‘Everything came crashing down’: Study reveals impact of health notifications

Jolyon Attwooll

12/05/2023 4:26:52 PM

The new research also stresses the pivotal role GPs can play in improving outcomes for doctor-patients.

Stressed doctor
Fear of mandatory reporting has been described as 'a significant barrier' for unwell doctors.

The devastating effect of health impairment notifications on doctors has been laid bare in a new study published in the latest Australian Journal of General Practice (AJGP).
The research is the first to consider the impact of Australia’s regulatory processes on doctors whose health allegedly affects their ability to practice, according to the authors.
First-hand remarks quoted in the research, which is based on in-depth interviews with 21 doctors, including 18 in Australia and three in New Zealand, give a vivid sense of the deeply personal ramifications on practitioners.
‘I received the notification and … everything came crashing down,’ one participant told researchers.
‘[When doctors receive a notification], they are in crisis – absolute distress,’ another said. ‘The risks are very high.’
‘The regulator cherry-picked the most stigmatising aspects of my entire life story and then included them in a report about me that was communicated to my employers,’ a third said.
‘This has left me perpetually re‑traumatised.’
Most of the notifications were the result of mandatory reporting, which is in place in every Australian jurisdiction apart from Western Australia.
‘This research is important because if regulatory processes worsen health outcomes for these doctors, the regulatory aim of public protection may not be achieved,’ the researchers write.
While the paper does not reach any conclusion about mandatory reporting, GP and lead author Dr Owen Bradfield, said the study shows that doctors’ perception of it can be detrimental.
‘My research shows that fear of mandatory reporting was a significant barrier for unwell doctors accessing healthcare, and this seemed to result in worse health outcomes for those doctors,’ he told newsGP.
‘That is not good for those doctors or for the patients they serve.’
He believes further research should be carried out to compare notification rates between jurisdictions, as well as the health outcomes for the doctors involved.
Earlier this year, findings from a separate study were made public, showing that 16 practitioners who received notifications from 2018–2021 took their own lives.
According to AHPRA, many of those faced ‘significant life and health challenges’, and the regulator said a ‘Health Management Team’ designed to support unwell practitioners has been introduced since that research was carried out.
Dr Bradfield says he acknowledges ‘important work’ that AHPRA has undertaken to improve the experience of practitioners subject to notifications in the past 12 months.
‘However, notifications can be incredibly distressing for doctors and it is crucial that AHPRA continues to listen to doctors – and those representing them – about their experiences and ways that systems and processes can continue to improve,’ he said.
Dr Owen Harris, a GP who has been open about his own experience following a notification, was among those who took part in the research published in AJGP.
In late 2015, he was subject to a mandatory report due to his own struggles with mental illness and drug use.
Having since returned to general practice in Melbourne, he has had direct insight into the acute strains the process can cause.
‘My main concerns have been the lack of transparency around process, and the incredibly slow pace for the board to make decisions,’ Dr Harris told newsGP.  
‘I also think it would be incredibly helpful for AHPRA to have an impartial person available to help people navigate the processes.’
Associate Professor Caroline Johnson, a GP with a special interest in mental health, and a senior lecturer in general practice at the University of Melbourne, commended the generosity of those who participated in the research.
‘It is really clear, and not unexpected, that receiving a notification at the same time as experiencing a serious health issue is an incredibly difficult place to be,’ she told newsGP.
‘This is a scenario we should all be having conversations about how to prevent.
‘I sit somewhere in the middle on the mandatory reporting debate, in that I absolutely want to have a strong trusting relationship with my patients who are also doctors, but I also see that as a profession we have a duty to the public to ensure our peers are not practising in a way that places the public at risk of “substantial harm”.’
She agrees with advice contained within the article, which recommends clear conversations with doctor-patients about the mandatory reporting threshold.
‘Reassure them that if they are seeking help, taking leave when not fit for work and/or making appropriate adjustments to practice so as not to risk harming patients, then the mandatory notification laws don’t apply,’ she said.  
‘As a GP, you can be an advocate for your patients, but that also sometimes means working with them to protect them in the relatively rare situations where they are so unwell that they lack insight or experience significant impairment in judgement that would place others at risk.
‘Not only is the threshold for mandatory reporting quite high, it is a decision no GP has to make in isolation, and when in doubt, the GP should get confidential advice themselves from appropriate channels.’

