Protecting Doctors in the Workplace: What's the law?

As a graduate of medicine and law, I am hoping to give you some insight into the legal issues surrounding health and medical professionals in their practice. Increasingly, health professionals are facing escalating violence and threats to personal safety – just in the last month or so, paramedics have faced violent assaults, as an example. Indeed, between 2009-2014, more than 24,500 health care employees reported being a victim of a violent incident at work in the past five financial years, and more than 4,400 of these were in the last year alone. Indeed, intoxicated patients have assaulted more than nine in ten emergency nurses and doctors in the last twelve months. What is to be done about this scourge upon our doctors by the public, and what has been done? This blog explores these questions.

 

Doctors and patients: a relationship built on trust, moulding into fear?

The philosophy that underpins the doctor-patient relationship has evolved from a paternalistic model in the early 20th century, to one that focuses on a collaborative approach. This contemporary model, reinforced by legal cases such as Rogers v Whitaker, involves the sharing of information, doctor-patient collaboration, and the mutual agreement upon treatment direction. However, there are noticeable changes in the community’s attitude towards the medical profession, with many patients appearing dismissive of medical advice, preferring information found on the internet, and may have an aggressive, litigious reaction to an unexpected outcome. In an already challenging profession, where clinicians have severe rates of depression and suicide (illustrated by multiple recent cases of suicide), are we doing enough to protect health professionals? High-profile, recent tragedies such as the murder of Dr. Patrick Pritzwald-Stegmann and the horrific killing of Gayle Woodford demonstrates that current practices are inadequate.

 

Mental health concerns rapidly on the rise

Importantly, the health of practitioners is being affected not only physical violence but also by non-physical forms of abuse such as aggressive language or intimidating behavior. These forms of abuse can be extremely damaging to mental health. Indeed, an employee who is bullied in the workplace has an increased chance of suffering from serious mental health conditions. As has been extensively documented, health professional staff (and students) are at an already heightened risk of mental health disease and suicide. However, sufficient support is often absent for health professional staff. The mandatory reporting laws that were introduced through the Australian Health Practitioners Regulations Agency have been argued to have a chilling effect on addressing mental health concerns in practitioners. These laws, at a basic level, mean that GPs and other doctors are technically mandated to report concerns relating to ‘fitness to practice’ in fellow health professionals, including ‘problems’ such as mental health issues. With these laws in place, practitioners may be hesitant in accessing mental health support if it will mean a ‘black mark’ against their name, and it is a significant barrier to addressing violence against health staff adequately. Indeed, a 2009 Senate Inquiry into the then proposed mandatory reporting laws demonstrated concerns that the legislation would discourage practitioners from seeking mental health treatment, and that exemptions from mandatory reporting should be created for treating health practitioners. However, Western Australia has been the only jurisdiction where such recommendations have been implemented, and the chilling mandatory reporting laws are a continued concern.

 

Further law reform to protect practitioners

Significant criticism of the mandatory reporting laws has been picked up by politicians, and the Council of Australian Governments (COAG) had announced their intention to work with State and Territory health departments, as well as the Australian Medical Association (AMA), in providing national legislative protection for doctors seeking treatment for their own mental health and stress-related conditions. Then, following the 13 April 2018 COAG meeting, Ministers unanimously agreed to remove barriers for health practitioners seeking treatment for mental health conditions. However, both the AMA and the Royal Australasian College of General Practitioners have been concerned about the wording of the COAG statement, with too much room for doubt and confusion as to how affected practitioners would be handled.

 

This piece demonstrates that the rise of violence against hospital staff, and the deleterious impacts that such physical and emotional abuse has on their wellbeing, is starting to receive more widespread community and political acknowledgment. It is imperative that practitioners and community members alike keep up the pressure on the government to make urgent reforms in this space so that health practitioners are not destroyed by their working environment, where they are at the mercy of the public they serve.

 

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