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THE Australian health regulator’s response to an ongoing debate about freedom of expression for doctors online was “confused and not at all reassuring”, according to one vocal opponent.
On Monday 25 July, the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia (MBA) issued a joint statement saying there was “no place for bullying and harassment in healthcare because it harms the lives and careers of doctors and it harms patients”.
“This cultural challenge extends to behaviour online. Social media is not a forum to bully, harass or intimidate. The same standards apply online and in person.”
Although the statement offered no context for why it had been issued, it came in the wake of three events – the placing of registration conditions on Broome GP Dr David Berger for his outspoken criticism of COVID-19 public health settings on Twitter; an open letter from 18 leading health practitioners and researchers, published on 14 July, calling for an independent audit of Ahpra’s handling of social media and public advocacy complaints; and a call from the Australian Medical Association’s (AMA) Victorian branch for a Royal Commission into Ahpra.
Dr Andrew Miller, (@drajm), an anaesthetist and former President of the AMA’s Western Australia branch, told InSight+ that he found the Ahpra/MBA statement “curious, confused and not at all reassuring”.
“It was issued without context other than the timing [regarding] Dr Berger’s issues, and the fact it commits the fallacy of conflating ‘freedom of speech’ with ‘bullying and harassment’ – I don’t know what they were trying to achieve.
“Dr Berger’s conditions did not in any way relate to any alleged bullying or harassment of anyone and it is disingenuous in my opinion to raise those topics when responding to criticism of the way they handled his case.
“Whether Ahpra like it or not, when you start to tell people you cannot speak that way, you must speak this way it is of course a limitation on freedom of speech. To say otherwise is nonsensical.
“Nobody disagrees that bullying and harassment are unacceptable,” said Dr Miller, who was one of the co-signers of the open letter.
“What is at issue though is robust criticism of what Dr Berger and others might argue are fools making foolish policies. Is Ahpra saying there are no fools or foolish ideas in politics, big pharma or medicine, or just that if there are we must not say so?
“Why should doctors, and no-one else in the community, be forced to feign respect for mediocre or incompetent authorities or individuals?
“The law must to be applied equally to everyone; you should not single out one person who opposes government policy while apparently not acting on myriad others who are emotionally pejorative online, and who now threaten and follow through with anonymous reports to Ahpra when they do not like what a doctor says.
“Ahpra is, in my view, open to being used as a tool of anonymous bullies, while they say without irony they are trying to improve culture.”
An InSight+ poll, which has been running since 18 July and so far has 1208 respondents, found that 94% said they either agreed or strongly agreed that a Royal Commission into Ahpra was needed.
In a statement to InSight+, Ahpra dismissed the results.
“There are 134 000 doctors registered in Australia. Your poll reflects the views of less than 1% of them. We are more concerned about the many thousands of doctors in training who have raised concerns about the culture of medicine. The Board is listening to our country’s future doctors and taking seriously the challenge of working with the profession to improve the culture of medicine,” wrote the Ahpra spokesperson.
“It is not acceptable to dress up bad behaviour as freedom of speech.”
The spokesperson said that it was not Ahpra’s policy that criticism of the government’s public health settings regarding COVID-19 was undermining public confidence in government and/or public health authorities, and that doctors should be allowed to voice their opinions about government policies and public health settings in a public forum, “respectfully”.
Professor Kerryn Phelps, former President of the federal AMA and a former Member of Parliament, was also a co-signer of the open letter. In an email to InSight+ she said she had been the subject of a complaint to Ahpra about her online content.
“I was informed of an anonymous complaint to the Health Care Complaints Commission (HCCC) about one of my COVID information videos,” she said.
“The complaint had no basis and I was informed that no further action was required.
“It certainly alerts you to the attempts by some people to anonymously use Ahpra and the HCCC as potential threats or weapons against doctors expressing views publicly.
“Anyone with expertise in health communications or marketing will tell you that the way a message is delivered is extremely important.
