Category Archives: AHPRA

AHPRA notifications: A junior doctors guide

AHPRA-Logo

In the past year, I have been subject to two notifications via AHPRA. This seems to be a trend across Australia, with numbers of complaints/notifications rising. A recent Age article demonstrated this and some of the predictive factors. For a junior doctor like myself having only practiced for three full years, it was like getting hit with a truck full of bricks. Of course I won’t to go into details, but suffice to say nothing permanent gone onto my record. However in both cases (one being from a parent in a tertiary ED and the other from another doctor), I have learnt a great deal. Yes the medical board is there to protect the public, but both times I had the feeling of having to prove my innocence, not the other way around. I’m sure that it is more the way my mind appreciated the situation rather than the intended effect of the process, but it certainly feels for want of a better word…shithouse.  The length of time taken for each issue was also appalling. It took at least 4-5 months from initial notification to final outcome. This is something that the big GP stakeholders have recognised in this article via Medical Observer. It is something that I would not wish upon anyone, but if you find yourself there…here are my tips:

Take good notes

In both cases, I was lucky to have written good contemporaneous notes that I was able to look back on. They not only helped me remember the particular case, but also to demonstrate that I am a competent clinician to the board. I could not imagine being hauled up and not have sufficient details to help explain my actions. Take good notes, its a must.

Contact your MDO

In trouble for that mo!

In trouble for that mo!

Again on both occasions, my first phone call following the notification was to my medical defence organisation. They helped set up a file, had their team look over the case and help me draft a response. Although some doctors may feel comfortable handling the response themselves, I certainly had immense support from my MDO during what is a difficult time. You will save a lot of hassle if you wish to defend yourself from any action the board may take if your MDO is on board from the get go.

Explain your situation

When it comes to writing your response, make sure that you let the reader know the situation you are working in. That might be an overcrowded or busy ED, rural location without support, walk up clinic and everything in between. Without coming across apologetic, if you at least provide some background, the board can put your situation in context.

Ask for support

Often your character or actions will be disputed by the complaint. Fight back! You know yourself the sort of doctor you are and why you joined the profession. If you have collegues that can appropriately support you in writing, do it. These are the people that know best how you work day to day. Not a single patient, family member or doctor you’ve never met.

Debrief

Talk with someone about the situation. Even though I would consider myself a moderately resilient person, when you get that first phone call or letter, your heart sinks. Here you are practicing in a profession that aims to improve the health of others and the big stick gets pointed at you. For me I felt many emotions both times, often all at once! In order to continue practicing and maintain a love of doctoring, I needed many chats with close friends and collegues. I also needed to keep working. The patients that thank you for your time and help can certainly heal a bruised ego. Unfortunately it only takes those one or two complaints (whether justified or not) to damage a whole day of grateful patients.

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Filed under AHPRA, Emergency Medicine, General Practice, Health Policy, Rural GP

Over regulation of social media in medicine: stifiling progress?

Dr. Google will tweet you now. Like?

Over the past three days, over 600 people involved in general practice education and training converged on Melbourne for the annual GPET conference. Peppered throughout the gathering were sessions relating to the current and more excitingly, possible future use of social media in the medical field. Some areas that have already started down this track and will in the future include:

  • National e-Health Record (PCEHR)
  • Registrar and medical student training
  • Connection of doctors, nurses and allied health
  • Patient education and FAQ videos or sites
  • Medical Practice information, booking and contact details
  • Videoconferencing between rural patients, GPs and specialists

At the afore mentioned GPET2012 conference, one notable session was run by noted internet savvy practitioner Dr. George Forgan-Smith (The Healthy Bear). He highlighted to the standing room only session the different uses of internet based systems. It was inspiring to hear about the use of exciting and ever-changing web-based tools. For example:

  • YouTube: for the production of medical themed videos
  • Facebook: for your own advice site and medical practice information
  • Yahoo Answers: providing common sense answers to those too scared to ask
  • Google: Patients being able to find you and your practice

It was especially heartening to listen to this doctor who has seen lots of misinformation on the internet trying to provide his own considered (and safer) information. As a GP registrar, I am both excited and wary of the prospect of this brave new world. Already after the conference and session run by Dr. Forgan-Smith, I am newly motivated to explore the role of producing amongst others: online teaching videos, patient consent videos and education snippets.

“why don’t they just get another cup?”

Recently, the national board AHPRA has released a consultation paper to help “to clarify…the expected standards relating to social media use.” Some blogs have already highlighted the lack of clarity offered by this statement. They have punctuated the areas (below) with related examples. I won’t delve into these myself, but please visit Impacted NurseCroakey and Phillip Darbyshire as all have summarised this very nicely.

  • Professional boundaries
  • Professional behaviour
  • Confidentiality and privacy

Interestingly, Impacted Nurse has observed that already their social media activity (along with mine and many others!) would already be in breach of the proposed policy. The whole tone of the AHPRA statement is restrictive and casts a dim view of social media in medicine. In fact it highlights a lack of knowledge and experience in the very area that they look to place boundaries around.

But AHPRA is not the first group to try to address professionalism relating to social media.  The Royal College of Nurses have already released useful and supportive guidelines. Medical peak representation bodies have also been proactive and drafted guidelines addressing these issues. The AMA DiT, NZMA DiT, NZMSA and AMSA released a joint initiative way back in 2010. They identified that there was the potential for legal and professional risks. As such, many medical defence organisations have drafted and published case studies, guidelines and recommendations for their members. In the age of an increasingly connected society and the further blurring of professional and social boundaries, an increase in medico legal cases with a social media focus is inevitable. Although I agree that there is a need for nationally regulated guidelines or policy regarding online conduct and behaviour, they need to be permissive enough to allow innovation and progress while maintaining professional standards. We must not let a nanny-state approach stifle this form of interaction that has to potential to do so much for a great number of patients in an increasingly fast paced online world.

Given that AHPRA is calling for feedback on the issue of social media in medicine, the lack of Twitter/Facebook*/YouTube presence is notable. Therefore, AHPRA is asking for feedback by regular old email (socialmediaconsult@ahpra.gov.au) by COB on 14 September 2012.

*The only AHPRA site to be found on Facebook is “Asociación Hondureña Protectora de los Animales y su Ambiente”

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A copy of the letter that I help GPRA co-author as a submission to AHPRA, sent on Friday 14th September 2012:

AHPRA SM Policy Response

 

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The story is picked up by Medical Observer on the 17th September 2012:

 

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Response from AHPRA on Wednesday 19th September 2012:

“Thank you for your submission to the preliminary consultation process on the National Boards’ draft Social Media Policy.

Your feedback will be considered by National Boards but as this was a preliminary consultation process, your feedback will not be published.

There will also be a public consultation process in which you are also welcome to participate, and information will be available on the Board’s website about this soon.

Thank you again for your interest in this issue.”

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Filed under AHPRA, e-Health, General Practice, Health Policy, Rural GP