Commentary on the private practice implications of the Deed of Settlement in the Honeysuckle Health - NIB Australian-Competition-Tribunal-hearing.

OBJECTIVE: To provide a commentary on the implications of the Deed of Settlement in the Honeysuckle Health - nib Australian-Competition-Tribunal Hearing. This hearing has major implications in relation to the potential for a single dominant private-health-insurance buying-group to contract for medical-purchaser-provider-agreements that might limit the clinical autonomy of patients and psychiatrists. CONCLUSIONS: The Australian Competition and Consumer Commission (ACCC) authorised the formation of a joint buying-group for private-health-insurers in 2021 to provide collective contracting and related services to private-health-insurers and other healthcare-payers. A consequent legal challenge resulted in a Deed of Settlement on 18 July 2022 that for 5 years preserves doctor-patient autonomy in clinical decision-making, the medical gaps scheme, the transparency of contractual arrangements, and if clinical data of those insured are collected by HH-nib, it must be with the full informed consent of patients. However, there remain options for private-health-insurers to apply for formation of new buying-groups, as well as to collect data and profile the general public and insured patients using online programs. Vigilance on private-health-insurer buying-groups, and the potential for US-style managed-care is warranted.

The erosion of psychiatrist-patient confidentiality by subpoenas.

OBJECTIVES: We explore the reasons for the prolific use of subpoenas to gain access to psychiatric records in Australia. We examine the applicable legal principles and practices at the New South Wales (NSW) and Commonwealth levels, aiming to develop recommendations for Australian Governments to curb the inappropriate and harmful use of subpoenas. CONCLUSION: Unfettered legal access to psychiatric records is inconsistent with professional ethical guidelines and risks undermining the provision of quality psychiatric care to the community. The existing legal provisions are failing to protect psychiatrist-patient confidentiality. In NSW, the onus is placed on the psychiatrist and/or patient to make a complicated application to the court, to direct that a subpoena be set aside on the grounds of "Professional Confidential Relationship Privilege." An absence of Commonwealth legislation to protect psychiatrist-patient confidentiality is used by some litigants in family law proceedings to disadvantage patients by stigmatising them, because they have consulted psychiatrists. We recommend that uniform legislation be implemented, giving effect to a primary rule of privilege with exceptions.

Primary Sjogren's Syndrome Associated With Treatment-Resistant Obsessive-Compulsive Disorder.

There is an increasing awareness that autoimmune diseases can present with neuropsychiatric manifestations. We present the case of a 17-year-old female requiring psychiatric hospitalization for obsessive-compulsive disorder and major depressive disorder with mixed affective features, who was subsequently diagnosed with primary Sjogren's syndrome. Treatment with potent immunosuppression resulted in remission of psychiatric illness. Due to a lack of awareness and/or the lack of specific biomarkers, clinicians may not associate psychiatric symptoms with autoimmune disease, including primary Sjogren's syndrome. This case demonstrates that Sjogren's syndrome may be a causative or aggravating factor in mental disorders and that autoimmune diseases should be carefully considered in the differential diagnosis of psychiatric illness especially in cases of concurrent physical symptomatology and severity or treatment resistance of psychiatric disease.