“The public is simply not getting the message [about COVID-19],” said Professor Phelps.
“Using the terms ‘recommending’, ‘urging’, ‘requesting’ mask use is just not working.
“There is a lot of frustration in the medical community that the precautionary principle and fundamental public health preventive measures to reduce SARS-CoV-2 transmission seem to have been abandoned, and doctors with a strong sense of social conscience have felt compelled to speak up.
“There is a risk to public safety when doctors remain silent when political and public health messaging is getting it wrong.
“This goes back to Dr John Snow and the Broad Street pump or Dr Ignaz Semmelweis [sic] and handwashing in birthing units.
“Throughout this pandemic, doctors have had to call out mistakes on issues like airborne transmission of COVID, the efficacy of masks to reduce transmission, children being able to transmit the virus, and many more examples where politics and misinformation have over-ridden evidence and clinical experience.”
Professor Phelps said she was happy to see debate at the AMA National Conference over the weekend about “the proper role and function of Ahpra”.
“This is a matter that needs to be discussed within the medical profession to get the balance and focus of Ahpra’s activities right, in the interest of freedom of speech, professional conduct and public safety.”
The anonymity of the complainant versus the public naming of the doctor being complained about is also a matter of concern to many.
Dr Andrew Watkins, a Melbourne paediatrician, said it was an issue that made him “particularly angry”.
“There are legitimate reasons for anonymity in clinical complaints against a doctor – medical privacy, power imbalance/dependent relationships etc,” he told InSight+.
“If they are political complaints against a doctor for public comments, they will be from interested parties and the complaint, process and any sanction cannot be fully assessed by the community and those complaining must be forced to do so publicly, so their actions can be judged.
“I think it highly unlikely that the complaint could come under any need for medical privacy.
“It is ridiculous for Ahpra to conflate robust criticism of governments, senior bureaucrats and drug companies with bullying of patients or colleagues, junior or senior – the power imbalance is in a wholly opposite direction and Dr Berger‘s targets are big enough and ugly enough to take care of themselves.
“There is altogether too much bullying in medicine, which needs to be addressed, but Dr Berger is not the problem – Ahpra should stick to its knitting.
“They already have more than enough important stuff to do. Every moment they spend on trivia such as this is time and resources which could be devoted to sorting out important stuff.
“The bottom line is that we doctors have to be politically active in defence of our patients and public health, instead of simply to defend our incomes.
“Rudolf Virchow’s 19th century comment is as relevant today as it was 150 years ago (and got him run out of Berlin by Bismarck): ‘medicine is a social science and politics is nothing other than medicine writ large’.”
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how is it that AHPRA can decide the only way to re re-register as a medico, is online ,and the only method of payment is by credit card.
I have not enquired if there is a Card fee
AHPRA is used as weaponry to silence whistle-blowers. We need to advocate for our patients subjected to discrimination and speak up when we witness misconduct.
I fully support an investigation into AHPRA. I was sexually assaulted by a patient on parole who has a history of violence against women. He put in a malicious and vexatious complaint about me. The AHPRA investigation has been more traumatic than the assault. No understanding of trauma and no due diligence to investigate the lies fabricated by the notifier. The process is being used by the perpetrator to continue the bullying and hurt. Co-incidentally this was after I raised concerns through a whistle-blower report. Was it an entrapment? Am I being silenced for my free speech? Does not make me feel secure about the process.
The Journal of Vascular Surgery was rightly criticised for publishing an article which suggested that online unprofessional behaviour included doctors drinking alcohol, or posing in bikinis. And that was long before Finnish President Sanna Marin was filmed partying.
The outrage was also accompanied by some humorous memes, like the guy lying in the ED bed saying that this was him, photographed topless in his own hospital.
