students’ Association told newsGP.

AMSA President Alex Farrell believes the healthcare profession has reached a point where changes must be made so doctors can more easily address their issues of mental health.
AMSA President Alex Farrell believes the healthcare profession has reached a point where changes must be made so doctors can more easily address their issues of mental health.

‘I think it would send a message about the culture of medicine – that we encourage people to talk about their mental health, that we encourage them to seek help, that mental health is something that doesn’t have to be stigmatised but can be treated exactly like all other healthcare issues,’ Australian Medical Students’ Association (AMSA) President Alex Farrell told newsGP.
‘Doctors should be able to expect the same level of healthcare for themselves that they would offer to anyone else that walked through the door.
‘We are reaching a point in medicine where we can’t ignore that mental health is an issue, and unfortunately the stories that keep coming up are a concern that something needs to change.’
Farrell’s comments follow recent news that New South Wales Health Minister Brad Hazzard wants to change the state’s mandatory reporting laws and allow doctors to safely seek mental health care.
‘Doctors should get the same benefits as every other patient. And that is, when they have a mental health issue they should be able to talk to their practitioner in privacy and know they can have their mental health condition addressed without necessarily losing their job,’ Minister Hazzard told the ABC.  
While Western Australia is currently the only Australian state or territory that allows doctor-patients an exemption from mandatory reporting, the Council of Australian Governments (COAG) has made a commitment to change the mandatory reporting laws nationwide.
‘When we see leadership coming from politicians on an issue like this and they acknowledge that there is a responsibility to look after medical students and junior doctors, then that is something that really should be celebrated,’ Farrell said. ‘That shows a commitment to not only the health of that state’s workforce, but to best practice in terms of making sure that the doctors looking after their patients are at their healthiest.’
AMSA has also called on the incoming South Australian government to fulfil the COAG commitment and adopt the Western Australia mandatory reporting model.
‘When we see the rates of mental illness among medical students and junior doctors, AMSA believes there is an obligation to insist that the culture is changed,’ Farrell said. ‘AMSA was really heartened by the COAG agreeing that there should be a national framework around mandatory reporting. Ideally, this change would occur nationwide.
‘The next step is for states to go along that path themselves, and actually make sure it’s not just an empty promise.’

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Kath Bankhead   20/03/2018 9:35:41 AM

The issue of bullying and mandatory reporting for mental health impairments in the Medical profession has been an absolute disgrace from the outset. AHPRA and the Medical Board's treatment of the impaired doctor is punitive, discriminatory and the process of dealing with the impaired doctor is still more of a disease in a democratic society where every adult has a right to earn a living. AHPRA can hound the doctor with continual assessments and hair, blood and urine screening randomly for 'addictive substances', psychotropic and alcohol intake. If the impaired doctor is on prescribed analgesia and psychotropic, they are, in effect, treated as addicted street users. The lengths they will go to to prove one is bucking an 'undertaking not to practice's goes to the extent of bullying and mind games where the end point is not known, nor what they actually want from you. The process can take the practitioner's living away for 2-5 years until the glacial amount of red tape is moved through. The process reminds me of Franz Kafka's 'The Trial' 1939 where the worker is arrested for a reason he is never told, the jury plays mind games with him because he does not know how to answer the questions. He gets a lawyer who says cases like these are rarely won but prepares a brief for the subsequent trials. When the sentence is read after the final jury meets, he still does not know what he is guilty of. After some years of bullying and mind games F decides he will take his own life. Before he does he is sentenced to death by execution by gunshot by 2 policemen. However, they decide they cannot shoot an innocent man and desist. F hands them the knife and tells them to stab him in the abdomen (as he himself had decided he would do anyway) and they 'help' F to do it and both men help stab in the gut as he asks as a human service. Of what he is guilty, not one person mentions this in the book.

In the vulnerable medical profession (remember Chloe Abbot's suicide) the book rings startlingly allegorical.

The laws must change or the will be more Franz's and Chloes. Doctors must have a 40 hour week like the rest of society with ample sick leave every year. It's a no brainer.

Mai Maddisson   20/03/2018 9:36:27 PM

‘When we see the rates of mental illness among medical students and junior doctors ,..’

I felt truly aghast to read such words: I asked myself how this could happen. Indeed, what has happened? And no, I have not lost touch with reality. One of my children too is a doctor.

Perhaps people tend to perceive retired doctors as ‘has beens’ who sip champagne while floating around on luxury cruises with naught but the rippling waves to tax their minds. That is far from the truth. Many of us are engaged in all manner of interesting sustained projects: Mine, among the other activities required of it, has included sieving through the old MJAs right back to 1907. Given it is a voluntary project I have the luxury of allowing myself to become side tracked and peruse other material which catches my eye. To date I have reached about 1966 when the powers-that-be let me loose on the public: Thus I have an entire panorama of the march of medical life for over a century. There have been many 10-year epochs each with their transitions.

