The Impaired Doctor

In this article, we address some common concerns from doctors about health assessments, the role of the Medical Board, and mandatory reporting.

Dr A phoned MDA National to seek assistance with a notification made about him to AHPRA.

Dr A was an Anaesthetist. He had recently broken up with his wife and not seen his children for some time. Distressed about his personal situation, he had unfortunately turned to alcohol. Theatre staff smelt alcohol on his breath during an afternoon list. As a result, the hospital staff made a mandatory report to AHPRA.

The Medical Board has asked me to go for a health assessment – what does this mean for my career?

The Medical Board (the Board) may become aware of a doctor’s possible health impairment when a notification is made. Under the National Law, the Board may require a doctor (or any registered health practitioner) to undergo a health assessment if it reasonably believes, because of information received, that a doctor may have an impairment that detrimentally affects, or is likely to detrimentally affect, the doctor’s capacity to practise.

Why does the Board require an independent assessment? My treating doctor could supply a report.

A health assessment is carried out by an experienced and suitably qualified independent medical practitioner or psychologist. The health assessor is not a member of the Board. The consultation is booked by AHPRA staff, and there is generally no cost to the doctor undergoing the assessment.

The doctor will be asked whether any conflict of interest exists which would preclude the assessor from carrying out the report. If that is the case, another assessor can be arranged.

The Board considers that an independent assessor can take an objective view because they lack prior knowledge of the doctor and have no ongoing responsibility for continuing care. A treating doctor may be reluctant to provide a report which could result in restrictions on their patient’s ability to practise. That situation could disrupt an effective therapeutic relationship.

Treating doctors who believe their doctor-patients can practise safely can and do provide supportive reports which assist the Board.

What happens next?

After the health assessment, the assessor will prepare a report for the Board. This report is usually very comprehensive, and may address specific questions from the Board regarding fitness to practise, and also whether any restrictions or conditions should be in place when the doctor returns to work. The report will also include a copy of any results from pathology testing performed as part of the health assessment process.

The doctor who has been assessed will then receive a copy of the report. This is usually provided directly to the doctor. However, if it contains information which may be prejudicial to their health or wellbeing, it will be provided to the medical practitioner or psychologist nominated by the doctor.

After the doctor has received the report, a meeting is arranged with the doctor and a person nominated by the Board. This is usually a Board member, and AHPRA staff are present at the meeting. The purpose of the meeting is to discuss the report, and ways of dealing with the findings of the report if it is necessary to alter the way the practitioner is working.

The Board reviews the outcome of this discussion at its next meeting and will decide if any restriction on the doctor’s registration is needed to protect the public. The doctor is then advised of the Board’s decision.

What decisions are available to the Board?

As a result of a health assessment, the Board may decide to:

• take no further action
• progress to further investigation
• refer the matter to a health panel
• impose conditions or accept an undertaking from the doctor
• refer the matter to a panel or tribunal hearing.

It can be difficult for doctors to be assessed in this way, and many doctors find it a very stressful experience. Doctors can take a support person along on the day of the assessment, but they will not be allowed into the room when the assessment is taking place.

It is very important that doctors are open and honest with the health assessor.

How can MDA National help?

During this very stressful process, MDA National staff can provide valuable support including information about how the process works and the steps that AHPRA will take. Unfortunately, the process takes some time. We provide peer-to-peer support (through our Doctors for Doctors Program) by a member of our in-house medical team for doctors who are distressed by this process.

When Dr A contacted MDA National, he was provided with assistance. Dr A was deeply remorseful and, on advice from MDA National, he made an appointment to see his GP as well as a Psychiatrist who specialised in drug and alcohol issues. The Board asked him to undergo a health assessment.

Dr A saw a Psychiatrist for his health assessment. The health assessor’s opinion was that Dr A’s use of alcohol was related to his acute distress. Now that he was receiving appropriate treatment for his depression, the assessor considered he was fit to start a return to work program, provided he underwent regular alcohol testing.

Dr A’s employers accommodated the conditions, and Dr A returned to work.

See the article: I'm Worried About My Work Colleague.

Dr Jane Deacon
Medico-legal Adviser, MDA National