WA News News & Reports Seeing is Understanding
Seeing is Understanding
Written by Peter McClelland
Monday, 02 October 2017

 A trip to the Kimberley with Patches Paediatrics was an eye-opener for second-year medical student, Nic Mattock.29092017-Patches-Team-Aug 17Nic, left, with Dr James Fitzpatrick and other members of Patches’ Kimberley team.

“One of the best things to come out of the trip was the realisation that my way of looking at life, as a young, white, privileged male, was pretty narrow. I’d never been more than 100km north of Perth, so everything I experienced in the Kimberley was completely new.”

“I had a ‘cookie-cutter’ perspective, that’s for sure.”

“We do get some teaching at university around these issues but it’s pretty difficult to deliver it in a completely effective manner. Until you get out into Aboriginal communities you can’t really understand what’s appropriate and what isn’t. The Kimberley is an incredible place and I got so much out of the placement.”

Nic doesn’t come from a family of doctors and an interest in science led him down the medico path.

Finding the right spot

“I loved science as a subject at school and felt that medicine was an ideal expression of that because it’s a really good marriage of theory and practice. I’m absolutely convinced it’s the career for me and I’m looking forward to spending more time in a hospital environment. My first placement was in a renal dialysis ward and, sadly, there are a lot of Aboriginal people with kidney disease.”

“It’s much easier to understand something of what Aboriginal people are going through with the benefit of the Kimberley experience.”

“The Patches Paediatric model and working with Dr James Fitzpatrick was inspiring. To be able to offer almost the full gamut of services in such a remote environment is a wonderful thing. It’s a completely different way of working compared with a doctor’s surgery or hospital ward, particularly when you’re dealing with something like Foetal Alcohol Spectrum Disorder (FASD).”

“It’s a terrible condition, and even more so because it’s entirely preventable.”

“But one thing that the Patches clinic showed me is that young people with FASD are able, with the right treatment, to live happy and engaged lives. It’s absolutely vital that they’re not ostracised.”

Changing perspectives

For a young medical student with relatively little prior rural exposure, a placement such as this can be career-defining, says Nic.

“I’m not from the country and probably wouldn’t have considered rural medicine. But to see how a small amount of money can make such a big difference in the lives of these kids was an eye-opener. Just to have one more teacher’s assistant with appropriate skills changes the entire dynamics of a classroom.”

“It’s pretty intoxicating stuff for a medical student!”

“My own career choices tend to change month by month. I’m leaning a bit towards critical retrieval care, something like RFDS but the problem there is that it appeals to about 90% of my peers as well. It’s important that all students, whatever the discipline, have the opportunity to experience professional placements that are challenging and rewarding.”

“One thing for sure is that I won’t be seeking a career that involves too much number-crunching. I did some work on a FASD database with a couple of other students before going to the Kimberley and I have to say I prefer the interpretative, writing-up side a lot more!”

“The internship at the McCusker Centre for Citizenship at UWA made the Patches trip possible and it’s been really helpful. Its broader purpose is to provide funding to enable young people to develop their skills and engage with the wider community.”

“They normally go to applicants in law or business so it was nice to see medicine getting in on the act as well.”

ED: In March, first year medical students from the University of Notre Dame and second year medical students from Curtin University will participate in a four-day Wheatbelt immersion program. Around 160 medical students will be billeted with local families in seven Wheatbelt communities where they will get involved in local activities and visit local health facilities and emergency services. Students will see up close the benefits and challenges of rural medicine early in their studies and improve their understanding of the challenges faced by rural communities in accessing primary health care. The three-year program is a joint initiative of Curtin University, Rural Health West, WAPHA, Wheatbelt East Regional Organisation of Councils and University of Notre Dame.

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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