David Nathan: Mandatory consequences

IT seems curious that society puts its faith in doctors to treat illness and injury while maintaining confidentiality and acting only in the patient’s best interests, and yet government policy mandates that doctors treating and supporting colleagues who need help must, in some circumstances, report them to authorities.

National mandatory reporting legislation took effect on 1 July 2010, with doctors now required to report “notifiable conduct” to the Australian Health Practitioner Regulation Agency (AHPRA). But does mandating notification by law mean that we may be failing to support Australia’s doctors and, in turn, failing to properly protect Australians?

As an organisation, Avant supports the reporting model used in WA,  where doctors are exempted from mandatory reporting legislation when they are providing health services to another doctor or to a medical student.

We believe this is good policy as, under this system, doctors who need support receive support.

The absence of this exemption in other Australian states and territories inevitably engenders reluctance by doctors who need help to seek help. As a result, they are less likely to perform their work to the standard we expect from all doctors. This is the root of our concern.

Avant is not suggesting doctors in WA or elsewhere refrain from reporting a colleague who is under their medical care and, against their advice, insists on continuing to work. However, the treating doctors’ decision to report should be their own and not be influenced by fear of AHPRA taking disciplinary action taken against them.

In the 18 months since national mandatory reporting legislation was introduced, Avant’s medicolegal hotline has taken more than 250 member calls on this topic, with more than half the callers seeking advice about the extent of their mandatory reporting obligations.

Some members notified Avant of their intention to report a colleague and sought advice on the consequences of doing, or not doing, this.

A typical example is when a member suspects a colleague may have alcohol-related problems which may be impacting on their practice but is unsure about the level of proof needed before proceeding to report the colleague under the mandatory reporting requirements.

Avant’s medicolegal advisers deal with such  questions by asking whether the member believes that the practitioner’s alcohol consumption is affecting their capacity to exercise reasonable care and skill, whether this behaviour is occurring in their medical practice and whether there is a risk of harm to patients as a result of a likely failure to appropriately diagnose and/or treat them.

A quarter of the requests for support on mandatory reporting relate to a member who has been reported to AHPRA. Unfortunately, a proportion of these cases involve an undertone of market competition or a personal agenda driving such reports rather than genuine concern about the capacity of the doctor to perform at an “acceptable standard”.

The only group of health care professionals excluded from mandatory reporting obligations are those employed by medical defence organisations (MDOs). However, even this is a Pyrrhic victory, given the inability of our members outside WA to seek professional support from, or give professional support to, a colleague, free from the spectre of mandatory reporting.

Avant and the other MDOs are supporting members who are under stress by providing confidential and independent counselling but this is not the optimal solution.

Both doctors and patients deserve a better model to achieve an optimal health care outcome for everyone.

Mr David Nathan is the chief executive office of Avant, Australia’s largest medical indemnity mutual.

Posted 31 October 2011

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