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This month the AMA and beyondblue hosted a forum to start to develop an action plan after the findings of last year’s survey of mental health and wellbeing of doctors and medical students. Among the many positive ideas and initiatives to emerge from the roundtable discussion, it was clear that mandatory reporting is perceived as a very significant barrier to those who should be seeking help.
There are widespread misconceptions about the threshold for mandatory reporting. The bar is high. Impairment, under the law, is something that detrimentally affects a person’s capacity to practise the profession and raises substantial risk of harm to the public. A doctor with an illness who seeks appropriate treatment and follows the advice of their treating practitioner, including advice about whether they are fit to work, would not reach this threshold.
Anyone who needs advice about whether they should be making a mandatory notification, or who believes they are at risk of being notified about, should read the mandatory reporting guidelines published by the Board and seek advice from their professional indemnity insurer.
The Board is committed to taking an active role in promoting doctors’ health and facilitating access to appropriate services. We are working on the implementation plan, after our decision to fund and expand doctor’s health services nationally. An important part of the overall strategy is to encourage doctors and medical students to be mindful of their own health and wellbeing and to adopt a proactive approach to addressing emerging problems before they become overwhelming.
Dr Joanna Flynn AM Chair, Medical Board of Australia
The Board regularly receives notifications about medical practitioners who perform medico-legal or third party assessments. We are publishing this article to provide feedback to the medical profession. By raising awareness about some of the potential pitfalls for medical practitioners who conduct medico-legal assessments, the Board aims to encourage practitioners who work in this area and who have had notifications made about them to reflect on their style of practice and communication.
Notifications to the Board about medico-legal assessments are generally made when the person who is being assessed:
The Board understands that there is often a subtle adversarial nature to medico-legal assessments. Also, the examinee may not understand that the role of the assessor is different to the role of their treating practitioner. All this can set up an environment that contributes to dissatisfaction and therefore notifications being made to the Board.
As in all areas of medicine, medical practitioners who perform medico-legal assessments should remember the importance of explaining and communicating their role and what they are doing, both at the outset and during the course of an examination.
The usual standards of Good medical practice apply. Examinees are entitled to the same level of courtesy, patience, explanation and consideration as any other person attending a medical practitioner. The frequency with which some medico-legal practitioners are subject to complaints, especially about their manner, raises concern that these practitioners may not have remembered these simple and time-honoured attributes of good practice.
Provided the Board is satisfied that the clinical method and reasoning used in a report is sound, it is unlikely that notifications about the content of a medico-legal report will lead to further action by the Board.
The Board will not take further action when a single notification does not appear to amount to unprofessional conduct or unsatisfactory professional performance. However, the Board may decide to take action in relation to practitioners who have been the subject of multiple notifications. Practitioners may be investigated further and a performance assessment may be required.
The Board can take a range of actions after an investigation and/or assessment. These include referral to a panel or tribunal or the Board can caution the practitioner, accept undertakings or impose conditions. These might include a requirement for further training or remediation, regular supervision of work, or a restriction on the way that they practise.
Practitioners who conduct medico-legal examinations regularly and who have been the subject of previous notifications should carefully reflect on their style of practice and consider whether they would benefit from review by peers or from additional training in communication.
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International medical graduates (IMGs) who are specialists overseas can apply to be assessed by the relevant Australian specialist college for comparability with an Australian-trained fellow. Once the IMG has been assessed as comparable and is eligible for fellowship, they can apply to the Board for specialist registration.
Further information about the specialist pathway is available on the Board's website.
The Board established the National Specialist International Medical Graduate (IMG) Committee as an advisory committee to:
The committee has broad membership including representatives from the specialist colleges, the Australian Medical Council, government, recruiters and the community. More information about the committee can be found on the Meetings of the National Specialist IMG Committee page.
The committee has decided to develop good practice guidelines to support colleges that are assessing specialist IMGs. The committee has established a working group for this purpose.
In developing the guidance, the working group will consult with the specialist colleges on issues for assessing specialist IMGs. It will then develop guidelines for the specialist colleges on good practice in the specialist IMG assessment process, consistent with the objectives and guiding principles of the National Registration and Accreditation Scheme (the National Scheme).
We will publish more information as the working group develops the guidelines.
South Australia Health has asked the Board to remind medical practitioners about the risks associated with prescribing narcotic medications to patients when they do not have sufficient clinical information about them, as there is potential for abuse of narcotic medications by illicit drug users.
Senior Counsel Assisting the South Australian State Coroner wrote to the Chief Executive of South Australia Health after a person died from fentanyl toxicity.
The man who died was an interstate resident visiting South Australia. While in South Australia, he visited a general practitioner and obtained a prescription for five fentanyl patches with a direction to administer one patch every 72 hours. The man manipulated the patch so that he could administer the fentanyl intravenously.
After his death, police established that over the preceding two months, the man had obtained a number of separate prescriptions for fentanyl from a number of different general practitioners. He therefore had access to a supply of fentanyl that exceeded the recommended prescription.
While the Coroner does not intend to hold an inquest into the death, he did ask that the matter be brought to the attention of medical practitioners.
AHPRA and the Board have started auditing a sample of medical practitioners for compliance with the approved registration standards and with the National Law.
We have developed a nationally consistent approach to auditing health practitioners’ compliance with mandatory registration standards. Audits are an important part of the way medical practitioners can demonstrate to the community and the Board that they are meeting the mandatory registration standards.
If you are selected for audit, you will receive an audit notice in the mail from AHPRA. This includes a checklist that outlines what supporting documentation is required for you to demonstrate that you meet the standard(s) being audited.
Each time you apply to renew your registration, you make a declaration that you have (or have not) met the registration standards for your profession. The audit requires that you provide further information to support your declarations.
Your audit notice letter will identify which standard/standards are being audited. One or more of the four mandatory registration standards may be audited.
Further information, including the four mandatory registration standards is available on the Board's Audit page.
Under the Health Practitioner Regulation National Law, as in force in each state and territory, AHPRA can request (on behalf of a board) you to provide evidence, within 28 days, that you meet the standards, as declared in your previous annual statement.
Your annual statement is made when you apply to renew your registration. It is supported by a declaration confirming that it is ‘true and correct’.
The annual statement also includes (among other things) statements about whether:
AHPRA on behalf of the 14 National Boards publishes a record of panel, court and tribunal decisions about registered health practitioners. Summaries are published when there is clinical and educational value.
Under the National Law, the Board must refer a matter about a registered medical practitioner or student to a tribunal if the Board reasonably believes that the practitioner has behaved in a way that constitutes professional misconduct; or the practitioner’s registration was improperly obtained because the Board was given false or misleading information. The Board must also refer the matter to a tribunal if a panel established by the Board requires the Board to do so.
Medical practitioners may also appeal certain decisions of the Board to a tribunal, or court.
AHPRA publishes summaries of selected tribunal or court cases from time to time. These can be sourced at Publications>Tribunal decisions on the AHPRA website. A full library of published hearing decisions from tribunals or courts relating to complaints and notifications made about health practitioners or students is available on the Austlii website.
When investigating a notification, state and territory committees of the Medical Board of Australia 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. Summaries have been provided when there is educational and clinical value. These summaries are accessible from hyperlinks within the table. Practitioners' names are not published, consistent with the requirements of the National Law. This table does not include summaries of panel decisions made under previous legislation, even if these were held after July 2010.
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 [email protected].
For registration enquiries or contact detail changes, call the AHPRA customer service team on 1300 419 495 (from within Australia).