State and territory representatives met in Adelaide on August 11th 2006. Although most services had maintained and further developed their activities, there were concerns regarding Tasmania, the ACT and the Northern Territory. A commitment was made to assist those services.

The continuing success of the Victorian program under Dr Jack Warhaft’s direction was acknowledged. The support of the Victorian Medical Practitioners’ Board shows exemplary leadership. The importance of good relationships with regulatory authorities, particularly having a clear and transparent memorandum of understanding on the division of responsibilities, was emphasised.

The issues discussed included:

§         Communication and coordination on a national level, particularly the continued development of the DHAS (NSW) website. Space has been made available for each State’s and Territory’s DHAS to post local information. Details of all services will be obtainable from the one internet site, with relevant documents and references.

• The International Doctors’ Health Conference in Sydney, Thursday 25 to Saturday 27th October 2007 is being convened by DHAS (NSW) and the AMA(NSW) with major sponsorship from the Australian Dental Association (NSW Branch). This will develop important links, interest and coordination with international colleagues.
• The Australian Doctors’ Health Interest Group (ADHIG), which meets by teleconference, provides an avenue for communication, incentive and support, a platform for further developments, and a resource for second opinions, advice, and consideration of relevant issues.
• Discussion of five de-identified cases of doctor suicides revealed the usual pattern, with at least some factors known to cause concern. However, because of the disparity between the high frequency of risk factors and the much lower incidence of actual adverse outcomes, the presence of risk factors neither indicates impairment nor allows for reliable prediction. The individuals concerned require particular care, as do personnel associated with them, to ensure good management. This includes those working in a DHAS.
• The respective roles and relationships of DHAS and regulatory authorities, especially regarding confidentiality and reporting. We discussed the tensions between protecting patients and providing care for the doctors. This is a particular concern in South Australia, following new legislation on mandatory self-reporting of impairment, without a clear definition of impairment nor guidance on practical implementation.

Two diagrams presented by Simon Willcock (NSW) helped clarify the issues.

Each of us can be placed somewhere along this continuum. The role of DHAS is to assist those in the distressed group, to prevent them from becoming impaired, and to assist those who have become impaired to obtain the treatment necessary for their recovery, rehabilitation and return to the workforce. By contrast, the role of the Medical Boards is to prevent adverse effects of a practitioner’s impairment on patients, while supporting the practitioner’s recovery from the impairment.

The precise point of distress when impairment begins is difficult to judge, especially as it is a gradual, irregular process. Significant difficulties include assessing acceptable risks of impairment, especially identifying degrees of impairment likely to affect practice.

The meeting strongly supported the primary protection of the public, while working very actively towards:

• maintaining the well-being of practitioners by preventive approaches;
• early intervention with ‘yellow flags’ before impairment occurs; and
• active treatment to retrieve impaired colleagues to again be functional, safe and valuable members of the profession.

• DHAS need new ways of communicating with practitioners, using new technology, especially to accommodate younger colleagues.
• There is a significant cohort of ageing doctors, which presents important issues for those considering retiring, as well as for the general community.
• Students, doctors in training and overseas medical graduates are vulnerable to many stressors. These are likely to increase, with significant changes regarding:

• national medical registration;
• a national approach to disciplinary issues; and
• medical undergraduate and postgraduate training, assessment and accreditation.
• Because dentists, veterinary surgeons, physiotherapists and pharmacists are known to experience similar difficulties, the meeting supported continuing services to these related professions.
• The training of doctors to treat doctors, and of doctors regarding how to be a patient.
• The concept of a specific health service for doctors, providing reassurance of a high level of professional expertise, practice and organization, especially confidentiality. Such a service could, in providing routine health care, attract health professionals who do not currently use available services.
• The next national meeting of DHAS will be held in association with the International Doctor’s Health Conference in Sydney between 25-27 October, 2007

Obituary: Dr David (Peter) Pullen
10/10/1927 - 8/10/2006

David Pullen established the Doctors' Health Advisory Service (NSW) and was President from 1982 to 1994. The organization was created to help rehabilitate impaired doctors and to assist them, emotionally and financially, during difficult times in their lives. In 2000, he was honoured for this work as a Member of the Order of Australia (AM).

David was the doctors' doctor who directed his talents and inexhaustible energy towards helping those around him, whether family, colleagues or patients.

He always believed "family comes first". His dedication to his late wife, Marion, and their four boys - Robert, Michael, Stuart and Anthony - and subsequently to his grandchildren, was a feature of his life. He was proud of his family.

David had many leadership roles, including President of AMA(NSW), Federal AMA Councillor, on the Board of Ryde Hospital from 1960 to 1992 and Chairman of the Board of the Poplars Private Hospital for many years. In the 1990's, he held portfolios in the NSW Medical Defence Union. He believed that "doctors are best managing doctors' affairs".

David graduated in 1951 from the University of Sydney. After internship at Ryde Hospital, he moved to Collarenebri for three years. He then set up a general practice in Ryde. He soon took an interest in anaesthesia, obtaining his Fellowship in 1968.

At his own instigation, he stopped anaesthetics in 1992 and returned to part-time clinical practice in the Pre-Admission Clinic at Westmead Hospital. He retired in 2001 at 73.

He concluded his CV with a statement of personal optimistic philosophy : "I have had a very varied career inside and outside of medicine since graduation and would recommend such a course to everyone. We have been privileged to practise during the golden years of medicine - for this I am extremely grateful."

adapted from Peter L. Klineberg, The NSW Doctor December 2006/January 2007