It was during my years of residency that many changes had begun to evolve: The old order which had stood for six decades was tumbled. Doctors began to demand more freedom: But nothing comes without a price.

During the old order we lived in, worked hideous hours for a couple of years and had become acclimatized to such in our latter years of clinical school. We got paid little, but our basic accommodation which was cleaned for us, and food which we didn’t need to prepare simplified our lives. The food was not cordon bleu, but we were probably too tired to notice, and a car was not a necessity as we had little time to go far. Our goal was to spend one or two years on concentrated training and THEN join the big wide world with its trimmings.

To today’s young that would sound like a cloistered existence, but we had something our younger colleagues have never known. CAMARADERIE! In those cloisters we had a common room to wind down in (and for me to learn not to shred the billiard table cover with the cue). We had our morning and afternoon teas and ate in a shared dining room where the specialists too called in for meals at times when a detour home was not convenient: That was the time before mobile phones! In those one to two years we learned to know each other. We didn’t need to like each other- just care about them. We recognized the ebb and fall in each other’s emotions, as did the specialists. And we dared remark if another appeared not to be travelling well: That’s what comrades do. Concerns were addressed in a timely way.

The notion of bullying had not yet been conceived: If a colleague was being ratty it was passed off that they had had a harder day than we had. It was not unusual to compassionately follow up the incident when the dust had settled.

I recall one day as a junior, being approached by a specialist who asked me how I coped with it all. I was just blundering along with no overt emotion and asked what had precipitated that question. His concern was for his wife, also a doctor, who felt she was being victimized as a female doctor. Women doctors at that stage were about one in seven. My remark: when people are overwhelmed they just lash out, they don’t discriminate whom they do this to: She just happened to be there, had it been a guy he would have been lashed out at. After 48 years as a clinician I cannot say that I have ever been victimized because I was a female.

Yes, in those cloisters we always had someone to be supportive: We didn’t need to ask: We could read each other. Of course, among any cohort are people who become overwhelmed at various stages of their lives. And fortunately, there was a freedom to knock at one of many doors. Mental Illness, as a plague, had not yet been invented.

I recall as a latter year medical student when life did become overwhelming. It was a mixture of long-standing demographic baggage and superimposed events. A knock on the clinical school’s dean’s door brought a prompt response. He was a SURGEON and quickly dissected out the priorities. Quite rightly, he reminded me that the age-old baggage would remain the same until well after I graduated and to just sideline it as best I could until better times came. He sought out a band-aid for the immediate concerns to allow me to pass the final exams and invited me to knock on his door again should the need arise. I passed with good grades.

There was no complex name for my emotions: I was simply overwhelmed.

How different things are today: The students appear to have no steady anchors, they have no steady mentors, many of the new-comers to the country do not have accessible families. They know no one well enough for a sustained enough time to gently tap them on the shoulder and say, “you look sad/worried today, time for a cup of coffee (or beer !!)”.
Medicine is so competitive that no one dare show any sign of being just human. No one dares lash out for fear of being accused of bullying. No one wants not to reach their pedestal in minimum time. The sociologists have brainwashed one and all of a sense of entitlement. That one should be able to access everything one wants. Everyone wants to have everything yesterday.
It has never been that way for millenniums, but those millenniums had something we have all lost: That human touch of a caring another. We no longer are even allowed to grieve for this lest someone technicalizies that grief casting it into now mandatory bureaucratic channels. The young especially have all become trapped in a revolving door with opaque partitions: Who could they reach out to in such circumstances.

I would suggest that most of what we are labeling our young is not mentally ill young but overwhelmed: Overwhelmed because they have not had the opportunity to form supportive bonds among their own cohort of peers.

My feeling is that we have thrown out the baby with the bathwater. 'Freedom' can be had without generating isolation.

Perhaps the time has come to restore some form of STABLE SUSTAINED CLUSTERING of students and young graduates: When they travel side by side they are bound to find twin souls to dilute life’s inevitable plight before such overwhelms them.

Ewen Cameron   22/03/2018 9:54:54 PM

I've been a Gp for 30 years.
When I first heard of the mandatory reporting laws I immediately said to myself this is wanking authoritian bureaucratic crap and I'm virtually never going to do it unless I think the professional involved is a psychotic nut. My first duty is yes, "to protect the public" but an awful lot of politically correct, Goerge Orwellian "1984" ,spineless, souless Gobbledegook can be hidden behind trendy catchphrases like that.
I'll follow my conscience and talk to and try to help and be loyal to my colleague who inevitably Is struggling like the rest of us with the complexities of modern medical practice and trying to do his or her best and who generally does a lot more good then harm.
Stuff the bureaucrats and the petty short sighted out of touch lawmakers in their ivory towers.
I learnt at Sunday school that my first allegiance wasn't to Caesar.