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Preference: General Medicine

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Five keys to taking charge of your medical career

 

You’ve done your internship, you’re nearing the end of your PGY2 year, and you’re thinking seriously about where you want to go next. It can be a daunting stage of your medical career, particularly as competition for training positions can be ferocious. What can you do to take charge and give yourself an edge when applying for positions?

Christine Brill, Career Adviser at the Australian Medical Association, says this stage of a doctor’s career is a complex crossroads but the key to navigating it is to know yourself first.

“You have to know what intrinsically motivates you,” she says.  “You’ll know what you like and dislike about medicine to this point, so it is more likely than not that you’ll have a number of specialty options in consideration. Our Career Service website’s Specialty Training Pathway Guide will help you narrow down your choices by allowing you to view up to five specialties on your screen.  This is one of our most popular web resources.”

Another critical factor, Christine says, is what kind of lifestyle you want as you move further into your medical career. Orthopaedic surgeons, for example, work very long hours and are often on call with a high level of unpredictability, so if this doesn’t sound like your preferred lifestyle, it may not be the right career path for you.

Location is also key aspect: in choosing a medical specialty, you should think about whether you’re ready to move to pursue your career, and whether your chosen specialty can be done in one location.

Other issues to think about are whether you want to work in the public or private sector, or a blend of both; how much it’s going to cost you to achieve your objectives; how long the training will take you; and how competitive you’ll need to be with your peers to get a place in your chosen program.

“You’re going to be competing, so what you’ll need above all else is a really good CV,” says Christine.

“Every CV that crosses my desk needs to be tweaked. People don’t always understand what needs highlighting. You need to present information so that it excites interest and offers a solid snapshot of the candidate in the shortest possible time. Because your CV will not be the only one looked at on any given day.”

Christine adds that the cover letter and any statement addressing selection criteria are equally important.

“These documents will determine whether you get an interview – or not.  So it’s worth investing time in them.”

Another question that junior doctors ask themselves is what other things they should be doing in their early years to help them achieve their objectives. Should they be going off to do a PhD, a Masters, or getting into research?

“Generally, good advice is just to get lots of experience,” Christine says. “Narrowing your focus may not serve you as well as getting lots of experience.  Look at what the Colleges are looking for in their candidates, and focus on those as your prerequisites.”

Here are some keys to making the right decisions as you move forward in your medical career:

  • Know yourself and understand what motivates you;
  • Make sure you get as much experience as possible. Find out what your preferred training College is looking for and focus on that. Time off for a PhD or Masters at this stage may not be the best idea;
  • Think about where you want work, how hard you want to work and how much you’re prepared to sacrifice;
  • If you’re leaning towards one specialty, talk to a senior colleague and ask if you can tag along to get a feel for the discipline;
  • Your CV and cover letter are critically important: get professional advice to make sure they’re as sharp as they can be.

Visit the AMA Career Advice Hub for useful information across the whole medical-life journey as well as Career Counselling Service resources. For one-on-one assistance, contact Christine at careers@ama.com.au .

Click here to sign up to the doctorportal jobs board.

CPD audits: what you need to know

 

Although it’s been three years since AHPRA started randomly checking medical professionals’ declarations about their CPD activities, many doctors are still unaware that they can be audited.

Particularly vulnerable to being caught out are IMGs, doctors in training and non-vocationally registered doctors, who are not affiliated with a college and so don’t get the same prompts that other doctors get from their college to do their required CPD.

