“I volunteer! I volunteer…”
If you can picture Katnis Everdeen saying that as she volunteers to participate in the Hunger Games then you will have some idea of the emotion(s) I felt on 9 March 2017: But, that’s not where this story really begins.
Everyone has seen the articles about doctors ending their lives, the impact of mandatory reporting, and the desperate need for a complete overhaul of our regulatory system. So, this is the point where I bring into the discussion a frank account of the lived experience of a doctor with a history of mental health issues, and what happens when AHPRA get involved.
I strongly contest the validity of the following statement made by Professor Anne Tonkin, current Chair of the Medical Board of Australia, in a recent interview.
“I’m very concerned about people saying that they don’t think they can get help, because the Medical Board is not the slightest bit interested in hearing about anybody who has any kind of health issue that they are dealing with appropriately, and that doesn’t affect their practice. We don’t even want to know.”
My own experience of AHPRA and the Board, including how my current appeal against imposed conditions that prevent me from practicing clinically is being handled, provides a wealth of evidence against there being any truth in what Prof. Tonkin has said. It is my intention to progressively address why Prof. Tonkin’s words resonate so far from the truth in a series of posts.
I surrendered my medical registration in 2015. At that time, I was completely broken and continuing to fight would have, without doubt, cost me my life. In the weeks leading up to my decision to surrender my registration one of my closest friends from high school told me that she was afraid that she would lose me in a battle against prejudice. She told me “I would rather have you alive and working in some crappy, boring, desk job; than live having lost my friend to suicide because you kept fighting an in-just system.” That message came with a link for a job advertisement in the Public Service.
At that moment, I wanted nothing more than to be dead. I didn’t want to wake up and face another day. I was, most certainly, clinical depressed; but, more importantly, I was traumatised. Traumatised by the impact my mental health had on my career, traumatised by the actions of AHPRA and the Medical Board, and traumatised that I had found out over and over that as a doctor-patient I had no rights to privacy, no rights to treatment, no rights to have a health condition. I couldn’t bear the idea of waking up one more morning to face the memories of those traumas.
Less than a month earlier my family had ‘extracted’ me from a toxic situation in Tasmania and relocated me back to our family home, just outside Canberra. I had just tried to end my life and gone to extensive length to ensure the attempt was successful. I never expected to wake up and was disappointed, anguished and distraught when I did. My final thoughts before at that time were not of loved ones and aspirations. My final thoughts were focused on pure dread that if I woke up AHPRA, the Board and their lawyers would subject me to further torture; nobody should have to think that way. When I returned to NSW, you could have described me as the walking dead: I was depressed to the point that I didn’t care about anything and, despite still breathing, was destroyed inside.
Like a robot, I applied for the job in the Public Service (APS) that my friend had sent me. The chances of succeeding in your first application for a role in the APS are slim; particularly when you have a diverse work experience background. I had no expectation that my application would be successful and applied to appease my friends and family. What nobody knew was that I had also planned my disappearance and suicide, including a letter with final instructions, and that I was waiting for the confirmation that my application was rejected before I carried out my final plan. In my mind, while depressed, I believed that if I could say I had at least tried that perhaps the impact of my death on loved ones would be less.
The conditions imposed on my medical registration at that time were publicly viewable and I worried that if the people assessing my application for a role in the APS saw those conditions that it would jeopardise my prospects of success. AHPRA had failed to process my registration renewal and my legal support advised me that it was unlikely they would allow me to remain registered; so, I signed a form surrendering my registration.
I will never forget the first appointment I had with my psychiatrist after surrendering my medical registration: I had no intentions of even reapplying to be a registered health practitioner. Choked up and struggling to breath, due to the flood of emotion associated with this particular realisation, I burst into tears and said.
“I don’t know what to say to you: This is the first time in my life where I’ve been able to attend a psychiatrist and ask for help knowing that I have privacy. They (AHPRA) can’t go through my files anymore. They can’t scrutinise everything that is private about my mental health conditions and treatment and throw it at me in my career. I have doctor-patient confidentiality… I don’t have to be scared when I see you now.”
My psychiatrist gave me the time I needed to digest that realisation and then prepared a plan to move forward and get me through the depression and trauma.
Each evening I dutifully took my antidepressant with no expectation of benefit or a positive outcome. Friends and family continued to cheer me on from the sidelines totally unaware that I had already made my decision and was waiting for the right moment. Then, I received an invitation to attend a job interview. My emotions were mixed; I was annoyed, but also saw the first glimmer of hope for any kind of future life/career in many, many months. Consistent with my perfectionist personality style, I decided that it would be wrong for me to attend the interview and give it anything but my best effort.
