I thought long and hard about whether or not I published this blog post.  I decided to, out of integrity and honesty, with regards to a situation.

You only have to read my opening post on this blog to find out that I have a battle going with the Medical Board of Australia.  

I’m a doctor who has experience severe depression, made attempts on my life and taken time off when impacted by the black dog.  I’m a challenging patient (I won’t deny it).  But, despite the severity of my episodes of illness, my ability to practice has never been impacted.  I’ve matched, or bettered, the performance of my peers.  I’ve never had a complaint from a patient and never had any notifications about my conduct or performance.  

Next year I’ll be a PGY12 (my 12^thyear out of medical school).  Right now, I am applying for PGY2 roles; yes, you read that right.  I’ve had interruptions to my clinical career to the extent that if I ever want to achieve my career goals, I’m faced with returning to practice as a PGY2.  Most people I graduated with are now fully-fledged consultants…  But, that isn’t what this post is about. 

I’m fighting in NCAT to have conditions that are currently on my medical registration removed.  The conditions completely block me from clinical practice, despite a clean record. I made a decision to fight the case publicly; that wasn’t easy.  It means being willing to have anyone, from anywhere, listen into the sordid details of my state when I have been impacted by mental illness.  It means allowing people to discuss my mental health history and speculate whether or not they think I should be allowed to practice. That’s not easy.  That has to be the most vulnerable situation I’ve ever been in, and I am, in some respects at the mercy of the Responding party (the Medical Board of Australia) when it comes to how they choose to deal with my mental health information.  

The decision to fight this publicly was easy.  There hasn’t been transparency, historically, regarding assessments of doctors with ‘fitness to practice’ concerns raised about them. AHPRA and the Board are very good at ‘encouraging’ those impacted by these investigations to stay ‘hushed’, for ‘their own benefit’; really it is for the benefit of the regulator and their lack of accountability in the process.  But, shaming people, and putting the fear of being publicly stigmatised if the alleged ‘dirty laundry’ of their mental health history is aired publicly works well; it’s a very effective way to keep people quiet. Unfortunately, silence and hiding leaves people who choose to in a position of relative power; it means they’ve succeeded in stigmatising an illness, and the impacts of that illness.

Fighting this appeal publicly means we can finally have an open and transparent look at how AHPRA and the Board handle these issues.  With someone willing to have their own case openly examined, we can look at the processes.  So, I’m not hiding any of it.  Anyone who wants to can ask me about my mental health history.  I’m not ashamed of it.  I’m willing to discuss it.  I know I am not a lesser person, or a riskier candidate to provide clinical care, than any other person without that history.  

I’ve become pretty vocal on social media over the past year.  I genuinely believe that it is necessary for us, as a profession, to keep being open and talking about these issues; well, if we want things to change.  

I lodged my application for registration on 9 March 2017. I knew how AHPRA and the Board would approach it; they proved me right.  I knew an appeal was likely.  I also knew how they’d approach the appeal (and, unfortunately, to date I have been proven right).  I lodged my application after hearing about the run of junior doctor suicides in NSW. I was physically ill when I realised that I wasn’t the only one subjected to the horrendous and inhumane processes of AHPRA and the Medical Board, when they’re ‘concerned’ about a doctor’s mental health.  The realisation that it wasn’t ‘just me’ came with the realisation I had a responsibility to stand up and do something about it.   So, I prepared to fight.

In 15 days’, the NCAT appeal Hearing will be over.  We’re returning, the Board, me, the Tribunal Panel, and my faithful four-legged assistant, for four more days between 16 and 19 July.  At this time, in 15 days, the Hearing itself will be complete and the Panel will be left to decide whether or not I pose a risk to the public.  

Although the law doesn’t stipulate the next part as what the Panel will be making a decision about, by the very nature of the case and the appeal, they will also be making a decision as to whether or not we have case law in Australia that says “Even if you’ve had shocking illness (mental or otherwise), if it hasn’t impacted on your practice and isn’t likely to, then we won’t take your career away.”  That is a far more significant decision than just the career of one 35-year-old doctor, who if allowed to practice will be joining the ranks again at the equivalent level of someone who is one year out of medical school and has just completed their internship.  

Right now, I’m still preparing my evidence (it’s a constant process) and I’m still thinking through what I may or may not have to address, how I will address it etc.  As someone who wasn’t fond of English in school, I’ve had a good ‘literacy intensive’ this year while self-representing in this case.  I take my hat off to those studying and practicing law.  

Right now, I also have the weight of the world on my shoulders. 

