Inherent barriers to reporting impaired medical practitioners in terms of regulations of the Health Professions Council of South Africa: an ethico-legal analysis

Abstract

Impairment of medical practitioners (doctors) is an acknowledged problem in the medical profession. Medical practitioners can become impaired to practice through physical or mental illness but impairment from alcohol and substance abuse disorders is the most difficult to deal with. The Health Professions Act (Act 56 of 1974) governs the practice of the medical profession in South Africa. The Act enables the creation of regulations governing impaired doctors and ethical rules of professional conduct by the Health Professions Council of South Africa (HPCSA). Ethical rule 25 stipulates that doctors are obliged to report themselves or their colleagues to the council if they are impaired. However, many doctors are not so willing to report impairment to the regulatory body. Using a desktop analysis of available literature and legislation, the writer sought to answer a pertinent question regarding the reporting of impairment. The question is whether, the current HPCSA regulations and ethical rules on the prevention and reporting of impaired medical practitioners should be revised to reduce barriers to reporting impairment. Salient factors that prevent practitioners from reporting impairment were identified. These include denial, stigmatisation, family dynamics and psychiatric co-morbidities. Problems with the ethical rules and the regulations were also identified. Further, the writer provides suggestions on how to prevent impairment of medical practitioners and to improve the effectiveness of reporting. These include rectifying the apparent weakness in the rules and early identification of potential cases that may progress to impairment. The report is concluded with an analysis of ethical aspects on impairment of medical practitioners through a perspective of principlism