Doctor impairment

The Health practitioner regulation national law defines an impairment of a health practitioner as “… a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect … the person’s capacity to practise the profession”.

 

• Out of character behaviour
• Less empathy for patients’ problems
• Unexplained time off work
• Spending more time at work
• Making errors
• Declining quality of work
• Change in appearance, e.g. weight loss, looking tired, less attention to grooming

Depending on the situation, it can help if a trusted colleague sits down with the health practitioner to discuss concerns, explore the underlying cause, and assess their insight:

• Ensure privacy and allow adequate time.
• Show care, not judgement.
• Use open and direct communication.
• Be respectful.

 

You could encourage your colleague to:

• seek medical attention
• take time off work
• seek advice from their medical defence organisation.

• General practitioner
• Psychologist or psychiatrist
• Doctor's health service, e.g. Doctors' Health Advisory Service, DRS4DRS
• Beyond Blue
• Lifeline

   

According to the Australian Health Practitioner Regulation Agency's (AHPRA's) mandatory notification guidelines, all registered health practitioners have a legal obligation to report if they form a reasonable belief that any other health practitioner (or student undertaking clinical training) is placing the public at substantial risk of harm (a very high threshold for reporting risk of harm to the public) by practising with an impairment.

A reasonable belief about the impairment must be formed while practising the profession, i.e. not during personal time.

✔ Direct knowledge or observation of behaviour that places the public at risk of substantial harm. Conclusive proof is not needed.

X  Speculation, rumours, gossip or innuendo.

The threshold for making a mandatory notification as a practitioner providing a health service to a practitioner/clinical student is higher than for other notifier groups. There are exemptions to the obligation in Queensland in certain circumstances and in WA.

You may not be required to make a mandatory notification if effective controls (e.g. treatment, change to scope of practice, or stopping work) are in place to manage the impairment and reduce the risk and severity of harm to the public.

In WA, treating practitioners are exempt from the requirement to make a mandatory notification. However, these practitioners still have a professional and ethical obligation to protect and promote public health and safety so they may consider making a voluntary notification. 

In Queensland, practitioners aren't required to make a mandatory notification when their reasonable belief forms while providing a health service to a health practitioner and where the treating practitioner reasonably believes that the notifiable conduct relates to an impairment that will not place the public at substantial risk of harm and is not professional misconduct.

The code of conduct states:(p24)

Good medical practice involves: ...

• not relying on your own assessment of the risk you pose to patients
• consulting your doctor about whether, and in what ways, you may need to modify your practice, and following the doctor's advice.

There’s no need to report if you’re managing your health issue and there is no substantial risk of harm to the public.

If you feel you may need to make a self-report, discuss the situation with your medical indemnity insurer.

Notify AHPRA in every state and territory except Queensland.

In Queensland, notify the Office of the Health Ombudsman.

Yes, provided the notification is made in good faith (well-intentioned and without malice).

The Australian Health Practitioner Regulation Agency will try to keep your details confidential if you ask to remain anonymous; however, there are limitations to confidentiality.