Mandatory reporting: is it killing doctors?

IT has been a little over 1 year since I penned an MJA InSight article on mandatory reporting of health practitioners. What inspired me to write a follow-up article was the suicide of Dr Chloe Abbott, which has been widely reported in the Australian media in recent months. Her story bore some similarities with SJ, the nurse in my original article.

The difference is that SJ survived and is now on the path to recovery.

SJ was admitted to hospital under the NSW Mental Health Act for psychiatric reasons. She was reported by her treating doctor to the professional state health council as is required under Section 151 of the Health Practitioner Regulation National Law (NSW). To be clear, this is a NSW-only law.

Chloe is dead, SJ is not. Let’s examine potential reasons why the outcomes were different.

SJ sought psychiatric care interstate as she initially found it difficult to trust treating doctors in NSW, due to the Section 151 mandatory reporting requirement. Local NSW mental health services actually discharged her from their care, despite her vulnerability after her recent suicide attempt, and conditions were placed on her nursing licence as a result of the mandatory reporting and assessment by the nursing council.

In severe financial stress, a single mother of two young children and in utter shame due to the mandatory reporting, SJ endured prolonged periods of suicidal ideation, racked in a state of existential despair and hopelessness. Slowly, day by day, with the help of an interstate psychiatrist and novel ketamine-based depression therapy, SJ started on a gradual path to recovery.

She is now back to nursing work, having passed further psychiatric assessments by the nursing council. She has found a local psychiatrist to manage her treatment, but still requires ongoing ketamine from the interstate specialist.

She survived. Why? Pure luck? The system worked? No. She survived because she went outside the mental health system of her state of NSW, and reached out for help from interstate.

The mandatory reporting law almost killed her by putting her into a state of hopelessness and shame. She could have had the same psychiatric treatment locally if not for the mandatory reporting laws creating a state of fear for her and her treating doctors.

What I can safely say is that a law that requires a treating doctor to report a mentally unwell doctor or nurse to a state and national authority – which will jeopardise their career and professional record – will absolutely not help their mental state, nor their recovery.

Medicine is built on trust. It’s called the therapeutic relationship or alliance. If you cannot trust your treating doctor to have your best health interests in mind, then you may as well not bother.

A year on from my original article calling for a change to the NSW mandatory reporting law, I am glad to report that SJ is on a good recovery path, but it required extraordinary measures.

It saddens me to hear of the tragic suicides of young doctors like Chloe Abbott. I hope that in a year from now, I am not writing another article about the same thing and lamenting that, indeed, the cure is deadlier than the illness.

Footnote: Newly appointed NSW Minister for Health Brad Hazzard has called for an action plan to deal with young doctor suicides and is convening a forum in June 2017 in Sydney. Now is the time to petition him for a change to the NSW law Section 151. You can tweet him @BradHazzard.

Dr Minh Le Cong works for the Royal Flying Doctor Service in Queensland and is the chief editor of the PHARM (Prehospital and Retrieval Medicine) blog site and podcast, the FOAM4GP blog site and the Ketamine Leadership Academy blog site.

 

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