Four years after controversial laws, cultural barriers in the health professions remain strong
Controversial laws which force Australian health professionals to report colleagues who they believe put patients at risk have failed to overcome nurses’ reluctance to implicate doctors, a study suggests.
The laws brought in four years ago were heavily criticised, with doctors fearing they would create a climate of fear.
But of 819 mandatory notifications made between November 2011 and December 2012, only 3% were by nurses about doctors, according to research published by the Medical Journal of Australia on Thursday.
Dr Marie Bismark, a doctor, lawyer and senior research fellow with University of Melbourne’s school of population health, led the research and found some of the predicted harms and benefits of the law were wide of the mark.
“Although nurses are often well placed to observe poorly performing doctors, our data suggests the new law has not overcome… factors that make it difficult for nurses to report concerns about doctors,” the study found. Cultural barriers included fear of retaliation or a lack of confidence.
Concerns that mandatory reporting would be used as a weapon in interprofessional conflict were also unfounded, with the notifier and the person reported from the same profession in four out of five cases.
Psychologists had the highest rate of notifications against them per 10,000 practitioners, followed by medical practitioners, then nurses and midwives.
Notifications against male practitioners were more than 2.5 times higher than for women – at 46 versus 17 reports per 10,000 patients per year. This was consistent with previous research that found male doctors were at higher risk of patient complaints and malpractice litigation, with risk-taking behaviour and communication style likely at play.
Whether those health professionals reported were found to be a risk was not included in the study, because that information was not yet available, Bismark said. NSW data was also not included, due to differences in the way health care complaints are handled in that state.
A co-author of the study, David Studdert, a professor of medicine and law at Stanford University in the US, said over last 10-15 years there had been an “awakening of awareness” among the general public that health care could be dangerous.
“Lots of adverse events happen in hospitals and clinics around the world,” he said. “The public is really demanding greater transparency around those events, so this law is a reflection of public expectation.”
The bulk of the mandatory reports – more than 60% – related to perceived departures from professional standards of clinical care. In one example given in the study, a director of nursing abused nurses through intimidation and outbursts.
Sexual misconduct allegations made up 8% of notifications. In one case, a male nurse in an aged care facility had sexually assaulted a female stroke patient who was immobile, the study reported.
Intoxication through drugs and alcohol, and impairment made up 13% and 17% of notifications respectively.
AMA president Associate Professor Brian Owler said while he welcomed the study, it did not reveal the outcomes of the reports which may have turned out to be “unfounded or unnecessary”.
“This report also goes no way to address concerns from doctors around the impacts of mandatory reporting may have on doctors who may be deterred from seeking treatment for medical conditions for fear of being reported.”
But Consumers Health Forum chief executive, Adam Stankevicius, said the study revealed a “much stronger” effort was required to ensure that all health professionals were aware of their reporting obligations.
“Given the length of time since the reporting had taken place, we are also very concerned that the researchers were not in a position to report on the outcomes of mandatory reporting in the 2011-12 period,” he said.
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