Our article about the culture of medicine last month struck a chord. Doctors have shared with us their experiences of bullying, harassment, discrimination and racism, and the negative impact these have had on careers and lives. Now is the time for health sector agencies to work together to build a positive culture in medicine. This cultural challenge extends to behaviour online. Social media is not a forum to bully, harass or intimidate. The same standards apply online and in person. It’s about respectful engagement, not freedom of speech. More information on the Board’s expectations of doctors, including when using social media, is on the Board’s website.
Dr Anne Tonkin
Chair, Medical Board of Australia
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Poor culture in healthcare is associated with poor patient outcomes, which places the issue firmly within the scope of regulators.
Doctors in training have told us in the Medical Training Survey that there are serious cultural problems in medicine, including bullying, harassment, racism and discrimination. Results of many other surveys across medicine and the wider healthcare sector reveal similar problems.
There is no place for bullying and harassment in healthcare because it harms the lives and careers of doctors and it harms patients.
Many health sector agencies share a commitment to building a positive culture in medicine. This cultural challenge extends to behaviour online. Social media is not a forum to bully, harass or intimidate. The same standards apply online and in person. It’s about respectful engagement, not freedom of speech. As others have noted, the standard we walk past is the standard we accept.
Communication and conduct – online and in person – involve both what we say and how we say it. Oversimplifying this debate to freedom of speech fails the first challenge in improving the culture of medicine – the ability to disagree with respect.
Sharing different opinions in person and online is core to healthy debate. Bullying, harassing or intimidating others while doing so is unprofessional, breaches the Code of conduct and increases risks of harm to patients and colleagues. It is not ok to yell at patients. It’s not ok to yell at colleagues. It’s not ok to intimidate others. It is not ok to communicate disrespectfully.
Part of creating a positive culture involves calling out the unacceptable. It involves having the courage to no longer turn a blind eye. We look forward to addressing this challenge with agencies across the health sector, because collaboration is the key to change.
Failing to stand up for a culture of respect fails our patients and our profession.
Three recent, independent tribunal decisions are on point:
In Ellis v Medical Board of Australia, the Victorian Civil and Administrative Tribunal remarked:
Doctors are free to make contributions towards the advancement of medicine. Ordinarily, they do so through appropriate discourse within the professional community. In this context, there is an obvious difference between publication via social media and, say, publication in medical journals. But there is a broader point. Dissemination of material by a registered medical practitioner to the general public that is disparaging, denigrating and demeaning, or that otherwise has the capacity to cause harm to the community in the ways we have identified, is expression of a different kind altogether. To take lawful, appropriate measures against the kind of expression that Dr Ellis has engaged in cannot reasonably be claimed to deter doctors from making contributions towards the advancement of medicine. The Code and Social Media Guidelines make clear where the lines are drawn.
The Medical Training Survey (MTS) opens next week, giving trainees a platform to share their experience of medical training.
MTS data from past years is already being used across the health sector to drive improvements in medical training.
Most MTS questions are consistent year on year, because comparisons are important. We streamline the format and layout each year to make the MTS quicker and easier to do.
This year, we are continuing to ask trainees about the impact of COVID-19 on training. We’re worried about the culture of medicine and are asking trainees whether they have experienced and/or witnessed racism. We also want to better understand the barriers to reporting bullying, harassment, discrimination and racism trainees face, so we’ve added a question on that.
The MTS is a longitudinal study that tracks the quality of medical training. Stringent privacy controls make it safe and confidential for trainees to take part. The MTS is run by the Medical Board of Australia, but the Board has no access to individual responses.
MTS results are collated, published online and accessible. Case studies showing how MTS results are being used to improve training are published on the MTS website. Past results are detailed in reports by specialty and geography, or reports can be tailor-made with the online data-dashboard. Across three years, MTS results have shown that while medical training in Australia is generally in good shape, there are serious cultural problems in medicine, including bullying, harassment, racism and discrimination. As a result, agencies across the sector, including the Medical Board of Australia, are prioritising actions to support cultural change.
Registration renewal is coming up for medical practitioners with general, specialist and non-practising registration.
Renewals open in early August. The fee for 2022/23 is $860, and $898 in NSW. More information is on the Ahpra website.
Information and FAQs for medical practitioners are on the Registration renewal page.
Apply early to avoid delays at our busiest time, especially if you are making a declaration. Renewal is now online only – you can pay by credit or debit card.
If you have an approved acupuncture qualification, minor changes to the Endorsement of registration for acupuncture for registered medical practitioners now apply. There is limited impact for most doctors. The changes include:
Health Ministers approved the revised registration standard late last year. You can find it on the Registration standards page of the Board’s website.
English language standards apply to all doctors applying for registration in Australia. It’s time to review the standard that applies to doctors applying for registration for the first time. The standard is consistent across all professions in the National Scheme, so all National Boards (except the Aboriginal and Torres Strait Islander Health Practice Board of Australia) are involved in this consultation.
You can share your feedback on the English language standard through the online consultation survey or email written submissions to email@example.com. There is a Word document submission template.
The consultation closes on 7 September 2022.
The consultation paper and more information is available on the Board’s Consultation page.
There are important lessons in tribunal decisions about registered medical practitioners. The Medical Board of Australia refers the most serious concerns about medical practitioners to tribunals in each state and territory. Recently published decisions include:
Ahpra, on behalf of the 15 National Boards, publishes a record of panel, court and tribunal decisions about registered health practitioners.
When investigating a notification, the Board may refer a medical practitioner to a health panel hearing, or a performance and professional standards panel hearing. Under the National Law, panel hearings are not open to the public. Ahpra publishes a record of panel hearing decisions made since July 2010. Practitioners’ names are not published, consistent with the National Law.
Summaries of tribunal and court cases are published on the Court and tribunal decisions page of the Ahpra website. The Board and Ahpra sometimes choose not to publish summaries, for example about cases involving practitioners with impairment.
In New South Wales and Queensland, different arrangements are in place. More information is available on Aphra’s website on the Concerned about a practitioner? page
Please note: Practitioners are responsible for keeping up to date with the Board’s expectations about their professional obligations. The Board publishes standards, codes and guidelines as well as alerts in its newsletter. If you unsubscribe from this newsletter you are still required to keep up to date with information published on the Board’s website.
Comment on the Board newsletter is welcome and should be sent to firstname.lastname@example.org.
For registration enquiries or contact detail changes, call the Ahpra customer service team on 1300 419 495 (from within Australia).