Here’s some key information about the auditing process:

  • Doctors under audit are sent an audit notice, and have 28 days to demonstrate that they’ve met the Medical Board of Australia’s registration requirements.
  • This includes not only CPD requirements, but also declarations about indemnity insurance, recency of practice and criminal history. If found to be in breach in any of these areas, doctors can be reported to the Board.
  • Doctors who belong to a college need to meet the CPD standards set by their college. But those who are not on the specialist register – whether they are in training or are simply non-VR doctors – must also demonstrate that they have fulfilled CPD requirements.
  • For non-VR doctors, this involves a minimum of 50 hours of CPD per year, which can be self-directed. Any self-directed program must include one mandatory self-assessment reflection activity or peer review, clinical audit or performance appraisal. Activities to enhance medical knowledge, such as participation in courses, conferences or online learning, are also required.
  • Trainees will need a signed letter or report from their supervising hospital to confirm your participation in training and education programs in the year being audited.

See here for more information on CPD requirements for junior medical officers, IMGs and non-VR doctors.

Sign up to Doctorportal Learning to access mobile-friendly medical education, track all your CPD points and activities in one place, and get assistance in meeting your MBA CPD reporting obligations.

Who’s paying for lunch? How drug companies wine and dine doctors

 

In June 2015, 24 Australian cancer specialists flew to Chicago to attend a five-day conference. Drug giant Amgen funded the trip, including registration, transfers and wining and dining. It cost almost A$270,000.

In December 2013, in a teaching hospital in New South Wales, 11 pharmacists and pharmacy technicians attended a 45-minute presentation by a pharmaceutical representative from a company called Menarini. The presentation was accompanied by a lunch that included sandwiches, wraps, sushi and fruit juice. Lunch cost A$200.

These are just two very different examples of the more than 116,000 events for Australian health professionals that drug companies funded in a recent four-year period, which we analysed in a study just published in BMJ Open.

You can examine the data yourself.

Since 2007, drug companies have been required to publish detailed reports of how they sponsor educational events for health professionals.

They have had to list the number of attendees, the name of the restaurant, resort or clinic, and the costs of food and drink. But so far, they have not had to list the names of the doctors enjoying it.

Until today there has been little analysis of these reports. This is because despite being publicly available, the millions of bits of data were “trapped” in PDF files. Now the information is available for anyone to analyse.

What did we find?

The data shows the routine, yet influential, ways health professionals interact with pharmaceutical companies when it comes to professional education.

Between 2011 and 2015, pharmaceutical companies sponsored more than 116,000 events – on average more than 600 a week. While many of the breakfasts, lunches and dinners were held in hotels and fancy restaurants across the country, most took place inside hospitals or doctors’ offices, suggesting drug companies have a pervasive presence in everyday clinical practice.

Most of the events (82%) included medical doctors, but many included different types of health professionals. For example, 39.6% included nurses, 38.3% trainees and 8.4% pharmacists.

Oncology or cancer – a field where there is increasing concern about the use of high-cost medicines – was the most frequent area of focus of the events, accounting for 19.7% of the functions.

Why does this matter?

Industry sponsored events for health professionals are commonly termed “educational” events. However, they are a key pillar of the pharmaceutical industry’s marketing strategy.

Although health professionals often fail to perceive commercial biases in such events, their educational content can be biased in favour of the sponsor. The prescription rate of the sponsor’s drug has also been shown to increase afterwards.

Even the provision of free meals, which are commonly provided at sponsored events, can influence clinical practice. Evidence of this comes from the United States, where thanks to the Sunshine Act, pharmaceutical companies have to report all payments to individual doctors.

Prescribing drugs based on exposure to industry-sponsored events raises concerns about the unhealthy effects on patient care and increasing health care costs when newer, expensive and aggressively promoted drugs are prescribed.

A recent study conducted in the US found the receipt of even a single sponsored meal worth as little as US$16 was associated with an increase in prescribing of promoted drugs.

Disappearing data

The analysis published today is timely considering two major changes to drug company reporting that have recently been implemented in Australia.

From October 2015, drug companies have no longer had to report on these influential “educational” events. Instead, they are now required to report on payments they make to individual health professionals, and to name those individuals.

This could improve transparency in some ways. For instance, people could check if their own doctor has attended an educational event sponsored by a drug company. But the new rules contain loopholes.

