Mary Langcake: Support or report?

IN 2013, a beyondblue study showed that one in 10 doctors had experienced suicidal thoughts in the previous 12 months.

The study also showed substantially higher rates of psychological distress and attempted suicide for doctors, compared with both the general Australian population and other Australian professionals.

Doctors face a huge amount of stress in their careers. Balancing personal life with large workloads, long hours and the responsibility for others’ lives can create a pressure cooker situation.

Among surgeons, the transition from study to work may be a difficult time for trainees. They spend extended periods of time in the operating theatre and long hours on call, while at the same time studying for the examinations that will determine their future progress.

Surgical trainees spend a maximum of 6 months on a surgical unit before rotating to a new speciality with new senior staff and, at times, a new hospital. This constant change contributes to the stress that they experience.

Men are particularly at risk. In 2010, men accounted for more than three-quarters (76.9%) of deaths from suicide, but an estimated 72% of Australian males don’t seek help for mental disorders.

A survey of members of the American College of Surgeons suggests surgeons were less likely than those in the general population to seek help for mental health problems. One in 16 surgeons reported suicidal thoughts in the preceding 12 months, yet only one in four sought psychiatric or psychological help. Depression, burnout and the perception of making a major medical error are closely linked to suicidal ideation.

Doctors should be encouraged to seek professional help if they experience any symptoms of psychological distress.

However, a potential impediment to seeking help is mandatory reporting of “notifiable conduct” by health professionals, which is now required by the Australian Health Practitioner Regulation Agency. This applies to not only health practitioners but also their employers, and for students, to their registered training organisation.

Is this resulting in better patient care or preventing health professionals from looking after their own mental health?

A recent article suggested that the spectre of mandatory reporting may impact on the “therapeutic relationship between a treating doctor and doctor-patient”. If doctor-patients perceive they could be reported, they may not access care when needed.

A review undertaken in New Zealand more than a decade ago found that true cases of incompetence may actually be less likely to be exposed through mandatory reporting.

Apart from reluctance to make a mandatory report about a colleague, there is uncertainty about what is classified as “notifiable conduct”. The grounds for notification include drug and alcohol abuse while practising, sexual misconduct, a departure from accepted professional standards and, notably, any “impairment” which places the public at risk of substantial harm.

While the misuse of drugs and alcohol or sexual misconduct during practice are clear indications for notifiable conduct, whether a person’s mental health poses a risk to their patients can be much more difficult to gauge. The Medical Board of Australia defines “impairment” as a person who has “a physical or mental impairment, disability, condition or disorder (including substance abuse/dependence) that detrimentally affects or is likely to detrimentally affect the person’s capacity to practise the profession”.

Western Australia is the only jurisdiction where a health practitioner can legally keep confidential a consultation with a colleague on mental health issues. This is granted through a special statutory exemption, which experts recently argued should be considered for adoption across Australia.

Perhaps it is time we revisited this aspect of mandatory reporting to ensure all Australian health professionals do not face real or perceived barriers to seeking help.

Doctors have a right to confidential care without being concerned that they will be reported, or stigmatised by their colleagues, while recognising mutual professional duties to uphold high standards of patient care.

Doctors who need help or advice can contact beyondblue, a confidential 24-hour referral, advice and support service, as callers do not need to provide their names. Visit beyondblue’s website — www.beyondblue.org.au.
 

Dr Mary Langcake is the chair of the Royal Australasian College of Surgeons NSW Regional Committee, and a trauma surgeon in NSW.