Mandatory reporting of health professionals: 4 options

If you are an Australian health professional and you have a health problem, there is a risk that your job is on the line if you seek medical assistance. But help is on its way…

As a result of mandatory reporting obligations under the National Law doctors and other health professionals may avoid seeking help or treatment for fear of being reported to the Australian Health Practitioners Regulation Agency (AHPRA) by their treating practitioner.

The reporting requirements were originally developed to protect the public against practitioners who have e.g. a health problem, an impairment or engage in serious misconduct.

Concerns have been raised repeatedly that health professionals are not seeking help and this has been flagged as a risk to the public in itself. Practitioners have also argued that their treatment should be kept confidential, just like every other Australian who seeks care.

Western Australia is the only state where these mandatory reporting guidelines are not applicable. Sadly, there is anecdotal evidence that this has created interstate traffic by practitioners in need of medical assistance.

Four options

The good news is that health ministers have reviewed this issue last month. The discussion paper ‘Mandatory reporting under the Health Practitioner Regulation National Law’ by the Australian Health Ministers’ Advisory Council (COAG) provides 4 options – of which 3 are new ones.

Option #1

This is the least favourable option as it would mean no change. This option would treat impairment matters and other notifiable conduct identically, requiring treating practitioners to report any notifiable conduct as is currently the case.

Option #2

This is likely the most favourable option from the perspective of health practitioners as it provides a complete exemption for treating practitioners from the requirement to report notifiable conduct in respect of their practitioner patients – similar to the Western Australian model.

Practitioners would have the same rights as any other Australian to seek care, without fear of being reported by their treating practitioner and recognising the importance of confidentiality.

This option would entrust the treating practitioner to make a voluntary notification in accordance with their professional and ethical obligations to protect the health and safety of the public.

When a patient poses a serious risk to the public, professional and ethical obligations require treating practitioners to report (even in the absence of a requirement to do so) and to encourage the practitioner that they are treating to self-report.

Other practitioners including colleagues and employers remain under a mandatory obligation to report impairment and other forms of notifiable conduct.

Option #3

This option would only exempt treating practitioners from the requirement to report an impairment matter if it will not place the public at substantial risk of harm.

All other types of notifiable conduct, current or past, must be reported by a treating practitioner. This means that practitioners with for example a mental health or addiction problem may not disclose issues to their treating practitioner, or may avoid seeking help.

Option #4

This option would exempt treating practitioners from reporting impairment matters and to only require reporting of other forms of notifiable conduct where there is a current or future assessment that the notifiable conduct is likely to occur.

This option creates problems with regards to for example risk assessment which is often based on past conduct. Health practitioners may not fully disclose health matters and avoid seeking help under this option.

The WA model

I expect that most practitioners will prefer option 2. This option allows full disclosure of health issues, facilitating diagnosis and treatment. It respects the confidentiality of the patient-doctor relationship which is the basis of a successful road to recovery.

The COAG discussion paper reports that an independent review found no evidence that the WA model impacted on notification rates, further supporting option 2 as the preferred nationwide solution.

RECOMMENDED FURTHER READING: Mandatory reporting of health professionals: has COAG delivered on its promise?

Why your GP doesn’t have a Facebook sharing attitude

The success of Facebook is based on sharing content with friends and family. I’m a fan of social media but in healthcare sharing of information is often a no-go zone.

Doctors don’t like sharing patient information with third parties for various reasons: they have sworn an oath, must adhere to a code of conduct and have an ethical and legal obligation to safeguard the privacy of their patients.

The patient-doctor relationship is built on trust: patients need to feel safe to share their concerns with a doctor. Unfortunately in Australia there are a few worrying cracks in the system, such as the access of insurance companies to health records.

Life insurance industry

Last week I had the opportunity to present the concerns of the Royal Australian College of General Practitioners (RACGP) at the Inquiry into the Life Insurance Industry of the Joint Parliamentary Committee on Corporations and Financial Services in Canberra.

The issue is well summarised in this ABC News article ‘Doctors resisting health records being sent to insurance companies’. Based on feedback from GPs, the RACGP recommends in its submission into the inquiry that insurers should not be allowed to ask for full patient health records.

This is an example of inappropriate sharing of information with a third party (which differs from sharing between health professionals) and can have serious ramifications.

Inquiry in Life Insurance Industry
Last week I had the opportunity to present the RACGP submission at the Parliamentary Inquiry into the Life Insurance Industry.

5 reasons not to share

There are five reasons why third parties such as insurance companies should never have access to health records:

# One

People often don’t understand that ticking a box on the life insurance application form means that insurers can have access to their health records, including confidential information that has been shared with doctors, often over many years, and may not be relevant to the insurance company.

In the experience of GPs many people withdraw their consent once they are aware of the possible repercussions, and in some cases discuss with their GP to submit a targeted, more relevant medical report instead.

# Two

The therapeutic trust relationship between a GP and a patient could be affected.

Patient knowledge of the issues they may face after disclosing symptoms or seeking treatment, particularly for mental health issues, is likely to discourage disclosure and help-seeking, which adversely affects patient wellbeing.

# Three

Understanding that medical records can be requested by an insurer may lead GPs to under-document or under-identify patients at risk in efforts to make sure the patient’s access to insurance is not affected.

GPs have advised that they feel they are placed in a difficult situation where they need to ensure adequate documentation of their consultation with patients while also considering the broader impact this may have on their patient. This in turn may have medicolegal ramifications for doctors.

# Four

Insurers not only have access to but also store thousands and thousands of health records. This raises all sorts of questions with regards to data usage and standards around security, privacy and confidentiality.

# Five

Many GPs are concerned about the risks of misinterpretation by insurers when reviewing a patient’s consultation notes.

Medical consultation notes are a comprehensive written record of concerns, symptoms, examinations, investigations, treatments and planned reviews. They function as an aide memoir and are not made for the assessment of risk for insurance purposes.

Suggested solutions

There should be a tightening of the requirements around requests for full medical records by insurers. With patient consent, doctors should only be asked to provide a targeted and relevant report to the insurer.

There is also a clear need for greater patient education on consent and the release of health information to insurance companies.