For example, they explicitly exclude the need for drug companies to report how much they spend on food and beverages. As 90% of the events analysed included the provision of food and beverage, a large proportion of potentially influential payments from drug companies to health professionals are now invisible.

The value of transparency and independence

As some authors have pointed out, transparency is not going to solve the problem of unhealthy industry influence as it does not eliminate the conflicts of interest that arise when health professionals interact with pharmaceutical companies.

The most important issue is not just transparency, but if it is appropriate for health professionals to receive meals from and rely on information provided by drug companies in the first place.

Evidence suggests that it is time to forge much greater independence between the companies marketing the drugs, and the doctors prescribing them.

Policies to limit health professionals’ interactions with pharmaceutical companies can be a more effective measure than disclosure to reduce and eliminate unhealthy commercial influence on clinical practice and professional education.

For example, some medical institutions in the US have limited interactions between their students and doctors and the pharmaceutical industry, banning gifts and free food by manufacturers and regulating pharmaceutical representatives visits to physicians. These policies have been associated with changes in prescribing behaviours.

Another example of a policy to provide greater independence comes from the Australian Medical Students Association, which has a strict ban on accepting drug company funding for its conferences – unlike most doctors groups which accept it.

However, notwithstanding the limits of disclosure, there are still enormous opportunities for designing effective and inclusive transparency policies.

Ten years ago, Australia introduced a world-first scheme to disclose every single drug company-funded event for doctors. Since then the US Sunshine Act created a new international benchmark, revealing all payments and naming the doctors who receive them.

The ConversationToday it seems that Australia has dropped the ball, with moves towards individual disclosure overshadowed by abandoning transparency around routine wining and dining, and is slipping backwards into the darkness of secrecy.

Alice Fabbri, PhD student, University of Sydney; Lisa Bero, Chair professor, University of Sydney, and Ray Moynihan, Senior Research Fellow

This article was originally published on The Conversation. Read the original article.

Seven survival tips for doctors in training

 

You’ve completed your studies, done your internship and are finally qualified to practise. You might think the worst is behind you, but research is increasingly showing that junior doctors in training are one of the most vulnerable groups in medicine.

According to a 2008 AMA survey, junior doctors routinely work up to 60 hours a week, with most sleeping less than seven hours and only a quarter finding the time to exercise regularly.

But it’s not just the long hours that can be deleterious, it’s also the lack of autonomy that goes with the job, with junior doctors having little say over how and where they spend those long hours.

The hours, coupled with uncertainty over placements, can take a heavy toll on personal relationships and family life. Days off are few and far between, and the temptation can be to use any spare time to do work-related activities rather than enjoy proper down time.

The workplace itself can add to a junior doctor’s stress. Doctors may be uncertain about their future, suffer inflexible work conditions and may be exposed to abuse from patients as well as bullying from senior colleagues. It can be a bewildering minefield for a doctor fresh out of internship to navigate.

Here are some tips for staying healthy and keeping your sanity during the training years:

  • Research as much as possible the demands of each specialty, including hours and placements. That way you’ll have a clearer idea of whether it fits in with your idea of an appropriate and healthy lifestyle.
  • Adopt a mentor: many hospitals have mentorship programs, and having a senior consultant with whom you can discuss clinical, professional and career-related issues on a one-on-one basis can be an enormous help.
  • Keep close relations with your peers. It’s good to find colleagues with whom you can socialise outside shift hours: that way, you’ll be able to debrief each other and also lean on each other through the tough times.
  • Make your own health your priority: you can’t manage other people’s health if you can’t manage your own. Find a GP before you need one, particularly if you’re moving to a new area. And resist the pressure to turn up for work when you’re sick: it’s not good for you, your patients or your colleagues.
  • Find time for physical exercise: it’s not only good for your health, it’s essential for combating inevitable work fatigue and potential burnout.
  • Work at maintaining family relationships and friendships: they are your outside support network, giving you perspective and helping you manage day-to-day stress.
  • Maintain or develop outside interests. Whether it’s sport, playing music or going to the movies, non-medical interests will help you find some work-life balance and can be an important de-stressor.

