News Review 7
News Review 7
Are older doctors a safety risk?
The Medical Board of Australia on its failed push for mandatory health checks.
Paul Smith THERE are painful humiliations for the Medical Board of Australia in its decision to put the machine in reverse gear and back away from imposing mandatory health checks on older doctors.
It seems to have failed to do the most basic homework before embarking on a long, contentious and ultimately flawed consultation where the most salient facts were missing in action.
The fundamental premise for the health checks— that significant numbers of older doctors were putting patients at risk because of health impairments— turned to dust.
So too did the other premise central to the enterprise— that health checks and cognitive assessments could materially reduce the harm allegedly being done. The rates of complaints among late-career doctors were higher than those below 70— but as the profession said from the very beginning, how many of these complaints were proven, how many of those complaints were related to health impairments, and if they were related to health impairments, where was the evidence that a mandatory GP consult every three years was the fix?
As we discovered in December, when the board got around to looking at these harder end points, it turned out just 14 older doctors had been subject to regulatory action as a result of health impairments— and this was over a two-year period.
Dr Susan O’ Dwyer
When Australian Doctor interviewed the board chair Dr Susan O’ Dwyer, I suggested that the figure was an embarrassment. If it had been known 12 months ago, the consultation would never have got off the ground. Dr O’ Dwyer did not offer euphemisms.“ I take on board your feedback there,” she said.“ Yes, in relation to that number, that is an embarrassing approach.”
Asked about the time and money involved, she mentioned the medical board policy team, the working hours of AHPRA employees and the board members themselves.
“ The cost to us financially wouldn’ t be that great, but certainly a lot of cost in terms of the cognitive exploration of these issues.”
There are a few things worth stressing. She said the board still believes that older practitioners do carry a higher risk when it comes to safety, and that there is an obligation to ensure it is addressed.
Once a notification comes in, Dr O’ Dwyer says, regulatory action is taken at higher rates when it comes to complaints relating to communication problems, issues around prescribing and medications, as well as clinical care.
She says it is also possible that health impairments underpin these notifications— it is just that the complaint system does not classify them in that way.
But the board’ s collective view now is that the issues are broader than health
impairments, and that health checks, and specifically the cognitive assessments, are not going to solve them.
If that is the case, would it not be more logical to embrace revalidation— the UK regime where you go in harder, not softer, and assess doctors’ skills to ensure they are fit to practise where they currently work?
“ With the professional performance framework developed back in 2017, the expert advisory group rejected formal revalidation,” she said.“ Instead it went for strengthened CPD.”
‘ We definitely want to push the agenda around a doctor for every doctor.’ AHPRA notifications from July 2022 to June 2024
A more nuanced approach
Dr O’ Dwyer says that when it comes to older doctors, the board wants to take a more“ nuanced approach” with a shift away from“ regulatory” mechanisms.
So it is about ditching the stick and hoping the profession will find ways of bringing cultural change.
“ We definitely want to push the agenda around a doctor for every doctor; that every doctor has their own GP and sees somebody regularly.
“ I think we also want to push open discussions about ageing in medicine as a practitioner and how to have those conversations.
“ Practitioners who age will change [ and adapt ] their scope of practice over time.
“ So how do you do that and how are you supported to do that and how do you know when to do that?
“ We want to open up those conversations in a way that is collegiate and supportive and not in a way that is judgemental.”
Complaint Under 70 70 + Comparison
Clinical care Notifications closed 4177 368 Action taken 212( 5.1 %) 34( 9.2 %) 1.8 × more likely
Communication Notifications closed 1557 159 Action taken 88( 5.7 %) 23( 14.5 %) 2.5 × more likely
Health impairment Notifications closed 234 39 Action taken 78( 33.3 %) 14( 35.9 %) 1.1 × more likely
Medication Notifications closed 1260 186 Action taken 142( 11.3 %) 30( 16.1 %) 1.4 × more likely
She adds:“ My message is that the medical board is genuine in its concern for the protection of the public and it is genuine in its endeavours to try to support practitioners to continue to practise safely.
“ We went out for consultation on what was thought to be a reasonable proposal at the time.
“ We considered the feedback, we did get support for the proposal, but we also
Medical Board of Australia chair Dr Susan O’ Dwyer.
got some qualified support for it as well.
“ And the cognitive testing [ of older doctors ] was one element where there wasn’ t great support.
“ So we went back and revisited the data, including [ analysing ] regulatory action taken, and we have thought hard about it and decided to try and engage with the profession in a proactive way.”
This is all very good. Yes, it was a consultation, and the point of consultations is you listen and respond and there is scope to back away— they should never be seen as a done deal.
The public narrative
But you sense that the last 12 months have left a bitter aftertaste for many.
The public narrative to many older doctors last year was that the medical board believed that older doctors were unsafe.
It spoke loudly to the media about older doctors being 81 % more likely to receive a notification than younger colleagues.
There were quotes from Dr O’ Dwyer’ s predecessor, Dr Anne Tonkin, declaring that there was a“ moral imperative” for the board to act.
But were the dangers of these older doctors simply not true?
“ On a broad scale, it’ s not true, and the absolute numbers of people in the notifications we get are quite small,” Dr O’ Dwyer says.
“ But every notification matters, every patient, every doctor matters … and so we take them seriously … It was not an unreasonable approach( and I was on the board at the time) to go to consultation. I think the narrative was unfortunate because that was not our intention.
“ We feel sad as practitioners and community members sitting on the medical board when you see a notification about an older doctor who has had a stellar career. It is sad when you see notifications bringing an end to careers.
“ There is a desire to prevent that happening … We want to support them to have a co-ordinated way to practise as long as they want in a safe way.
“ So yes, the narrative that came out was unfortunate.”