In the lead up to this final instalment of my NCAT appeal, that’s how I feel.  Having publicly stated that this is an ideal test case as to whether a doctor can lose their career for seeking mental health care, I have taken a big risk.  A positive outcome for me, in the final determination, is clearly going to be a change-maker for the situation doctors currently face; it would be case-law that others can rely on to say ‘it doesn’t affect my practice, therefore, you can’t destroy my career’.  But, the other side of the coin is that if the Tribunal for some reason follow the current ‘pattern’ that AHPRA, the Board and other Tribunals have followed (in imposing conditions based on speculation because mental illness is seemingly scarier than physical illness) then the message that gets sent to the medical fraternity is ‘Yes.  You can lose your career over a mental illness that doesn’t impair you in practice.’  No doubts that kind of outcome would increase the fear doctors already have in seeking mental health care and potentially lead more to believe that suicide is a better option than engaging in care.  

Imagine not knowing the outcome of your own case.  Imagine knowing it would have been easier to get your conditions removed by simply waiting a couple of years and quietly approaching AHPRA.  Imagine knowing that you’re out-gunned in terms of legal representation and resources.  Imagine knowing that your efforts to ‘create positive change’ in a particular space could backfire horribly and that you have no control over that outcome; the decision sits with four panel members.  

That feeling is one of having the weight of the world on your shoulders.  The intensity of that burden is greatly heightened having heard about more recent doctor suicides in the very State (NSW) where you’re fighting the battle.  

I felt ill, and I fell to pieces inside when I read the recent Sydney Morning Herald article about the recent doctor suicides.  I didn’t know them.  I don’t know their families.  I do know the fear and sense of trepidation and debate that they may have faced when considering suicide versus seeking help.  To the families and friend of those doctors, my heart breaks with yours and I am so deeply sorry for your loss.  

For me, seeing that we’ve lost more of our profession in the context of a regulatory system that could have been changed before now to ensure those individuals felt safe seeking care, and recovering, then going on to live health and happy lives, felt like I’d lost the ‘appeal’ already.  

I’m being totally open here, wisely or not, about just how terrifying it is considering what the implications of various decisions in my case will mean for others.  I don’t think it is a reason to make it any less public.  But I do want to openly say I know I’m taking a risk here…

It’s not a Disney movie.  I don’t know what the outcome is going to be.

It’s a tough gig being that person that says ‘go ahead’ look at anything, look at everything, I’m not ashamed.  Even if I am not ashamed, there is still stigma and prejudice out there. I dare say, we wouldn’t be seeing this appeal if there wasn’t.  So, my own lack of shame is not in itself ‘protection’; people can still choose to target me with that knowledge once its public.  To the Panel engaged in my Hearing, I say this:  I know that people can try and use this against me and I’ve made a decision that I am ok with that, just please don’t let this become another case with no transparency and no accountability.  It’s my story, and if I am willing to have it told, please respect that and let me. 

If there is something, I have learnt from the amazing army of advocates screaming out on social media for some much-needed cultural change in medicine, that it is to ask for support when you need it.  The case is lonely, it’s tough, it’s daunting, and it is so highly and deeply personal.  The support I need in that Tribunal room, particularly coming towards the end of the case, is to know that I’m not the only one who’s willing to stand up and fight for change in this space.  It’s not overly interesting listening to evidence being presented to a Tribunal Panel; even I ‘nodded off’ briefly during one of the sessions in April.  I don’t need people to agree with me on everything, or even to have decided in their own minds what the outcome of my case should be.  I do need people to be willing to stand with me (or in this case ‘sit’) and say through their presence “we know this needs to change”.  Even if you’re just there for a few hours, I’d be grateful.  Personally, I’d suggest the 19^thof July, because that’s the final day and the ending is always the best bit, right?  

Who? Anyone who is available, even briefly, and believes we need change in the way health practitioners with mental health issues are handled and treated.  Anyone who believes that doctors should have the same rights to accessing health care as those we care for.  

When? 16-19 July 2019

Where?  NSW Civil and Administrative Tribunal (NCAT), John Madison Tower, 86-90 Goulburn Street, Sydney.

What? If you do come, consider wearing #CrazySocks4Docs, at least then we’ll have some colour in the room and I’ll know who wants to see change.   

Finally, asking for support is hard.  Whether you’re asking people to publicly support something, or you’re asking someone to help you in private (like a GP or psychiatrist).  It’s hard because asking for help and support makes you vulnerable; people don’t have to respond, and you can’t control their response.  Today, I’m choosing to be that vulnerable.