We should not forget that it was well-meaning medical regulators who refused admission for women to train as doctors, and even after that barrier had been broken, only a generation ago my senior colleague Dr Grace Warren (subsequently Australia’s most experienced leprosy and tendon transfer surgeon), was not allowed to train as a surgeon, because it was ‘unprofessional’ to train women as surgeons.
We should also remember that the term professional refers to being paid. What a doctor does in their unpaid out of work time, has no bearing on the work time, provided they turn up clean and sober and rational for the next relevant medical shift. On the weekend a doctor can be filmed on national television wearing a chasuble and swinging a censer in a liturgical setting of a requiem mass, praying for the souls of the dead. A doctor can be filmed on a national broadcaster atop a Mardi Gras float, wearing arseless chaps, drunkenly calling for an orgy. A doctor can post shots of herself life-modelling or praying in a niqab. A doctor can call the health minister a spineless moron for failing to prevent violence against aboriginal women, who are 35 times more likely to be admitted to hospital than white women. A doctor can complete a Tough Mudder then fight in an MMA cage. A doctor can extol the benefits of chiropractic treatment, while working a second job as an AHPRA-registered chiropractor.
On Monday morning, the doctor will advise chemotherapy, not faith, for cancer treatment. Any discussion of sex will include HIV prophylaxis and monkeypox warnings. The doctor will work in professional clothing, and not refuse treatment to a patient who arrives in ED either nude or in a niqab. The doctor will treat the abuser’s broken hand with professional courtesy, care and skill, with appropriate mandatory notification where required. The doctor will be clean, and will not hit a patient. The doctor will treat acute appendicitis with surgery, not spinal adjustment.
Regulators should censure any doctor whose treatment is unprofessional, that is what professional regulation is by definition. But a doctor posting bullshit on social media, in their own time, is not acting in a professional capacity. A Facebook post is not professional publication, unlike Andrew Wakefield’s Lancet paper. Although the regulator asserts: “It is not acceptable to dress up bad behaviour as freedom of speech”, there is no reason why a doctor should be held to a higher standard of off-duty behaviour than any other Australian citizen. Freedom of political discourse is an implicit Constitutional right, and as governments at all levels have implemented Covid management measures, they are fair game for as much abuse as is generated at a CFMEU or BLM rally. I would personally agree with the Taliban, that intemperate invective against government is every bit as bad as educating women.[insert wry yet pondering emoji here]
AHPRA Good Medical Practice Code of Conduct Oct 2020 was varied to allow for AHPRA to take action against frivolous and vexatious complaints. There are often complaint/notification by one medical practitioner against another, done with ulterior motive such as business damage, reputational damage, territorial (example palliative care specialist and GP). It has nothing to do with consumer complaint or protection of public interest. In disputes against public hospitals doctors vs private practitioners, state organizations such as NSW HCCC almost always side with NSW Health/public hospital-this is then escalated to AHPRA who once again protect the well funded public system that talks much and delivers little. Even if a complaint from a hospital specialist against a private practitioner is dismissed, AHPRA never takes action against the hospital specialist for bringing a frivolous and vexatious complaint. The medical specialist is on hospital payroll and spend waged time to generate complaints, patient care is not a priority in the public system-focus is survival and elimination of anyone who dares raise an issue. Freedom of speech is barred. The private practitioner can’t pay business expense if they do not consult. I believe about 30% of AHPRA complaint is one clinician against another. If Doctors need to fight it out, they can utilize private legal services, not misuse regulatory resource. AHPRA selectively elect to utilize its resources, destroying some practitioners/system & protecting others. Royal Commission into AHPRA is absolutely necessary to investigate regulator abuse of process, misuse of resource, lack of transparency, integrity, bias. Thank you.
I voted neutrally as Royal Commissions are expensive and often not acted on. I cannot see a Gov’t finding election swinging popularity in making major changes, but if we were to agree on some changes, maybe improving our chance of redress, and campaigning for that, maybe some good could be tweaked. (or is “tweaking” unprofessional?)
