This article is one in a monthly series from members of the Australian Medical Students’ Association (AMSA).

IN February 2019, medical students were disappointed to see the Queensland Parliament reject recommendations to change the Health Practitioner Regulation National Law which would exempt treating practitioners from mandatory reporting, similar to the Western Australia model.

While the recommended changes would have been a step in the right direction, I would like to reflect on a personal experience that reminded me of the reality for vulnerable medical students and doctors attempting to seek help.

Several months ago, I relocated to a new area in Sydney – new suburb, new GP, same old medical history. While I still have a regular GP, now about half an hour away, a practice down the road from my new abode was too convenient to turn down. The consultation was friendly enough and conversation flowed easily as we bonded over our experiences in the medical field (albeit mine being far earlier along the path than the GP’s).

During my long-winded history, I recounted my experience with what I still assume was stress-induced fatigue in 2018 during a particularly brutal rotation that required 35 hours per week of clinical contact. This was in addition to the 20 hours per week of studying for the end-of-placement exam, and the 20 hours per week I worked part-time on weekends to support myself. Taking days off, even for illness, would have meant remediating those hours on a weekend and forgoing my weekly income.

To make matters worse, I was placed at a satellite hospital an hour’s commute away from my home. Moreover, there was only one staff member at our medical school trying their hardest to support the dozen students on the rotation.

A month into this placement, I went to the only local GP available after-hours. I was convinced I had developed narcolepsy, as I frequently found myself on the verge of falling asleep throughout the day, most worryingly during my hour-long drive to and from the hospital. I never had the time to go back to confirm a diagnosis, or the money to follow up with the sleep physician the GP referred me to. By the end of the rotation, I had developed acid reflux symptoms, daily headaches and sleep paralysis.

I recounted this to the new GP, partially to vent my frustrations to someone who had certainly gone through the same experiences during their medical schooling, but also seeking some sort of retrospective medical validation for a level of fatigue that profoundly affected me during that time.

Instead, the GP scolded me: “You should have followed up. If I had seen you last year and you were as fatigued as you say, I would have been required to report you, you know!”

To be clear, the Medical Board of Australia’s Guidelines for mandatory notifications say the following about reporting “impaired students”:

Practitioners are required to make a mandatory notification in relation to a student if the practitioner reasonably believes that a student has an impairment that, in the course of the student undertaking clinical training, may place the public at substantial risk of harm (section141(1)(b)).

In all cases, the student’s impairment must place the public at substantial, or considerable, risk of harm in the course of clinical training.

In relation to a student, “impairment” is defined under section 5 of the National Law to mean the student “has a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect the student’s capacity to undertake clinical training —

(i) as part of the approved program of study in which the student is enrolled; or
(ii) arranged by an education provider”.

I cannot fully describe the incredulous mix of emotions I felt when the GP said this – surprise, anger and, mostly, shame. I thought I had been forming a rapport with a new GP, lamenting over the barriers of time, money and social pressures that stop many medical students from seeking help. Instead, this GP put up another barrier for me: fear.

Just a month before seeing this GP, AMSA sent a focus group to consult with the Australian Health Practitioners Regulation Agency to identify the best way to positively communicate to medical students that they are able to seek help without fear following the mandatory reporting reform. I remember leaving that focus group feeling positive and ready to encourage my peers to reach out when they needed to.

Despite feeling significantly more deflated after my GP consultation, I reflect on this experience with a hopeful outlook that requires action. While positive communication from the top is vitally important, it is just as important to educate those who will be interacting with vulnerable medical students and doctors on their reporting obligations. All the positive messaging in the world is not helpful if vulnerable medical students, so early on in the medical careers, are being deterred from seeking help due to the practitioner’s ignorance of the notification guidelines.

Jessica Yang is the President of the Australian Medical Students’ Association, the peak representative body for Australia’s 17 000 medical students. She is a medical student at Western Sydney University. She can be found on Twitter at @YourAMSA and @JessHYang.

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.


Poll

More should be done to educate doctors about if and when they are obliged to report a colleague
  • Strongly agree (76%, 108 Votes)
  • Agree (18%, 25 Votes)
  • Neutral (3%, 4 Votes)
  • Strongly disagree (3%, 4 Votes)
  • Disagree (1%, 1 Votes)

Total Voters: 142

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9 thoughts on “Mandatory reporting: educate the reporters

  1. Anonymous says:

    Common sense must apply. AHPRA is not an organisation that looks after doctors – in fact it is the opposite. Without demonstrating its powers on a regular basis AHPRA has no reason to exist. Therefore AHPRA is and should only ever be the last resort. Nearly all situations can be solved by common sense. And that is something AHPRA lacks.

  2. Stan J. Doumani says:

    Dear oh dear. What has the world come to when a member of a profession cannot safely seek help from another member of the same profession for a condition/problem that falls within the purview of that profession. Ridiculous! The quoted text “make a mandatory notification in relation to a student if the practitioner reasonably believes that a student has an impairment that, in the course of the student undertaking clinical training, may place the public at substantial risk of harm” is at the crux of the matter.

    “Reasonably believes”, it leads on to a big question. Reporters of such are still charged with the professional responsibility to make an expert judgement before they go shooting their mouth off and opening a can of worms for the reportee. “Reasonably believes” is always going to be arguable and in order to report you need to reasonably believe that the public is in danger. It’s a big responsibility, it’s a big club with which to beat people and the consequences are potentially dire. Wield the club with caution.

  3. Jonathan Page says:

    This a terrible experience recounted by poor Jessica – frim the all too common causes for the original stress and then a medical response lacking any compassion. The reporting experience is not magical, compounds the stress and shame, does not create a “safe” doctor and doesn’t protect the public, as other doctors and students hear of the ugly process and keep their concerns as a deep secret. More compassion please.

  4. randal williams says:

    Educating doctors about sensible, responsible and appropriate reporting of colleagues is vital.

    Additionally, my advice is; if you think you need to report a colleague to AHPRA, take the time to put the situation
    ( hypothetically and anonymously) to a peer, or if you are young doctor, a senior colleague. If the second opinion is in line with yours then go ahead. This also protects you from any criticism that your report was unnecessary or inappropriate. I actually think getting a second opinion should be mandatory in this situation because the consequences for the practitioner in question can be severe and profound.

  5. DANNIELLE KOLOS says:

    In this state of uncertainty and lack of trust among the medical profession, it may be safer to consult a naturopath!

  6. Andrew Nielsen says:

    Other doctors are as much as a problem as the registration.

  7. Anonymous says:

    I had a similar experience some years ago as a medical student, from a supervisor – who, when challenged on what danger I presented admitted there was none. He then seemed surprised that this ?threat had upset me. If I were being unkind I would say that clearly they weren’t selecting for empathy in medical students 35 years ago, but then again burn out doesn’t just happen to medical students or early career doctors.

  8. Geoff TOOGOOD says:

    Too true
    There is great deal of education required as many Drs and indeed many admin feel it’s required just for very manageable health issues
    It’s just one of the vexed issues in this mine field
    No wonder we don’t seek help or are afraid to
    GT

  9. Anonymous says:

    In the hospital context, I’ve found administration ill prepared and unwilling to take a leadership role in regards to mandatory reporting so it gets left to individual practitioners with all the stress and retribution that entails. Since the hospitals are usually privy to more information often from multiple sources they should be the ones putting their necks on the line. Step up administrators and do the hard stuff!

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