Source: Avant

The Australian Medical Association has a wide range of online resources for doctors in training on their website.

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.

Study quantifies junior doctor distress

 

Australian junior medical officers (JMOs) suffer from dangerously high levels of psychological stress that are considerably greater than in the general population, according to new research published in the Internal Medicine Journal.

The study of over 1,000 JMOs surveyed between 2014 and 2016 assessed distress according to the commonly used Kessler Psychological Distress Scale (K10). The average score was 18.1, compared with 13 in the general Australian population shown in previous studies.

Unsurprisingly, increasing hours of work correlated with higher distress, with every extra hour worked per week increasing the odds of a high K10 score by 3%.

Smoking and drinking alcohol as ways of relieving stress were correlated with higher levels of distress, as was taking illicit drugs, which 7.7% of those surveyed admitted to doing.

Feeling ill-equipped during internship and workplace bullying were also associated with higher distress levels.

On the other hand, spending time with friends or family correlated to lower levels of distress.

Only 17% of those surveyed had resorted to professional help for their psychological distress. GPs were most commonly the first port of call, followed by private psychologists or psychiatrists.

Worryingly, nearly 20% of JMOs said that if they had their time over again, they wouldn’t choose to do medicine.

The researchers from Sydney’s Nepean Hospital said that theirs was the first study to measure psychological distress in Australian JMOs over a three-year period. The bulk of existing literature relies on data from overseas, they noted, and even that literature was skewed towards senior clinicians rather than junior doctors.

They wrote that although long hours correlated with increased distress, one of the issues was the difficulty of accurately monitoring how many hours JMOs worked, due to a culture of unpaid overtime.

They said their work demonstrated the need for a more focused approach to JMO support and education, encompassing increased administrative support, education on coping strategies and action around bullying behaviour.

You can read the study here.

The Australian Medical Association has a wide range of online resources for junior medical officers on its website.

For more information about health issues for doctors, access online resources from Doctors’ Health Services Pty Ltd.

Doctors’ health: the wrap

 

All this month at doctorportal we’ve been highlighting the critical issue of doctors’ health and wellbeing.

The doctorportal website hosts the online resources of Doctors’ Health Services Pty Ltd, an organisation funded by the Medical Board of Australia and coordinated by the Australian Medical Association. Its aim is to ensure doctors and medical students, no matter where they live in Australia, have access to consistent and readily available services, including advice, referral and health-related triage.

Here’s a roundup of doctors’ health stories we’ve covered at doctorportal this June:

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.

Or phone:

NSW and ACT … 02 9437 6552

NT and SA … 08 8366 0250

Queensland … 07 3833 4352

Tasmania and Victoria … 03 9495 6011

WA … 08 9321 3098

New Zealand … 0800 471 2654

Lifeline on 13 11 14

beyondblue on 1300 224 636

How a stroke made me face up to my depression

It took a minor stroke before I was able to take much-needed leave from work. But it wasn’t the stroke I needed to most recover from – it was the severe depression I had that was many times worse. The stroke afforded me the time and space I had wanted, and needed, in order to recover.

– Geoff Toogood

 

In 2013, I faced major stresses at work and my marriage was ending. It got the best of me. I had experienced moderate depression a few years prior – moderate enough that I could work through it – but this time it was a lot more severe. I was so depressed and stressed that I had suicidal thoughts. I confided in some people at work; I told them I was suicidal. I told them I wanted to take leave. But it was the stroke symptoms that allowed me to get the leave more easily approved. I took about a month off. As a result, I had to make the decision to step down as head of my department for a while.