I support an investigation into AHPRA. This organisation is totally out of touch with doctors working on the frontline. The every increasing burden of CPD activities such as the requirement for a personal development plan is yet another example of how out of touch is the organisation. For too long the focus has been on over scrutinising the compliant while there has been no attempt to reign in the cowboys. Where are our annual fees going? I am sure by posting my name I will now be audited
Dr Miller’s comments in the report and Dr Ieraci’s comments in the responses are both very much valid, but it’s difficult for any thoughtful, respectful clinician to make pub-test judgements on the case of Dr Berger because of the veil of secrecy under which the Board and other AHPRA boards operate. At its best, this can limit the damage to an accused person, since reputational damage can occur even if an accused person is cleared. At worst, that opacity means that the motives can be mistrusted in a case such as this where public interest is high. If both the respondent and the Board were to agree to publish the transcripts including the allegedly offending material, the air could be cleared, much better than AHPRA and the Board simply putting out a excusing statement reiterating broad principle. If such transparency were to prove that this is nothing more than, as Ella Fitzgerald said, “it ain’t what you do, it’s the way that you do it” then the clinicians would be far more reassured.
However, I echo others’ concerns regarding how anonymity is used, and potentially misused, in Board complaints. There should be no guarantee of anonymity for people with no skin in the game in question. This appears to have happened in the Berger case, giving the online trolls a convenient silencer to fit to their sniper rifle. This policy should be looked at seriously.
AHPRA takes its place with so many ‘expert’, academic, Big Tech and governmental entities these days that see it as their role to weed out WrongThink.
The minds of the lumpen proletariat are regarded as too feeble to be discerning, and content needs to be curated to be deemed suitable for their limited capabilities.
In fact free speech and the robust exchange of ideas – where silly notions are rightly lampooned – need not be respectful at all if a nostrum deserves ridicule.
It may be entirely within the bounds of professional behaviour to be vociferous in rejecting foolishness (which may originate, yes, even from government), but the AHPRA guidelines are of a piece now with the enfeebled resilience of large swathes of the population who regard words themselves as violence, and who are coddled by legislation which makes it illegal even to insult.
Having been sexually bullied by someone on my state APHRA, it is hard to take anything they say on this issue seriously.
At the same time, respectful Scientific/clinical debate doesn’t need people accusing you of “Nazism” or “eugenics”.
“There is no crueler tyranny than that which is perpetuated under the shield of law and in the name of justice” Charles de Montesquieu
Aphra ,using it’s powers, behaves tyrannically by trying to stifle debate re the ever changing “science” of the pandemic in an attempt to protect people’s feelings and the government line. The effect has been,
I believe ,the profession has been damaged in the eyes of many doctors and members of the public by the public perception that all doctors were in lockstep with every rule and mandate of governments and their representative organisations like Aphra.
As physicist Richard Feymann once said,”Science is the belief in the ignorance of experts”.
Aphra is not one of those experts and must allow robust debate by the experts when those experts have that opportunity.
I fully endorse an inquiry in to the powers and responsibilities of Aphra.
Let’s not forget, an organisation is the sum of its parts and in the case of AHPRA that is people. It is these people who dictate the direction of an organisation and these people who can steer that organisation to calmer waters and make good. Are any of these people actually listening or are they just hell-bent on creating general chaos? increased stresses and all round bad vibes. That is not leadership at work. I consider that a dysfunctional culture, fed from the very top of it’s hierarchy. C’mon AHPRA, pull it together, we deserve better.
“Mr ‘X’ … is entitled to be an agitator” — Mr Justice Murphy.
Control passes to the angriest or most outraged person in the group.
It is not a crime to disagree with someone.
Rational or irrational people are free to make their own decisions and live or die from the consequences.
Freedom to insult someone is a basic human right.
This new generation is the most mentally fragile in history.
Thanks for reading.
