Trust impaired: Practitioners’ views on ethics and the law regarding mandatory reporting of impaired practitioner-patients

Marie M Bismark1, Ben Mathews2, Matthew J Spittal,1 Jennifer M Morris1, Laura A Thomas1 and David M Studdert3

1 Centre for Health Policy, University of Melbourne, 207-221 Bouverie Street, Parkville, VIC, 3053
2 Australian Centre for Health Law and Research, Faculty of Law, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000
3 Center for Health Policy, Freeman Spogli Institute for International Studies, Stanford Medical School, 291 Campus Drive, Stanford, California, CA94305

In Australia, mandatory reporting laws require registered health practitioners to report other health practitioners to the appropriate regulator, if they reasonably believe a practitioner poses a significant threat to the public due to practising while intoxicated, sexual misconduct, significant departure from accepted professional standards, or a practice-affecting health impairment.

A particularly contentious element of mandatory reporting laws is that, in most states and territories, they extend to situations where a practitioner becomes aware of another practitioner’s health impairment in the course of providing care to that person. That is, the laws require, under some circumstances, that practitioners breach the confidentiality of their practitioner-patients in the interests of public protection.

This presentation explores the findings from our research into the way in which this requirement is understood and applied by Australian practitioners. The research consists of two parts. First, it includes an analysis of 819 mandatory reports made to the Australian Health Practitioner Regulation agency between November 2011 and December 2012. Second, this analysis is complemented by semi-structured interviews conducted with eighteen health practitioners and four medico-legal advisors, in which they described their experiences and views regarding the mandatory reporting requirements.

The research paints a vivid picture of practitioners torn between ethics and law, and between the duties of public protection, confidentiality and professional loyalty. It reveals a number of myths and assumptions about when, how, why, and by whom, such mandatory reports of impaired practitioner-patients are made. It also highlights an oft-overlooked distinction between ideological debates about the aims of regulation, and empirical debates about the efficacy of particular approaches.

We will explore practitioners’ views on the appropriateness and effectiveness of mandatory reporting, their experiences of reporting practitioner-patients, and the ways in which they seek to reconcile tightly-held ethical principles with this new legal duty.


A/Prof Marie Bismark is a public health physician and health lawyer. Her research focuses on the role of clinical governance, regulation, and patient complaints, in improving the quality and safety of healthcare. Marie works within the Centre for Health Policy at the Melbourne School of Population and Global Health.

Marie is also a practicing medical doctor and experienced company director. She has previously served as a legal adviser to the Health and Disability Commissioner, been a solicitor with a leading New Zealand law firm, and completed a Harkness Fellowship in Healthcare Policy at the Harvard School of Public Health.

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