Doctors , we ’ re listening

IN Australian Doctor ’ s recent special report on surviving complaints , a Melbourne doctor wrote about her deep emotional response to being the subject of a notification to the Medical Board of Australia and AHPRA .

Her experience is not unique . Most practitioners find it very distressing to be the subject of a complaint . For more than a year , we have been listening to both practitioners and notifiers to better understand the notification experience and how we can improve it .

We recognise that being the subject of a complaint is never easy , but it should not be devastating . We want the process to be humane and respectful .

We are committed to improving the experience of practitioners so that , whenever possible , they can quickly return to providing the high-quality and safe healthcare the community needs and expects , and which the vast majority of doctors provide every day .

We have received frank and detailed survey feedback from almost 2000 practitioners and conducted in-depth interviews with another 40 that were randomly selected . We are building a start-to-finish picture that highlights the emotional , personal and professional impact of notifications .

Martin Fletcher is CEO of AHPRA ( left )

Susan Biggar is AHPRA ’ s national engagement adviser ( right )

Practitioners have asked us to be quicker and more transparent , and provide updates more frequently and appropriately . They have stated emphatically that they feel ‘ guilty from the word go ’. Many have questioned the nature of some notifications , wondering why we even bother with them .

In an environment where the number of notifications continues to climb — up 20 % in the past two years — we need different ways of quickly assessing matters . We have implemented a new triage system that has allowed us to close more than 7000 notifications across all professions in the past financial year — 40 % more than two years ago .

We know that the key to accurate triage is the ability to quickly and meaningfully assess risks to patient safety .

Implementing a more comprehensive risk assessment framework and increasing our use of early clinical advice has led to a 26 % decrease in the length of time we take to close medical notifications in the initial assessment phase .

Being more transparent about what is happening , when and by whom is also important .

More than half of all notifications about doctors and medical students are closed within 90 days . But some matters do take longer than three months , and practitioners tell us this can feel like a very long time .

These matters often require additional steps , such as a health or performance assessment , or gathering additional information through an investigation .

We have initiated fast-track investigation teams to streamline more straightforward matters and renewed our focus on older investigations . Our work towards achieving quicker outcomes for all notifications will continue .

Practitioners have said that it ’ s not only speed that matters . Being more transparent about what is happening , when and by whom is also important . We have heard that a lack of information leads people to imagine the worst . That means informative regular updates are essential . We ’ re working hard to do this .

We have consistently heard that telephone calls make the experience feel more personal and , in response , AHPRA staff are picking up the phone more often . When we do write to practitioners , we are conscious that our language should not be legalistic because it can be intimidating , which is not our intention .

While we cannot predict what the medical board will decide , we can point people to statistics on outcomes . For example , practitioners tell us they worry that a notification will lead to loss of their registration . Last year , less than 1 % of notifications about doctors resulted in suspension or cancellation of registration . And in about 80 % of medical matters , the board took no regulatory action .

That last figure leads some practitioners to believe we are looking at matters that should not be coming to the regulator . Maybe , but our discretion is limited .

Under the National Law , which directs our work , anyone has the right to make a notification . Once we have the name of a registered health practitioner and other basic information that meets the legal grounds for a notification , we are obliged to consider the matter . And , of course , it is important that patients can raise concerns .

Medical regulators worldwide are tackling the challenge of building a more humane regulatory system , and we are sharing our experience with other countries and learning from them .

Most importantly we are listening to practitioners and notifiers , and acting on their feedback .

Read more of our Special Report : Surviving complaints — bit . ly / 2NieqJd

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Journal Talk with Rada Rouse

How Big Formula is failing a new generation of mums

fully independent infant feeding curriculum and resources for medical students and doctors ,” she writes in an editorial in the BMJ .

Dr Shenker suggests that lobbying by Big Formula was likely behind the “ remarkable ” decision of the US earlier this year to oppose a WHO resolution at the World Health Assembly in support of breastfeeding and against marketing of breast milk substitutes .

The sector has spent about $ US60 million ($ 82 million ) lobbying the US government alone in the past decade , she notes .

The US attitude to the WHO resolution suggests “ a new level of Trumpian disregard for maternal and infant wellbeing that should be resisted in the strongest terms ”, she writes .

The US administration didn ’ t just vote against the motion that called on nations to “ protect , promote and support breastfeeding ”, it also apparently threatened the proponent , Ecuador , with suspension of trade and military support .

Internationally , the level of dismay over the US hard line was palpable , with commentators describing it as anti-science , aggressive and blackmail .

Among public health advocates , it stirred memories of the 1980s when the US went out on a limb to oppose an international code of conduct to temper Big Formula ’ s push into the developing world , which had sparked First World consumer boycotts .

Dr Shenker ’ s message is highly relevant in Australia , where the Health Ministers ’ Advisory Council is overseeing the development of a new national breastfeeding strategy , expected later this year .

Advocates are keen to haul our voluntary infant formula manufacturing code of conduct into line with the WHO code , to rein in marketing of breast milk substitutes and non-evidence-based toddler milks , and to embed infant feeding guidelines in health professionals ’ education .

“ Doctors need to advocate breastfeeding , so another generation of mothers and babies are not failed ,” Dr Shenker says . BMJ 2018 ; online .

Australian Doctor Australian Doctor 7th September 2018 | Page 15

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Special Report : Surviving complaints

Doctors , we ’ re listening

IN Australian Doctor ’ s recent special report on surviving complaints , a Melbourne doctor wrote about her deep emotional response to being the subject of a notification to the Medical Board of Australia and AHPRA .

Journal Talk with Rada Rouse

How Big Formula is failing a new generation of mums