APHRA – our enemy or our friend?

APHRA – our enemy or our friend?

February 19, 2015

I am sure that APHRA would regard itself as neither. APHRA regards its role as protecting consumers. No one would argue that there is a legitimate concern about the practices of a small number of health-care providers. My experience and that of others is that APHRA does acknowledge that performance assessment can be a stressful experience for practitioners however our concern is that a significant number of complaints about independent medical examinations are from disgruntled people who want to lash out at the IME if the opinion provided is not acceptable.

Doctors are frustrated by the trivial nature of many of the complaints, they are frustrated by the time and emotional energy expended in responding to these and by the economic cost.

The recent issue of Australian Medicine of 16 February 2015 on page 8 has an article about “Flawed Complaints Process Undermines Health and Care”. Their article makes the point that research published in BMJ Open Has Found Significant Levels of Depression and Anxiety amongst Medical Practitioners Who Have Had a Complaint Made about Them. The Study Involved 7926 doctors and found that 70% of those who are currently or as recently the subject of a complaint or moderately or severely depressed and 15% reported moderate or severe anxiety.

Alarmingly, doctors who currently or recently had complaints against them were twice as likely to consider hurting themselves or contemplate suicide.

This study found that not only did being the subject of a complaint affect a doctor’s health, but it could also have a significant impact on how they practised. the vast majority of doctors involved reported adopting a defensive approach to how they practised, 20% felt victimised, almost 40% felt bullied and 27% took more than a month off work.

Dr Browne, the senior medical officer with Avant said the results were “virtually identical” to a similar study co-conducted in Australia in 2006. She said the way patient complaints were handled in Australia risked making doctors “a second victim” causing them an enormous amount of stress and undermining their health.

The AMA has called for an overhaul of the system. The complaints system is being examined as part of a review of the National Registration and Accreditation Scheme for Health Professionals in both the AMA and Avant have made submissions urging major changes in the way complaints against doctors are handled.

The AMA has called for improved triaging of complaints and notifications, greater transparency and fairness, and changes to make the scheme more responsive to medical practitioners and accountable to the medical profession. The notification process was noted to be arduous and lengthy with more than 30% of investigations to open after nine months.

The AMA noted that it was disappointing that the findings of the review had been pre-empted by the Australian Health Practitioner Regulation Agency, which last year released an action plan of changes.

APHRA wanted more information to be provided to complainants, and a greater focus on improving the experience for consumers, when “in fact, efforts need to be directed to improving the investigation process-that is, the practitioner experience. Medical practitioners and consumers, equally, want a regulatory system that is is timely, fair, transparent and effective.”

I have provided a summary of this report. The recommendations are focussed on ‘the consumer’ although Recommendation 7 mentions health practitioners, burrowing down  we find a sub-set of recommendations including in the short term:

In relation to NFA (jargon for cases where there is to be no further action). Particularly where there are issues but they do not reach the AHPRA threshold, create an opportunity for notifiers to contribute to the collective patient voice and lead to improvements down the track, translating cumulative issues into recommendations for improvement. So while an individual complaint may not have a result for the particular consumer, it contributes along with other complaints to improving the system.

The assumption is that although there is to be no further action, the complaint has some legitimacy but did not reach the threshold.

In the long term:

Provide more publicly available and easily accessible information about individual health practitioners.

 There is no mention of whether or not this would include health practitioners about him complaints have been made as opposed to health practitioners who have had adverse findings.

You will also note that recommendation 8 talks about measures to increase APHRA’s engagement with consumers and the community but no mention about better engagement with health practitioners.

Recommendation 1: Provide better information on the website, using professionals with skills in health communication with consumers working with a consumer panel

Recommendation 2: Develop more meaningful communication with consumers throughout the notification process

Recommendation 3: Improve the initial contact and invest in skills and expertise at this first point of contact.

Recommendation 4: Build on current collaboration between AHPRA and the OHSC ( Office of the Health Service Comissioners) to develop seamless complaint management and resolution across the two organisations. This should be based on the ‘consumer

journey’ and seeking to address the full range of issues in the consumer’s complaint in the most timely and complete manner.

Recommendation 5: Use process redesign and lean principle to explore options for swifter resolution and more timely management of notifications.

Recommendation 6: Reconsider the role of the consumer as a notifier in the ‘model of practice’.

Recommendation 7: Ensure that complaints and notification contribute to systems change and that is demonstrated to the community and to health practitioners.

Recommendations 8: Consider measures to increase AHPRA’s engagement with consumer and the community

The IME complaint I have mentioned previously is a good example of this process. The IME has written to APHRA requesting information about the assessors, issues regarding confidentiality and the provision of a support person.

The response from the Manager Notifications with APHRA stated that on 5 February 2015 the Medical Board of Australia formed the relief that the way the IME practices may be unsatisfactory and decided to require the IME to undergo a performance assessment. The Board noted that the issues raised by two complainants were similar (see below). The IME was informed that both assessors are psychiatrists one of whom is an IME, the date of the assessment was provided and indicated that a schedule would be forwarded. In response to a request to have a support person the IME was told that the support person can remain present:

  • at the beginning of the assessment while assessors conduct a preliminary interview.
  • during the final discussion between the assessors and the practitioner
  • during allocated breaks

Surprisingly the writer goes on to show say “however, to ensure the independence and objectivity of the assessment, the support person is not present during the interview sessions of the practitioner and his/her patients.”

The letter goes on to say “The Board will decide what, if any, action is to be based on the assessment and the outcome of the discussions with the IME about the assessors report. The Board’s actions are not intended to be punitive, but aimed to enable the IME to practice safely” (my emphasis, note that the IME here had been notified on 14 January 2013, 17 March 2014 and 6 October 2014 that the replication lacked in substance, no further action was to be taken and “this matter has now been closed”. The last letter noted that the complaint it alleged “that your manner and communication with X during an IME was unprofessional in that you were angry, board and abrupt.”)

These complaints mirror similar vague complaints made about other IMEs.

APHRA has to recognise it must not be seen as the enemy if it has to have more than grudging co-operation from us.


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