Unwell doctors fear reporting impacts

A new study reinforces evidence that doctors fear reporting symptoms of mental health or substance use issues, even to their doctors.

A study of the impact of the regulatory complaints process on doctors has found just what many have suspected – that it deters doctors with mental health problems from seeking help.

The study was conducted by doctor and lawyer, Dr Owen Bradfield, from the University of Melbourne, who interviewed doctors at the centre of a medical complaints process relating to mental health or substance use challenges.

A 2019 study by Beyond Blue found that doctors experience high rates of depression, anxiety and substance abuse, with risk factors including long working hours, stressful working environments, poor work-life balance, and easy access to medication.

Dr Bradfield interviewed 25 doctors, 21 with a history of mental health and substance abuse challenges and four with experience as treating doctors as patients.

The aim, says Dr Bradfield, was to to explore how unwell doctors experience regulatory processes and the impacts of those processes on their health.

He says he found interviewing the doctors ‘humbling’.

‘For many of them, I was the first person they felt safe talking to about their problems. Some had not wanted to burden their family or talk to their colleagues or peers, due to fear or shame,’ he says.

His study, published in the International Journal of Law and Psychiatry, found the regulatory complaints processes often resulted in the doctors receiving muchneeded treatment. However, it also found the regulatory processes themselves led to worse outcomes for the doctors and their communities, because they delayed seeking help.

‘One of the things I have observed in my career working in medical defence is the impact that a claim can have on some doctors,’ Dr Bradfield says. ‘Any kind of complaint from a patient …. strikes at the heart of what it means to be a doctor. As doctors, we can have strong perfectionistic traits.

‘When a complaint comes, it can be devastating to a doctor’s sense of identity and self-worth. While most doctors eventually deal with the stress, some suffer extreme reactions to having a complaint.’

He says doctors reported their fears of telling their own treating doctors that they had symptoms of mental health or substance-use challenges, for fear they would be reported and that the regulator would remove their registration.

‘Participants said regulatory processes triggered psychological distress, symptom relapse, and adverse financial and vocational implications. They also told us that these processes eroded their trust in regulators and regulatory processes and, if

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the situation were repeated, they would seek help overseas.

“It was a paradox – they were scared of seeking treatment because of being involved in the regulatory process, but then, because they were more unwell at the time they were reported, they often had worse health outcomes and suffered more severe regulatory sanctions … than they would had they had received help sooner.’

The study found that the regulatory approach, including fears that treating doctors do not understand their regulatory responsibilities, lengthy delays and a punitive or judgmental culture contributed to poor outcomes.

Dr Bradfield’s study concluded that, despite recent efforts by Ahpra to make regulatory processes kinder and more therapeutic, more work is needed.

This includes establishing regular, accessible, and personal communication with unwell doctors about the progress of the regulatory notification, improved staff communication skills and development of staff knowledge and understanding of mental health and substance use challenges.

Dr Bradfield also argues that these findings add further weight to growing calls to repeal mandatory reporting laws for practitioners who treat unwell doctors.

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