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THE Medical Board of Australia has been inundated with submissions on the proposed update of the doctors’ Code of Conduct, receiving about 700 submissions and counting.
One day before the closing date of the consultation on Good medical practice: a code of conduct for doctors in Australia (June 2018), a spokesperson for the Board said it welcomed the “massive” number of submissions.
“The Board is very grateful for the response that it has received [to date], with submissions coming from the medical community and organisations, as well as individual medical practitioners,” the spokesperson said. “Some of the responses are very thoughtful.”
In June, the Board invited the profession to provide feedback on the proposed changes. The Board said it was “not proposing significant changes” to the current code, and any impact on practitioners was expected to be “minor”.
Key changes included:
- strengthened guidance about discrimination, bullying, sexual harassment and vexatious complaints;
- changes to the section on culturally safe and sensitive practice to be clearer about the responsibilities doctors have to provide care that is culturally safe and respectful and to support the health of Aboriginal and Torres Strait Islander peoples;
- expanding sections on professionalism and patient safety; and
- new guidance on career transitions for doctors.
In a letter to the Board, published on the Australian Medical Association (AMA) website, AMA President Dr Tony Bartone raised “significant concerns” about the tight timeframe of the consultation period. He wrote that even seemingly minor changes were important and required sufficient time for consideration and response. The Board subsequently extended the consultation period from 3 August to 17 August.
In his letter, Dr Bartone expressed several other concerns about the proposed changes, including the use of “vague, ambiguous” statements in the code, as well as possible “overreach” by the Board in respect to a section calling for doctors to consider the effects of their comments and actions “outside of work, including online,” on their professional standing and on the reputation of the profession.
“The intention of this statement is unclear and may be considered by some doctors to be a significant overreach of the Board’s authority. It could be interpreted as trying to control what doctors say in the public arena by stifling doctors’ right to publicly express both personal and professional opinions while also undermining doctors’ contribution to the diversity of public opinion, debate and discourse,” Dr Bartone wrote.
“It would be unprecedented for a regulatory authority’s Code of Conduct to attempt to control a doctor’s public expression of opinion in a context which may not impact on the standard or quality of direct patient care or the wider health system nor reflect a lack of medical professionalism.”
In the RACGP’s submission, President Dr Bastian Seidel said the College was supportive of most of the changes to the code, however it identified several issues that required further consideration before the code was finalised.
In relation to the section that states that “recognising the impact of fatigue on your health and your ability to care for patients, and endeavouring to work safe hours wherever possible”, the College said it was important to also recognise the system and institutional influences on a doctor’s ability to manage their own fatigue.
Dr Seidel also wrote in the submission that the College had previously raised frustrations regarding the code’s inability to identify health practitioners’ responsibilities for follow-up of health services or tests they have ordered. He said this was particularly concerning for GPs who, as central co-ordinators of care, often referred patients to other health professionals.
“Responsibility for the timely review and action on tests and results ultimately rests with the health professional who ordered the test. However, expectations of who is responsible for follow-up can become blurred – especially if the patient’s interaction with the secondary service is ad hoc,” Dr Seidel wrote.
“The code should explicitly outline that medical practitioners have responsibility for following up the health service they initiate. This will ensure that GPs are not expected to follow up tests (or other services) that they may not be aware of.”
Writing in Croakey on 9 August 2018, Professor Stephen Duckett, Director of the Health Program at the Grattan Institute, pointed to several gaps in the proposed code, and suggested the addition of subsections to address concerns of overdiagnosis, overintervention and patients’ out-of-pocket costs.
“Doctors, especially GPs, should be aware that some patients may face financial difficulty in paying for the tests they order, the prescriptions they write, and the specialist referrals they make. Patients can be faced with invidious decisions about which prescriptions to fill or which diagnostic tests to have,” Professor Duckett wrote. “The Code of Conduct should require doctors to consider this issue.”
Professor Richard Murray, President of Medical Deans Australia and New Zealand, said that the changes to the code were part of a national and international trend to more explicitly specify the expectations of professional behaviour of medical practitioners and other health professionals.
“That’s something that we strongly support in the business of medical education and training,” said Professor Murray, who is also Dean of Medicine and Dentistry at James Cook University.
“There is a continual evolution of these documents, often in relation to new thinking or new insights around what should be explicit in such statements. Many of the [areas] that are being strengthened in the code – issues around professionalism, bullying and harassment, and patient safety – are all on our agenda.”
Professor Murray also welcomed the draft code’s recognition of medical practitioners’ professional obligation to teach, supervise and assess students and junior doctors.
“This is a strong tradition in medicine, so making that an explicit expectation in the Code of Conduct is something that we welcome,” he said.
Professor Murray said that a clear Code of Conduct was crucial in reinforcing the “social contract” between medical practitioners and the community they served.
“A medical practitioner is granted by society the privilege of having a protected status and title, working in a field where there is a lot of reliance on self-regulation, and, in return, society is absolutely entitled to expect altruistic service where the patient and community come first,” he said. “So, we strongly support the code’s role in supporting the profession to honour that contract.”
The Board spokesperson said it would be some time before the updated code would be finalised.
“Due to the large response, [the Board is] going to take time to consider each response,” they said. “It’s important not to rush this. The Board wants to be sure that all responses submitted are considered and any concerns raised are taken on board.”