Call me a pedant but the John Snow pump was (the replica still is) in Broadwick Street
I did vote for a commission but as someone else said – is that the only available method for achieving change? They always seem to cost a lot of money and produce recommendations that are then not acted upon anyway.
Indeed bullying junior doctors in hospitals is one thing. Harassing doctors for speaking out is another – as long as it in a factual scientific based way. I’ve been amazed at people in the medical field posting mud information during this pandemic.
The responses of some of the people quoted in this article appear to be a little disingenuous.
For example, both Andrew Miller and Kerryn Phelps are members of the group “OzSage” – whose purpose appears to be to present alternative or diverse views on pandemic management (presumably, as alternative to the advice given by those apppoitment to positions with respondiblity for advising on public policy). This group, despite sometimies presenting different views to the organised public health response, have not been “silenced” or even cautioned.
Could this be because they post in a professional and rational style, rather than personally criticising or questioning the motivation of their public health colleagues? It seems that it is.
As AHPRA has explained, the AHPRA action being complained about is not about freedom to disagree – it is about exercising discipline and professional behaviour in our public communications.
If Andrew Miller says that AHPRA “conflates ‘freedom of speech’ with ‘bullying and harassment’ . perhaps he has not understood the details of the case he is commenting about. AHPRA puts it simply: “It is not acceptable to dress up bad behaviour as freedom of speech.”
As a frequent user of social media, particularly to counter anti-vaxx and other misinformation posted on-line, I am aware that my style of communication is on public view. It’s not difficult to exercise good judgement in how views are expressed. This isn’t self-censorship – it reflects maturity and common-sense.
I won’t imply that there is any organisation whose processes can’t be improved, but to stir up a storm because someone exercised poor jugement in his public communication and was cautioned and asked to learn about proessional behaviour is out of proportion to the event. He has not been “silenced” at all but continues to post publicly – hopefully exercising better judgement.
I agree with all of AHPRA’s good thoughts about bullying, gender etc..
But these are my personal opinions. Like so many of our public institutions (AFL, ABC, Qantas, Shrine of Remembrance, NRL, etc), they are using their institutions to promote personal beliefs.
The Kok case is a disgrace – basically it is a $4 million dollar fine for being rude. If that standard is applied, woe betide any one of us whose personal conversations might be overheard.
AHPRA, Medical Board, Medical Councils have had an unparalleled power for too long. They are not subject to any regulation or check and balance. It is only natural that they become tyrants, abusing their power. Royal Commission into these organisations and the some measures to ensure check and balance are necessary, just like any other profession/ organisations in our democratic society. I would be very willing to contribute to the funding of the Royal Commission. This is not only important for current practicing medical professionals but also for future health providers.
I support and happy to be part of any petition etc to help this go forward
I will definitely donate and contribute money and time to ensure ROYAL COMISSION INTO AHPRA.
Please make this happen and send me the links for donations/contributions.
Also please make it tax deductible.
AHPRA is the most despised government agency I am aware of. It is dysfunctional and not doing its job which is to register properly qualified practitioners and deal with genuine complaints regarding professional practice.
As a working senior doctor I was aware of numerous completely frivolous issues investigated by AHPRA with no clinical insight. On the other hand three serious professional misconduct cases, impaired doctors I reported, were dealt with sloppily, took over a year to manage and failed to uphold the opinions of a number of medical experts.
The whole bureaucracy is dysfunctional and does not contribute to high standards of medical care which should be its goal. Overly politiciized, woke and without sufficient clinical insight or internal performance review processes. It is the lack of respect in dealing with for health professionals which contributes to the complete lack of respect shown for the agency itself by working clinicians.
Ahpra should never have been established in the first place. The state and territor registration boards were and still are quite capable of effectively administrating the various legal and ethical requirements for health professionals across Australia.
50% of the comments published above are anonymous. Says it all.
