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OBSTETRICIANS and gynaecologists, followed by psychiatrists and GPs, are more likely to be disciplined for professional misconduct than other doctors, according to an analysis of disciplinary cases published in the MJA. (1)
The analysis also found that male doctors were four times more likely to be disciplined for professional misconduct than female doctors.
The University of Melbourne research analysed 485 medical tribunal cases between 2000 and 2009 in which doctors were disciplined for professional misconduct in Australia’s four most populous states and New Zealand.
The leading types of misconduct were sexual misconduct (including sexual relationships with patients), which was the primary issue in 24% of cases, followed by illegal or unethical prescribing (21%) and inappropriate medical care (20%).
Dr Joanna Flynn, chair of the Medical Board of Australia, said the nature of the doctor–patient relationship in the three specialties could perhaps explain the higher rate of disciplinary action.
“Compared with other doctors, the relationship is more ongoing, particularly for GPs. Psychiatrists and obstetrician–gynaecologists often have a more intimate relationship with their patients, which could create the potential for transgression of professional boundaries”, she said.
However, Professor Michael Permezel, vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said that doctors in his specialty were well trained in “dissociating” their work from their private lives.
He believed that because obstetricians and gynaecologists deal with “highly emotive, life-changing events” such as childbirth and reproductive health, patients may be more likely to make complaints.
However, he said the low number of cases in the study (24 cases involving obstetrician–gynaecologists) made conclusions difficult.
RANZCOG has several training courses on improving professional practice, as well as a support service for doctors going through the disciplinary process, Professor Permezel said.
The researchers described the penalties imposed on disciplined doctors as “severe”, with 43% of cases resulting in removal from practice and 37% in restrictions on practice.
Dr Flynn said she was not surprised at the severity of the penalties because the research examined cases at the end of the disciplinary process.
The research also found that in 78% of cases the tribunal made no mention of any physical or mental harm to a patient as a result of the professional misconduct.
Dr Flynn said even if no patient harm is mentioned in relation to a case before the tribunal, it still may have occurred. “There is ample evidence that any breach of trust leads to subsequent harm to the patient”, she said.
Doctors were judged on their misconduct, not the outcome for patients. “If what the doctor is doing is risky, we should be intervening, not waiting until a patient is harmed.”
Dr Flynn welcomed the research, and said she looked forward to future research using medical tribunal data, to enable analysis of trends in disciplinary matters involving doctors.
– Sophie McNamara
Posted 2 May 2011
Doctors need to be able to “trust” their patients as much as the reverse applies. In 20 years of private O&G work, I could usually tell the patient with whom it would be prudent to have a chaperone present. Most of the time I just asked the patient if they were comfortable without. It was their choice. Call me a little paranoid, but it would be very easy for a disgruntled patient to destroy a doctor’s reputation. I’ve been threatened but not directly affected. Now in my TTR (transition-to-retirement) phase and working part time in the public sector, I wouldn’t examine anyone without a female staff member present in the room, but get criticised for slowing things down. Go figure!
I think that with regard to Herb Horst’s comments, my take is this: that there are doctors who are in positions where they judge their peers, eg “expert witness”, reviews of cases where things go wrong etc – in some cases, these doctors passing judgment have very little clinical responsibilities. Take the specialty of emergency medicine where many of the directors and senior medical staff in public hospital EDs spend more time not seeing patients but attending to administrative duties. In addition, there is very little accountability for these judgments against peers – think about the Kossmann affair. I think that whoever gives an opinion needs to state how many days a week they actually spend seeing patients and making decisions on patients. This might add some credibility to value judgments that they subsequently pass. I actually do not think it counts for much whether the person passing judgment is of a particular age or who holds an honorary title such as associate professor, etc. Remember, we are all human and prone to mistakes. A colleague of mine stated he is yet to meet the perfect doctor or nurse. I do not envy the position of those who have to judge others but I do think that there can never be enough kindness, compassion.
Whilst the MJA article considered who was disciplined by medical tribunals, I am interested to know whether a register is made of those who make complaints, especially those that are dismissed by the tribunals.
As Richard Middleton has said, being investigated by a tribunal can be very trying regardless of the outcome. I would like an assurance that if a complainant/organisation makes 2 or more allegations that are effectively dismissed by a tribunal, that person/organisation be investigated by the tribunal as to whether the allegations are made in good faith. If proven not to be, that person/organisation should be publicly named for possibly wasting the time and resources of the tribunals.