The culture of the health industry doesn’t offer the best support for health professionals experiencing mental health issues. That was certainly my experience anyway. Some health professionals frown upon taking sick leave. There’s a perception of weakness. beyondblue research actually confirms that perception from people in our industry.

According to a beyondblue survey of Australian doctors, approximately 40 per cent of doctors felt that medical professionals with a history of mental health disorders were perceived as less competent than their peers. Almost 59 per cent of doctors experiencing depression find it is embarrassing for them. Even more worryingly, almost 50 per cent of doctors feel those with mental health disorders could face setbacks in their career progression.

Additionally, beyondblue’s research showed that one in five medical students and one in 10 doctors had suicidal thoughts in the past year. It’s not difficult to see the significant issue of the health industry dealing with, or in some ways failing to deal with, mental health issues. Though it’s positive to learn from the research that doctors show great resilience, personally and professionally, to the negative impacts of mental health.

My road to recovery was gradual. It took me a while to summon up the courage to see my GP. Instead of booking an appointment I used natural remedies, such as taking B vitamins, as a way of self-medicating. It made little difference. What I needed was counselling and medication: professional help.

Admitting to myself that I had a serious illness and seeking help was a major turning point. Part of my self-admission came after a long-time friend texted me saying ‘I’m concerned about you’, and provided me with the beyondblue Support Service number. Having a friend recognise and voice the seriousness of my situation also reinforced my need to seek help.

I finally called my GP. She took control and told me what we needed to do so I could start to recover. Following her advice and treatment plan was pivotal. A compassionate doctor will understand exactly what you’re experiencing, as an individual and as an industry peer. Now I’m well and back working as a senior cardiologist at The Alfred and Peninsula Health.

I really feel for today’s junior doctors. I think pressures on them have increased since I was in their position. The health system has changed, which has increased pressure to get more things done in less time.

There are also so many challenges that haven’t changed: the pressure high achievers put on themselves to perform continuously at a high level; and the pressure to keep up with peers, whether it’s managing high workloads or giving accurate diagnoses the first time, every time.

The stress of the high workload for junior doctors can’t be ignored. You’re working 50- to 60-hour weeks and then studying for 20 or more hours. Exam study adds to the intensity. You always have that uncertainty of passing, which everyone goes through.

Throw in the unsociable working hours, as well as job instability due to short contracts and frequent rotations, and it’s easy to see the impact on young doctor’s mental health.

Still, even when doctors aren’t well, we often put our own health second.  You tell yourself to always put patients first. But we need to fit our own oxygen mask first. If we don’t look after ourselves, our patients won’t have a doctor to look after them. A doctor needs to be well to provide high-class care to their patients.

Here is what I’d advise young doctors do to stay well:

  • Look after yourself by doing what you can to develop work-life balance. This could mean making extra effort to catch up with family and friends, establishing an end-of-day routine to unwind, or planning a holiday;
  • Develop interests and passions outside work. I’ve taken up ocean swimming. What I love about swimming is the need for minimal equipment, getting time to myself so I can practice mindfulness, and I always feel great afterwards;
  • Realise that you’re more than a doctor, you’re human. Yes, we too can be ill, and we need to follow the advice we give our patients about self-care;
  • If you’re struggling, seek help early;
  • Make sure you have your own health professionals, especially a GP, that you trust and can be open with;
  • If you see a colleague struggling, reach out to them. Offer to catch up over coffee or just offer support. When hospital culture is positive, it can feel like you’re working in a small town or community so you notice and react if someone isn’t well. beyondblue has a range of resources to help you have these conversations;
  • Show leadership at work by not tolerating poor behaviour towards mental health issues;

As a beyondblue speaker, I’m proud that our education and research tools have helped break down stigma surrounding mental health conditions. There are also other great resources such as ‘Keeping Your Grass Greener: A wellbeing guide for medical students’.