I have done an audit of my own clinical practice outcomes post vaccination. A social media leak (not of my own doing) prior to formal publication has seen me professionally ostracised and now without work. AHPRA started the fear campaign, now our fear-filled peers are cultivating it. The culture needs to change. Please God, a well appointed Commission may achieve something for those many who are contemplating or surviving early retirement.
A cost benefit assessment* for AHPRA is well overdue. So much money spent with so little community benefit coupled with the ‘fear and loathing” of AHPRA leading to the medical profession being an unhappy workplace leading to burnout and early retirement.
* Have a look at the numbers of investigations and the resulting outcomes. I have and it is appalling.
On Monday 25 July, the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia (MBA) issued a joint statement saying there was “no place for bullying and harassment in healthcare because it harms the lives and careers of doctors and it harms patients”.
The hypocrisy of two of the major bullies in the health care field is breathtaking.
AHPRA regularly responds to anonymous complaints but when the Medical Board finds not action to be taken the delay and long process is amazingly wearing and time consuming on the person complained about .
Is the complainer notified ???
Is there natural justice when the person complained about is not able to face the person who complains?
Is action taken when the complaint is found to be mischievous??
I think it may be time for me to retire. I originally planned to work in the public system when I graduated, but bureaucrat interference – trying to tell me what medications to prescribe based only on cast – led to my leaving for private practice. In recent years, having inherited substantial money, I have been doing only occasional public system locum work in areas of need. But that is becoming futile too due to bureaucracy growth in every state. Now AHPRA is becoming a pain…
In my retirement I think I’ll pester the politicians.
Science is generally transparent about the known facts and also the benefits vs risks of any therapy whereas the pseudo-science put forward by many people needs to be called out. Respectful criticism is valid only if backed up by available factual or strongly supported evidence. Otherwise criticism should not be published as the gullible out there will potentially suffer as a result.
I am deeply concerned that doctors who express any concern or point of view that is judged to be contrary to “the public good” or “not respectful” is threatened with suspension, legal proceedings, or are placed under enormous stress by threats to their registration and ability to practice.
How can any meaningful robust discussion occur on any matter if contrary points of views are publicly silenced? How can we be advocates for our patients if we cannot even raise concerns or questions freely, without fear of censure or suspension?
Intimidation? Harassment? Bullying?
“Quis custodiet ipsos custodes?” (Who watches the watchers?)
I have been a personal witness to a another medical regulator not acting when complaints where made about 2 practitioners that carried out actions that they had been asked to do by a Commonwealth Entity in regards a patient. This entity, was carrying out a campaign of bullying and harassment to the individual, in order to extricate them from the organisation. The 2 doctors actions were found to be wrong by the regulator, but no action was taken.
Selective regulation is No Regulation.
AHPRA is part of a broader strategy, together with corporate ownership, to disempower and control the medical profession. Which means AHPRA has to be feared, as is the case, consistent with other forms of arbitrary authoritarianism. Medical practise must revert to being owned and regulated by the medical profession, for the good of patients and practitioners.
Berger’s posts are abusive, inflammatory and unhelpful to the general public. I agree with AHPRA.
The former medical board of Victoria used to consist largely of doctors appropriately investigate non-frivolous complaints of possible serious medical malpractice. AHPRA – and it’s clueless bureaucrats – seems to think that it should act like the thought police for any public statement a doctor makes. Royal Commission needed ASAP.
Quote
But Ahpra also says any criticism ‘must be respectful’.
“Nobody should be forced to express respect for a policy they do not respect.
This nails the problem. Eg Doctors believe they have been gagged by AHPRA in giving patients adequate advice as to the risks of covid vaccinations.
I have voted ‘Strongly agree’. However I also think a Royal Commission is overreach. There are simpler forms of inquiry.
I have read some of Dr Berger’s stuff and sometimes we need to be careful about what we say. Social media is not a free pass to say whatever we like.
The only bullying I can see is AHPRA bullying doctors. It seems more and more as a toxic anti doctor organisation with a political agenda. It should be dismantled and rebuilt from scratch.