16 JUNE 2023

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We cannot assess the risk of future claims , says insurer .

Heather Saxena and Kemal Atlay “ THERE is no evidence to support the notion that gender-affirming care is an inherently high litigation risk area of medicine .”

This is Dr Portia Predny , a Sydney GP who cares for young people with gender dysphoria , talking about the decision by MDA National to limit indemnity cover for clinicians like herself .

From 1 July , doctors who practise outside of a hospital-based multidisciplinary team will not be covered by the medical defence organisation ( MDO ) for any future claims that may arise from starting gender-affirming hormones in under-18s .

Cover will also be denied if a claim eventuates after a private doctor makes an assessment that a child or adolescent “ is suitable for gender transition ”.

The decision , which affects around 50 GPs , has been attacked by doctors caring for patients , who warn of the dangers of MDOs dictating the limits of mainstream clinical practice .

Dr Predny , chair of AusPATH , the peak organisation for clinicians working with gender diverse people , said : “ We know that access to gender-affirming treatments can quite literally be life-saving for transgender people .

“[ But ] not all jurisdictions have access to a paediatric gender clinic — the Northern Territory has no public gender service at all . And those that do exist are located primarily in capital cities .

“ Many of my colleagues who provide this essential medical care outside of a

‘ This decision has a significant ethical and moral impact .’

hospital setting are living and working in regional and rural areas , providing care to those who would otherwise not be able to access it .”

MDA National stressed that doctors would still be covered for assessing or treating adults with gender dysphoria , as well as for repeat prescriptions for gender-affirming hormones if the therapy was initiated by a non-GP specialist in a hospital-based team . PAGE 3

Antony Scholefield AN AHPRA review that identified 16 suicides of health practitioners under investigation found there was no clear process for investigators to escalate concerns about a practitioner ’ s mental health .

The review of practitioner distress , led by Psychology Board of Australia chair Rachel Phillips , identified the suicides along with four instances of self-harm between 2018 and 2021 .

The resulting 12-page report

FIRE & FLY MEDIA did not go into detail on individual deaths , but it said the practitioners commonly expressed “ feelings of shame , self-doubt , loss of hope ” to AHPRA staff in emails and phone calls during the investigations .

It said the mental illness and substance use disorders they were experiencing required expert intervention , but there did not appear to be “ a clearly articulated policy for staff to follow for how identified risks on these grounds should be escalated ”.

“[ It was also not clear ] whether practitioners were asked early in the process whether they had any mental health challenges or suicidal thoughts , or whether there was a specialist team managing these cases with a higher level of training in identifying risk of self-harm , distress or diagnoses .”

The report noted that the absence of records suggested that wellbeing was “ not front of mind or monitored in a systematic way ”.

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Sometimes doctors must put their own needs first .

OPINION , PAGE 16

Extrafine * Trimbow is the only 3-in-1 option for adults with asthma who prefer a pMDI 1 , 2

* Mass median aerodynamic diameter particle size < 2 μm . 2

Trimbow 200 is indicated for the maintenance treatment of asthma , in adults not adequately controlled with a maintenance combination of a high dose of ICS / LABA , and who experienced ≥1 exacerbations in the previous year . 2

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Please review Product Information before prescribing . Product Information is available by scanning the QR code .

PBS Information : Authority required ( STREAMLINED ). Severe Asthma ( 200 / 6 / 10 mcg presentation only ). Criteria Apply . Refer to PBS Schedule for full information .

NEW HIGH

STRENGTH 2 Abbreviations : ICS , inhaled corticosteroid ; LABA , long-acting beta2-agonist ; PBS , Pharmaceutical Benefits Scheme ;

pMDI , pressurised metered dose inhaler . References : 1 . Pharmaceutical Benefits Scheme ( PBS ). Available at : https :// www . pbs . gov . au . 2 . Approved Trimbow Product Information . Chiesi Australia Pty Ltd , Suite 3 , 22 Gillman Street , Hawthorn East , VIC . 3123 , Australia . Tel : + 61 3 9077 4486 ; Fax : + 61 3 8672 0792 ; Email : medicalaffairs . au @ chiesi . com ; Website : www . chiesi . com . au . Copyright © Chiesi 2022 . All rights reserved . Date of preparation : December 2022 . AU-TRI-2200167 . CHIE00042c .

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