Q&A - Healthier practitioner, better patient care

The MIPS Medical Indemnity Insurance Policy can only respond to claims arising out of the provision of healthcare to a patient. Members however may also approach MIPS for discretionary assistance under the MIPS Protections for non-medical indemnity matters related to professional activities that may not otherwise be covered by insurance arrangements. MIPS can certainly provide general advice to members in this area. A request for further assistance (such as a legal representation) in circumstances stated above will be considered in accordance with the MIPS Constitution and the law. For information and other websites about bullying https://www.headsup.org.au/supporting-others/workplace-bullying

This can be a significant issue requiring detailed investigation and a considered response. In general terms, there is a legal requirement for equal opportunity in healthcare as in all workplaces. Appropriate or improved recognition and education may assist. It is in everyone’s interest to try to resolve matters without resorting to a formal dispute process by engaging with senior management or a trusted supervisor early. Helpful websites on gender equity include: The Australian Workplace Gender Equality Agency https://www.wgea.gov.au/ Recent report on eliminating everyday sexism, ‘We set the Tone’ http://malechampionsofchange.com/resources/

As with all consultations it is all about trust. Sometimes this takes time. Of course, it’s most important to listen fully, and reassure a practitioner patient about strict confidentiality. As treating practitioners, we often adjust our approach to different patients. It may be appropriate to adopt a more collaborative approach for patients with high healthy literacy. As for other patients with complex issues, it may be necessary to offer long consultations for detailed mental health history and optimal review. Always consider the atypical symptoms and signs of mental illness, which are sometimes partially self medicated.

The registration standards do not include any specific restrictions for the registration of medical professionals, who suffer from mental or physical health issues, unless ‘The practitioner has placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment.’ This is rarely the case. Refer to: http://www.medicalboard.gov.au/Registration-Standards.aspx In reality, many medical professionals with mental health issues continue to provide a high standard of patient care, but sometimes at the expense of their own health. Clearly, it is essential that any practitioner with a mental or physical health condition has their own treating practitioner, who will objectively assess their fitness to work.

Yes, MIPS advisers can provide advice and assistance in individual circumstances. There is also valuable information available at the AHPRA website including detailed mandatory notifications guidelines. The threshold to trigger a mandatory notification to APHRA is high, and should only be taken on sufficient grounds: ‘The practitioner has placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment.’ It is advisable to first discuss any concerns you may have with MIPS.

If you are concerned about a colleague, sometimes it helps to ask them if they are OK or if there is anything you can do to support them. However, this can be difficult because of the stigma your colleague may experience in admitting they are having issues. Many practitioners wear an emotional shield at work. If this is the case, try raising practitioner health and stress management at your next team or practice meeting as a routine agenda item, encouraging all staff to have a comprehensive preventive health assessment with their own trusted GP outside the workplace. A comprehensive preventive health assessment should include routine mental health screening. Your colleague may also wish to seek advice from their supervisor / senior colleagues or Hospital Employee Assistance Program or MDOs such as MIPS or their local Doctors Health Advisory Program.

I am concerned that we are not being effective in addressing the stigma related to mental illness in our professions. The 2013 beyondblue national survey of the mental health of 14000 Australian doctors and medical students documented many worsening statistics in relation to high levels of depression, anxiety, self medication and suicide. In the study, approximately 40% of doctors felt that medical professionals with a history of mental health disorders were perceived as less competent than their peers, and 48% felt that these doctors were less likely to be appointed compared to doctors without a history of mental health problems, which indicated the negative stigma attached to mental illness. Approximately 59% of doctors felt that being a patient causes embarrassment for a doctor, and over 50% do not have their own GP. There are solutions. We have to change this.

Many practitioners feel like this at different times of their careers because lack of control and uncertainty are common realities. If work feels out of control for any length of time, try taking control of how you spend your time outside of work to make sure you rejuvenate fully. If these feelings persist, talk them over with your trusted treating GP. It may help to have routine debriefing and mental health screening. It may help to think about the culture of your workplace and raise practitioner health and wellbeing at your next team or practice meeting. This is an issue that concerns everyone.

There is no specific list at the current time. However many GPs have specialised mental health training and are very happy to treat other GPs. If you find it difficult to obtain a personal recommendation from a colleague, try searching the local GP websites in your area. The practice websites usually indicate if the GPs have any mental health expertise and are able to offer long consultations.