Simon Schama, the eminent British historian, Cambridge scholar and lecturer, Oxford Fellow, History Professor at Harvard and Columbia University, and author of the acclaimed BBC series ‘History of Britain’, made the following observation of Edward 1st (also known as the Hammer of the Scots): “However the subjugation of Wales was far more subtle than the surgical application of brute force. Edward had the chilling, uncanny modern knowledge that to break your enemy, you must first strip him of his cultural identity.”

The National Registration and Accreditation Scheme (NRAS) is part of a programme designed to remove the Australian Medical Profession from its central role in the delivery of Australian health care.

The Australian medical profession, by action or inaction, will determine the success or failure of this agenda. My aim is simply to provide some researched observations for critical analysis.

My central tenet is that the Australian medical profession has been a remarkable force for good. Anything that would weaken its confidence and ability to deliver world-class medical treatment needs to be opposed in the interests of the welfare of all Australians, particularly the most vulnerable.

Introduction: It was not realized at first how dangerous was the practice of secret evidence and secret informers, how alien to all our conceptions of justice and the rights of the citizen… Experience proved again how soon good men become callous in the use of bad practices.

Dean Acheson, US Secretary of State, commenting on the American loyalty security program

Mandatory reporting

The NSW Government has introduced mandatory reporting into the NSW Medical Practice Act 1992 and the Health Care Complaints Act 1994.

The QLD Government has called for “new laws to force doctors to report cases of harm by all colleagues”.

Speculation has arisen as to whether or not mandatory reporting will become national under the proposed COAG/IGA legislation (and regulation) should it be introduced.

A draft National Code of Conduct has been issued by the Federal Department of Health covering all doctors. Changes to this code could facilitate mandatory reporting.

What are the justifications for mandatory reporting are they valid?

What evidence exists that mandatory reporting is effective?

What are the likely outcomes of a mandatory reporting system?

Are there adverse and unintended consequences?

Why is mandatory reporting not universally adopted? 10. What should an independent profession’s approach be to mandatory reporting?

Conclusions: Mandatory reporting is designed to redirect public concern over health care standards from health administration to an independent profession that has been restricted in its ability to control professional standards by competition law and other interventionist regulation.

Mandatory reporting uses as its justification certain high profile cases of alleged breaches of health care standards by doctors. However close examination of these cases may lead to the conclusion that reporting was sufficient to justify earlier intervention i.e. that cases were not a result of a lack of reporting, rather a lack of decision making and following routine procedures by a tardy administration. The recently released Garling Report needs close examination. It must be emphasised that in some of these high profile cases against doctors, judicial proceedings are still in progress and final verdicts remain to be determined.

Mandatory reporting is being introduced on top of a plethora of ethical codes, codes of conduct, regulation and legislation. The Australian medical profession is one of the most highly regulated groups in Australia. Are we making it impossible for our doctors to undertake their professional responsibilities?

Mandatory reporting as a public safeguard needs greater examination as to its efficacy and justification. Systems that produce poor outcomes reduce public confidence and are counter-productive.