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I honestly despair at the almost paranoia expressed by some of the above. Where does it say (or suggest) that doctors have no right of “free speech” or are going to be “gagged”? As long as a doctor identifies the opinions as his/her (not gender neutral!!) own, unless authorised to speak on behalf of others, then there should be no problem. Go ahead, we need to hear a plurality of views.
I’m always fascinated that those who doth protest the loudest often remain “Anonymous”, perhaps a further sign of paranoia.
I do appreciate Dr Bartone’s AMA submission for consideration.
I agree that threshold be no further retractions. Everyone has to follow the common law and act in the patients / persons best interest.
Why further codify?
To the anonymous Dr on here stating this: “I strongly oppose the revision as it gags doctors like me to express my opinions in public that are against cultural views and goes against my conscience” — there needs to be a dramatic change regarding employment as Dr’s in these types of cranks and like what we referred to as those who want to return to those good olden days as quacks.
Agree with Dr Bartone
sorry that should read issue #1 may be the greater umbrage. apologies
The more tendentious section is 2.1 under Professionalism. Incidentally, I think the definition of professionalism should be up front rather than half way down the section as it helps as the reference point (in the spirit of the idea promoted of considering orthodoxy before speaking)
Draft section 2.1 is as follows:
“Community trust in the medical profession is essential. Every doctor has a responsibility to behave ethically to justify this trust. The boundary between a doctor’s personal and public profile can be blurred. As a doctor, you need to acknowledge and consider the effect of your comments and actions outside work, including online, on your professional standing and on the reputation of the profession. If making public comment, you should acknowledge the profession’s generally accepted views and indicate when your personal opinion differs. Behaviour which could undermine community trust in the profession is at odds with good medical practice and may be considered unprofessional.”
There are two issues here and the way the paragraph is worded could be seen as conflation.
Issue 1 – what you say and do outside of work might impact on “community trust”. Breaching community trust = unprofessional.
Issue 2 – delineation of self from professional orthodoxy when making comment (about medical matters in public)
I think the 2 issues should be separated in the wording to make the message clear to the reader, or even make them separate subsections
Does anyone really takes umbrage with issue #2? It seems pretty standard. However, maybe not. An example, some doctors will never agree with abortion, perhaps for religious grounds, perhaps due to views about the value of human life. However, should such a doctor get into a heated discussion in a public place and is overheard by members of the community, the draft proposal changes to the code open up new ways that offended parties may pursue complaint and unpleasantness upon the doctor, should the doctor not have explicitly outlined their viewpoint as a matter of personal opinion (even when a reasonable person may conclude so).
It can be tedious and cumbersome to have to outline the current belief system each time before saying something heretical or controversial. Medicine is full of uncertainty and controversy after all.
Issue 2 may be the greater umbrage. Comments 1-5 are well said. But is this really about free speech? This would be where better clarity is given in the wording.
Doctors around the country work in very different cultures and environments. A small town country doctor could be more vulnerable to exposure to the consequences of the proposed changes, merely by being a relatively well known figure and thus recognised in public places.
At the same time, urban culture is quite different and what may be culturally acceptable in Canberra or Ultimo (let’s say at a cafe near the base of the ABC HQ) may be quite the opposite in a small country town.
Also, the difference even between the major cities can be significant in what constitutes medical orthodoxy in their health care facilities. Having worked around the country there is considerable variation. This is the benefit of having a federation of states and territories and should be seen as a feature not a flaw.
The problem is, “community trust” depends on the community and community standards vary. I hope the proposed draft changes will define and reflect on this concept of “community trust” to the same level as “professionalism”.
I worry that community trust becomes synonymous with genuflection to political matters.
We live in an era where there are increasing restrictions on free speech.
The Profession should not be party to this in any way.
Codes, Guidelines, and Consensus Statements while having a place are able to be abused and misused. They can and will become weapons of control and as presented have little scientific validity. Codes, Guidelines and Consensus statements represent values held at a particular point in time by those with the power to enforce them. Codes, Guidelines and Consensus statements often portray values and opinion rather than being justified by scientific enquiry. They often become difficult to improve, alter or correct. That is not to think they do not have a limited place.
Their relevance, importance and application is totally dependent on whether, when applied, they are subject to rigid compliance with principles such as proof of validity, honesty in application, transparency in interpretation, due process, being challengeable, and compliance with the rule of law. Some actions by AHPRA and our medical board in Australia are exempt from any such requirement under current regulations and laws.
We should staunchly expose the many deficiencies in the current code as it is presented with such loose and unexplained statements. Freedom of speech and the expression of opinion is the currency of our democracy and is the basis for scientific advancement. There are dangerous un-intended consequences for the practice of medicine if we don’t protect our rights.
At a time when freedom of expression is under so much threat, and with various manifestations of this desire, on the part of institutions, to constrain freedom of expression so evident, ( witness the absurd attempts to render the English language gender neutral ), the medical profession should be seeking to ensure that doctors always feel free to express their views, most especially in those areas of social policy, such as Euthanasia, which are currently at the forefront of public debate, and public policy formulation.
I strongly oppose the revision as it gags doctors like me to express my opinions in public that are against cultural views and goes against my conscience.
I wholeheartedly agree with Dr Bartone’s view regarding “ the intention of this statement is unclear ………”
Doctors do have a right to publicly express their opinions.