January 2016 was when I found out that I was successful in that application. A number of weeks had passed where I was consistently able to take my antidepressant while also being safe from attacks, hostility and further trauma. My depression had already begun to lift and suddenly there was a tangible piece of hope that I may have a ‘life’. By the date I was due to commence my new career, I was safely out of the grips of depression. Of course, I still had to face the memories and live with the trauma, but I was well and had a way forward.
My first supervisor in the APS was supportive and a God-send; he made integrating into a new work environment easy and we remain friends even though we are no longer in the same team.
That brings us to 2017. By January of 2017 I had well and truly moved on from the traumas of the past. Living back in the region where I had grown up allowed me to rekindle old friendships. Working in a job role that allowed for healthy working hours allowed me to manage my own health effectively. I can honestly say that at some point between January 2016 and January 2017 I started to feel and experience genuine happiness again.
Then it hit me. The first article I read about the spate of doctor suicides in NSW and the impacts of mandatory reporting hit me like a freight train: I actually threw up and sat curled up in a shaking, crying, mess on my bathroom floor for a number of hours. There was a sudden realisation that the pain, trauma and fear that I had experienced at the hands of AHPRA and the Board wasn’t limited to my case. Until that point, in an unintentionally self-absorbed way, I had assumed that the traumas I had experienced relating to my own medical registration were limited to me. Certainly, in all my interactions with AHPRA I was left feeling like I was the ‘worst case’, ‘most terrible person’ etc and, that there could not possibly others they invested similar energies into.
Suddenly my own resignation from medical practice became unacceptable. I could live with feeling as though my own career was ‘stolen’ by those with prejudices. What I can’t live with is knowing that others are being subjected to the same processes, the same traumas, the same fears; and, that it is costing lives.
On 9 March 2017 I mailed my application for (re)registration as a medical practitioner to AHPRA.
I volunteer to stand up and fight against a serious flaw of our registration system and regulatory body. I volunteer to stand up and speak out about how doctors (and other health practitioners) with mental health histories are treated and handled. I volunteer to have my own history and story laid out publicly for the world to see in the interest of having a real discussion about what does and does not make a health practitioner a ‘risk’, or ‘impaired’.
I am the perfect ‘test-case’ for a discussion about how we should assess if a practitioner poses a risk because of their mental health. I have an extensive history of depressive episodes, suicide attempts and hospital admissions: The details of how misdiagnosis, incorrect treatment, prejudice, and inability to access care without the focus being first on you as a doctor, and my own genetic susceptibility to certain medications played a role in this will most certainly come out in the near future. Importantly, what I do not have, is any record of complaint by patient, family member, or colleague about my ability to perform well and behave appropriately in a clinical setting. There are no complaints to AHPRA (or the previous state based Medical Boards) about my performance or conduct in practice. I have taken time off from practice when unwell. Yet, despite a ‘clean record’ in my actual work as a practicing medical practitioner, I am blocked from working clinically.
A De Novo hearing of my case goes before a tribunal panel of four members at the NSW Civil and Administrative Tribunal (Sydney) on 15-17 April 2019. I am appealing the conditions on my registration. If successful, there will be case law that other practitioners can rely on in their own struggles with AHPRA (that’s the goal, my own return to practice would be a bonus). If unsuccessful, then we will be able to clearly state that how we assess whether or not a practitioner is a risk is not based on their performance or practice history, but merely on a presence of illness (past, or present); and we will have stayed in a place where stigma and prejudice prevail.
I am all too aware that a statement like I have written here today opens the door for people to say all manner of things about me, my past, my future etc. It opens the door for a discussion that may not always be pleasant. Many people have their own views, and I accept that. It may have taken me until age 35 to be able to say the following with any degree of integrity, but here it is:
“I know who I am. I know my past. I know my history. I am a doctor who has experienced mental health problems and made attempts on my own life. I am autistic, and don’t quite ‘fit the mould’. Many people think they know my story, or something about me; many people also don’t have the full story or context. I will not be shamed, and I am not ashamed, for having experienced mental illness, nor for having been a less than perfect patient. I am a good doctor and a safe doctor, regardless of what the Board’s imposed conditions may imply. Most importantly, I will not be defined by the words of others, past, present or future.”
With this in mind. I start this series of posts about the lived experience(s) of a doctor with a mental health history faced with AHPRA and the Medical Board.