Family violence is in scope for medical regulation, reflecting the current standards and expectations of the community and the medical profession. Family violence takes a terrible toll on the Australian community and our regulatory decision-making and processes need to be safe, fair and sensitive when we deal with these issues. We have updated our processes to prioritise safe and sensitive management of matters involving family violence, including when the doctor is either the victim or the perpetrator. If you’re keen to follow up, there’s more information in our media release.
Dr Anne Tonkin
Chair, Medical Board of Australia
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The Board continues to receive cases that highlight the problems that can arise when medical practitioners treat people with whom they are close. While this is most often family and friends, it can be anyone with whom the doctor has a close personal relationship.
The Board’s code of conduct, Good medical practice: a code of conduct for doctors in Australia, provides guidance, stating that whenever possible, doctors should avoid providing care to anyone with whom they have a close personal relationship. In particular, medical practitioners must not prescribe Schedule 8, psychotropic medication and/or drugs of dependence or perform elective surgery, such as cosmetic surgery, on anyone with whom they have a close personal relationship.
The type of cases referred to the Board include medical practitioners:
Sometimes practitioners are hesitant but provide a prescription or other treatments because they feel obligated or find it difficult to refuse persistent requests. Some practitioners try to justify their actions by convincing themselves that they aren’t really ‘providing treatment’, ‘it’s just a script’ or because they aren’t billing through Medicare. Others are trying to protect their family member from possible stigma associated with the condition, especially in the area of mental health.
Providing treatments to those with whom you have a close personal relationship can be fraught. The standard of care provided to family and friends can be compromised, because the close relationship can cloud professional objectivity and affect professional judgement.
For example, prescriptions written informally are sometimes done without the doctor taking a comprehensive history. Thorough assessments, including physical examinations can be embarrassing and therefore may not be done, and diagnoses are not made and/or not documented.
When treatment is provided outside a formal doctor-patient relationship, the usual monitoring is less likely to occur, records may not be kept, and continuity of care can be adversely affected.
Doctors can play an important role in advocating for and supporting family members and friends with their medical care. However, they should encourage any friends or family to have a general practitioner who can be objective and provide continuity and coordination of care. Medical practitioners should not be taking on the role of primary medical practitioner for family members and should avoid providing prescriptions and treatment except in an emergency or where other medical care is not available.
An evaluation has found that the intern preparedness survey was an effective quality improvement tool for medical schools’ curriculum reviews, for strengthened collaboration in the early phases of medical education and training, and provided useful information to inform the Australian Medical Council’s (AMC) accreditation functions.
The evaluation looked at the effectiveness and impact of the Intern Preparedness Survey, which was jointly run by the Medical Board of Australia and the AMC from 2017–2019. The survey asked interns how well their medical school programs had prepared them for practice in their first year as a doctor.
Intern preparedness survey results showed that interns in their first year after medical school generally felt well-prepared for practice. Survey results identified prescribing medicines and providing care for Aboriginal and Torres Strait Islander patients as areas for improvement.
The AMC has used the intern survey results in its accreditation processes, asking medical schools to identify the reasons for lower ratings in key areas and report on work to ameliorate them. This reflection has resulted in broad and sometimes substantial changes to medical programs.
The AMC is also considering the survey results in two reviews of AMC standards: the standards for assessment and accreditation of primary medical programs and the National Framework for Medical Internship.
The evaluation also identified possible systems improvements including the need for ongoing dialogue between medical schools, health services and intern training accreditation authorities so the expectations of medical graduates are clearer.
The evaluation report and the intern survey results are available on the Board’s intern resources page.
We’ve published a new fact sheet that explains the factors that the Board takes into consideration when it assesses requests from international medical graduates (IMGs) to change supervision levels. This should help IMGs to provide the necessary supporting evidence and it helps to explain the Board’s decision-making.
All IMGs with limited or provisional registration must be supervised. The Board approves supervision arrangements, including the level of supervision for each IMG. An IMG can request a change of supervision level and outline why the change is appropriate, in writing, on a form on the Board’s website.
The fact sheet is published on the Board’s website on the FAQ and fact sheets page and on the IMG supervision page.
We remember the contribution and generous spirit of Dr Greg Kesby, former NSW Medical Council President and NSW Medical Board Chair, who passed away in October 2021.
A leader in medical regulation in Australia for many years, Dr Kesby was an obstetrician and gynaecologist, and specialist in maternal-fetal medicine both in private practice and through his public appointment with Sydney’s Royal Prince Alfred Hospital.
He was a medical regulator for many years, initially as a member of the Medical Board of NSW and from 2010 as an inaugural member of the National Scheme’s NSW Medical Board. He was Chair of the NSW Medical Board from 2012–2015 and President of the Medical Council of NSW from 2015–2018.
Dr Kesby was also active and accomplished in accreditation of medical education and training, through his numerous positions with the Australian Medical Council, including as a Director.
Dr Kesby’s lively, insightful and engaging personal and professional contributions will be sorely missed.
The Board publishes data each quarter on the medical profession. Data are broken down by state and territory, registration type and for specialists, by specialty and field of specialty practice. The latest data are available on our website under Statistics on the News page.
Changes to the management of complaints (notifications) about doctors and other registered health practitioners in Queensland will start soon. The changes aim to improve timelines, reduce duplication and enable whichever agency is best placed to manage each notification to get started sooner.
From 6 December 2021, all notifications made about practitioners in Queensland will be jointly considered by National Boards, Ahpra and the Office of the Health Ombudsman (OHO). For the first time, all notifications that raise a concern about a medical practitioner’s clinical performance will be screened by a clinical advisor who is a registered medical practitioner.
Currently, the OHO deals with the most serious matters it receives and refers most of the remaining notifications to Ahpra and the National Boards. From 6 December, both agencies will review each matter to agree on how each notification should be managed. System improvements and the use of a shared risk assessment and controls framework will support consistent decision-making.
All notifications in Queensland will continue to be submitted initially to the OHO.
For more information on how notifications are managed, see the Ahpra website. A news item on the joint consideration changes is also available.
A revised supervised practice framework that reflects a responsive and risk-based approach to supervised practice across the National Registration and Accreditation Scheme is now published.
The framework comes into effect on 1 February 2022 and we have published it early to allow time for practitioners, supervisors, employers and others to become familiar with it. The framework applies to medical practitioners when supervision is used for the purposes of eligibility or suitability for registration. For example, when doctors are returning to practice after an absence, changing their scope of practice, or when they are not able to meet a requirement of a registration standard. It will also apply when a doctor is required to complete a period of supervised practice after a complaint.
This framework does not apply to international medical graduates with limited or provisional registration, to interns with provisional registration or to vocational trainees. Supervision requirements for these medical practitioners have not changed.
The framework is published on the Board’s registration page.
Ahpra releases fortnightly episodes of the Taking care podcast, discussing current topics and the latest issues affecting safe healthcare in Australia. You can access these on the Ahpra website or listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking care’ in your podcast player.
The latest episodes are a two-part podcast on Being a health practitioner during a pandemic. Listen to four practitioners from NSW and Victoria tell us how the pandemic has affected their professional and personal lives:
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. These decisions were published recently:
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 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).