A colleague of mine engaged in a romantic relationship with a patient. There was no ethical problem because she (i) talked to the board about it, and (ii) followed the board’s advice, which was essentially to end the clinical relationship and give some breathing space before taking the romantic relationship further. No problems, no difficulties, and when the relationship ended many months later, no fallout.
I have at times been frustrated with the board’s systems — once I had to defend a complaint against me by someone I had never met or provided medical care to (nor anyone they knew) and it took a ridiculous amount of time and effort to respond to what was clearly a spurious complaint — but on the whole the board does a very good job of a difficult role, and almost all the medical members of the board are working doctors, often with years of hard clinical experience. Intimating that board members are “boutique” in some regard is not exactly fair, and, if taken to its logical conclusion, would automatically disqualify anyone who sits on a medical board from sitting on a medical board.
Medical Boards have in my experience over eight years been composed of at least 25% community
I write as a Medical board member for near 8 years with the Board having 25% community members and for most of this time a predominance of female members. boards have no problems with doctors deciding to romantically commit to a patient. Boards do recognize the risks to patient care through a loss of objectivity and at worst through exploiting power imbalances. Our profession self regulates through an agreed Code of Conduct by insisting that doctors remove themselves from any subsequent clinical care once they set out on such commitment. Boards receiving complaints often from declared victims weigh the matter by seeking bilateral comment. Where a case for judgement is established, referral to a Tribunal separate from Board influence occurs as penalties available to Boards are below a scale that has emerged from judicial consideration of the range of factors applicable to both patient and doctor. I would suggest this is not the domain to use as a stick
to beat AHPRA.
apply in such a human domain apply.
It always intrigues me that nurses who marry their patients are regarded as romantic and caring, but doctors who marry theirs seem to end up before the Board 20 years later when the relationship sours.
Horst Herb – you may be a bit confused regarding the various roles of the different players in disciplinary processes. Firstly, the Medical Tribunal is a court, presided over by a judge – it is not part of AHPRA and not under AHPRA’s control. Secondly, members of the various state boards are not “administrators” – they are often full-time clinicians, I’m unsure who the comment “anybody who merely works in a part-time boutique practice” refers to – are you saying that judges on the Medical Tribunal are conducting boutique practice?
“Dr Flynn said even if no patient harm is mentioned in relation to a case before the tribunal, it still may have occurred. ‘There is ample evidence that any breach of trust leads to subsequent harm to the patient,’ she said.”
She would say that, wouldn’t she? Where is the peer reviewed proof??
Time the Board was held to the same standard of professionalism that it demands (with menaces) from us.
Let us not forget that the Medical Board exists to “guide doctors” (into the light?) and any doctor unlucky enough to find themselves up before them will find that they are presumed guilty as charged until proven so.
Of course, this will only happen after careful, caring, exhaustive and lengthy investigations, the least of which, for even the most insignificant of imagined infractions of their standards, can take up to a year to “progress”. This investigation will leave the hapless practitioner debilitated and often considerably worse off.
Should the practitioner be clearly ‘innocent as smeared’ the Board will grudgingly admit this in a backhanded way.
The other issue that I find illogical in this day and age of equality and assertion is this matter of ‘sexual misconduct’. Who started this?
A woman can ‘take control’ of her decision to seek medical aid, accept the diagnosis at the GP, give permission for treatment and accept the financial responsibility for it at the specialist’s rooms, arrange hospital admission and accept responsibility for that, accept the procedure in hospital after entering under her own volition, give permission for all associated procedures and investigations, give permission for anaesthesia and then all related follow up.
After all this, if, say the surgeon or anaesthetist or a male nurse should ask her out, she suddenly and unaccountably becomes a quivering emotional jellyfish, utterly incapable of making decisions about her own life, vulnerable in the presence of these torrents of testosterone.
This double standard is utterly pathetic.
Not only is this attitude demeaning to the woman, it is paternalistic and patronising to all sentient adult humans.
This is NOT to excuse genuine assault, etc, but an appeal for a quotient of common sense when interfering with relationships between consenting adults.
I doubt that anybody who merely works in a part-time boutique practice will ever be able to understand the emotional toll of a full-on patient-doctor relationship in the context of severe life-changing medical events and working long hours every day, every week.
A difficult situation – any significant involvement in administrative duties such as a role on the medical board automatically excludes these colleagues from being considered as true peers, and the longer they work in such administrative positions the more they will be alienated from the professional realities we have to deal with every day.
I think it would behoove AHPRA well not to start a “holy inquisition” without at least making some effort of true peer consultation first, lest the damage they will inflict upon the community will exceed the damage some individual doctors might inflict.