WA News News & Reports Revalidation Proposals
Revalidation Proposals
Written by Jan Hallam
Friday, 26 August 2016

At some point on August 16, the Medical Board launched its discussion paper on revalidation urging medical practitioners to offer their feedback online. It gave the media organisations just enough time to formulate the next morning’s headlines such as “Shonky doctors who put patients at risk face Medical Board crackdown” and “Medical Board of Australia's proposal to root out underperforming doctors”.201609-Changes-Ahead-sign

At precisely 10.55am EST on August 17, the feedback started flowing in. The process is open to everyone and you can leave your name or post anonymously until November 30. You just can’t be obscene as the site is moderated, though it hasn’t stopped a cascade of forthright views.

You may see names of doctors you might know but you won’t read anything you haven’t read before or many endorsements of the plans. We did see one from some poor lone voice from the general public who was challenged by a medico to confess he was a stooge of AHPRA. The quick comeback by John or Jo Doe was to suggest they could be the doctor’s patient!

Apart from the comment’s general entertainment factor, there is much to ponder. The discussion paper is well laid out and there seems to be a genuine attempt to formulate a revalidation process that will not be too cumbersome, will use systems already in place and engage the ‘stakeholders’. However, there is no suggestion minds will be changed on the core need for revalidation.

The AMA president Dr Michael Gannon told the SMH the medical profession welcomed the board's “modest approach” to the issue. “I don't think there's a great deal of evidence that the professional development system is broken," he said.

The sticking point is and always will be identifying at-risk doctors. On this issue the Expert Advisory Group has gone out on a limb. It has identified the subset of practitioners based on these risk factors:

  •                      age (from 35 years, increasing into middle and older age)
  •                      male gender
  •                      number of prior complaints, and
  •                      time since last prior complaint.

Additional individual risk factors found in certain studies include:

  •                      primary medical qualification acquired in some countries of origin
  •                      specialty
  •                      lack of response to feedback
  •                      unrecognised cognitive impairment
  •                      practising in isolation from peers or outside an organisation’s structured clinical governance system
  •                      low levels of high quality CPD activities, and
  •                      change in scope of practice.

Give your concerns voice at www.medicalboard.gov.au/News/Current-Consultations.aspx by November 30.

 

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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