Who reports health professionals?

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A cohort study has examined five years’ worth of AHPRA notifications and found pharmacists comprise only 5% – while more than half pertained to doctors

Dr Marie Bismark from the University of Melbourne and colleagues write in the Journal of Public Safety that while doctors comprise 16.7% of the registered workforce, they were the subject of more than half the notifications (56.4%) studied.

The authors had analysed 43,256 notifications lodged with AHPRA between 2011 and 2016.

Of these, 24,400 were about doctors, while 2203 were about pharmacists (5.09% of all notifications).

Nurses and midwives, the largest practitioner group, accounted for approximately one-fifth (19.1%) of notifications, and dentists accounted for about a tenth (9.6%).

“Patients and their relatives lodged more than three-quarters (78%) of notifications regarding clinical performance, including diagnosis, treatment, and communication. Fellowpractitionerswere a common source of notifications about advertising and titles,” they write.

“Self-reports commonly related to health impairments, such as mental illness or substance use. Other agencies played a role in reporting concerns about prescribing or supply of medicines.”

Nearly 60% of notifications involved concerns about practitioner performance, one-third related to conduct issues, and less than 10% concerned practitioners’ health.

The authors write that while fellow practitioners have an ethical duty – and sometimes a legal mandate – to report risks to patient safety, multiple previous studies have revealed hesitance to do so.

“In our study, fewer than 10% of all performance notifications were lodged by fellow practitioners,” they write.

“Researchers examining incident reporting have identified multiple barriers to reporting by practitioners, including time constraints, unsatisfactory or unfamiliar reporting processes, perceived lack of value in the process, professional loyalty, and a culture that discourages and punishes whistleblowers.

“The extent to which these barriers also inhibit practitioners’ willingness to file notifications to regulators is unknown.

“However, given the pervasiveness of cultural norms, it is reasonable to expect similar obstacles are at play, possibly alongside heightened concerns about tarnishing the professional reputation of colleagues.

“An alternative explanation for practitioners’ infrequent notifications about performance issues is that they may address their concerns via other mechanisms, such as peer review meetings, college processes, or reports made to employers instead of AHPRA.”

Fellow practitioners were disproportionately likely to raise concerns about advertising and use of titles.

They filed only 12% of all notifications, but a quarter of those pertaining to improper use of advertising and titles.

“It is unclear whether these notifications were primarily motivated by concern for patient safety or by mercantile and competition concerns.”

The findings were reasonably consistent with recent data released by AHPRA regarding its 2017-18 notifications.

During this year, AHPRA received more notifications than in any other year, with only 6% of notifications about pharmacists.

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