Dr Harris makes a similar point.
‘Mandatory reporting guidelines have changed and you will not be reported unless there is a significant risk to the public,’ he said.
‘Take time off if and when you need. If you are not working, then there is no risk to the public and no notification.’
What GPs can do
The AJGP article also stresses the role that GPs can play, including in preventing the notification process in the first place.
‘GPs play a critical role in managing the health and wellbeing of their doctor-patients, including identifying early warning signs of burnout, depression, and anxiety,’ Dr Bradfield said.
The study suggests that doctors impacted by symptoms of mental illness or substance use may be reluctant to access treatment for fear of being reported.
‘[GPs] may consider targeted mental health screening of at-risk doctor-patients, especially those with the predisposing or precipitating factors identified in this study; for example, those with a history of mental illness, those working long hours or currently studying for examination, and those exposed to high levels of vicarious trauma,’ the authors write.
Associate Professor Johnson agrees that early intervention ‘is much better than waiting for things to unravel’.
For those who undergo what she describes as the ‘traumatic’ experience of a mandatory notification report, she says ‘timely and supportive responses and active stigma-reducing strategies’ can help mitigate the strain.
Dr Harris has also previously stressed the need for support and advises those who find themselves subject to a notification to reach out for help promptly.
‘Speak to your medical defence organisation early,’ he also advised. ‘They were incredibly helpful and supportive for me once I contacted them.’
His final recommendation is also emphasised in the AJGP article, and will be familiar to doctors –  even if it is still ignored by a surprising number.
‘Find a good GP and see them regularly,’ he said.
Mental health support for GPs
The RACGP has self-care and mental health resources for GPs published on its website.
There are also free, confidential doctor-to-doctor telephone services available across Australia.
ACT 1300 374 377
NSW 02 9437 6552
NT 08 8366 0250
Qld 07 3833 4352
SA 08 8366 0250
Tas 1800 991 997
Vic 03 9280 8712
WA 08 9321 3098

See also Drs4Drs for more information.
For immediate support, you can call Lifeline 13 11 14, or Beyond Blue 1300 22 46 36.
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Dr Scott David Arnold   13/05/2023 9:24:59 AM

I have just returned to the work place after 3 months away. Conflict in the workplace, financial distress and an exacerbation of a preexisting mood disorder culminating in breakdown of my marriage. It is difficult to imagine a darker place and still be here to tell the story.

Things came to crisis at work. I spat the dummy, fortunately with staff and I walked out. I ran headlong into the crisis in General Practice and couldn't get to see my GP. Desperate, I ended up taking myself to an emergency department, something I had thought would be the most demeaning moment of my life. Instead I received excellent care and appropriate urgent treatment.

Three months later , my treatment has been optimised, I am back working part time and I am accepting of the loss of my marriage.

My message is clear, I acknowledged my impairment, sort and received help and AHPRA was only ever mentioned to confirm they did not to be notified. Please don't be afraid to seek medical care.

Dr Mileham Geoffrey Hayes   13/05/2023 11:14:17 AM

Some years ago my wife did a public speaking course wherein the class had to give a graduation speech. I was horrified as I saw the future when one angry person announced how she would soon be the citizen representative on AHPRA and would be able to pursue "those doctors". She was not wrong as AHPRA actively encourages complaints and will even provide an interpreter. It is regarded by my colleagues as a vile organisation filled with 'doctor haters'.

Susan   13/05/2023 9:36:46 PM

Thankfully I have never been placed in the position of these doctors. I can see how the use of mandatory reporting can be vexatious. I was significantly bullied in a practice I left just as the manadatory reporting came in. The particular doctor threatened me that she would report me. I had worked with a chest infection and she had already been bullying in multiple other ways. I called to discuss the matter with my medical defence union who said that I was not at any risk of a report being taken further. I do fear that mandatory reporting may be abused by those who unfortunately lack a moral compass and use it to bully. Even if the matter is dropped it can cause severe menatl health issues for those who have them.