I definitely encourage doctors who might be experiencing mental health issues to talk to someone. It might even be best to speak to a trustworthy friend outside of the workplace to ensure confidentiality. If you need to speak confidentially to a professional, your state Doctors Health Service and employee assistance programs can provide support. beyondblue has several confidential support options for doctors. The Support Service provides free impartial, solutions-focused counselling from mental health professionals by phone 24/7 on 1300 22 4636, online at www.beyondblue.org.au/get-support or via webchat from 3pm to midnight AEDT.

Sharing my experience of depression with other medical professionals has shown two sides of the industry. I have doctors approach me at conferences to thank me, and to share their own mental health issues. Unsurprisingly, they often tell me they haven’t spoken to anyone else about their struggles. That in itself speaks volumes about the relationship between mental illness and our profession.

When senior executives from our industry attend and engage with my beyondblue advocacy talks – including Grand Rounds – that’s when change and improvements most often happen. Support from the top is imperative. Leaders must walk the positive talk.

beyondblue provides organisations free practical information and resources about how to create mentally healthy workplaces. The Heads Up website is developed by beyondblue in collaboration with the Mentally Healthy Workplace Alliance. Heads Up has specific resources for doctors and medical students to support their mental health at work. To learn more, visit http://www.headsup.org.au/doctors.

Dr Geoff Toogood has been working in medicine for 30 years, specialising as a cardiologist for the past 20 years. He works at The Alfred Hospital and Peninsula Health, at which he has held director roles.

This blog was originally published on www.onthwards.org.  Read the original article here.

onthewards is a website dedicated to delivering practical, high quality free open access education for medical students and junior doctors.

 

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Advisory Services Pty Ltd.

Or phone:

NSW and ACT … 02 9437 6552

NT and SA … 08 8366 0250

Queensland … 07 3833 4352

Tasmania and Victoria … 03 9495 6011

WA … 08 9321 3098

New Zealand … 0800 471 2654

Lifeline on 13 11 14

beyondblue on 1300 224 636

 

Six tips for coping with patient death

 

A couple of years ago, a photo of a doctor outside a hospital crying after losing his 19-year-old patient hit a nerve, and ended up being shared hundreds of thousands of times on social media. The photo captured one raw reality of working in medicine, which is that patients die, and it’s not always possible to respond with the stoicism that is expected of doctors.

Dealing with death is a fundamental part of being a doctor, and most doctors intuitively understand the need in professional life for a balance between compassion and maintaining a certain emotional distance.

But sometimes they will find themselves profoundly affected by a death, possibly of a patient they had known for a long time or with whom they had a special rapport. In these circumstances, the patient death can provoke feelings of helplessness, guilt or failure.

An added stress for doctors in some cases may be the worry of a complaint or even legal action from the family of the deceased.

Research seems to suggest that doctors are not especially good at coping with feelings of grief about patient death, nor do they receive adequate training for this. More worrying still, there is evidence that poor coping with patient death affects doctors’ ability to treat their other patients.

A recent study of 20 Canadian oncologists reported that more than half struggled with feelings of failure and self-doubt after a patient death, and felt their grief could affect their treatment decisions with subsequent patients.

Losing patients also affected their ability to talk about end-of-life issues with patients and families. Half of the participants reported distancing themselves from their patients as the patient got closer to dying.

The study suggested that grief in medicine is still considered shameful and unprofessional, and that even when doctors struggle with their feelings of grief, their instinct is to hide them from their colleagues.

Here are some tips to dealing with the death of a patient:

  • Be completely honest with the patient’s family, and with yourself, about what’s happened;
  • Convey empathy to the family and share their feelings of loss, if they are open to it;
  • Discuss the case with your colleagues;
  • See your GP if you feel a patient death is unduly affecting your professional or domestic life;
  • Accept that negative outcomes will happen in your professional life;
  • Accept that grieving is natural, even in the context of the doctor-patient relationship.

Source: BMJ

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.

Or phone:

NSW and ACT … 02 9437 6552

NT and SA … 08 8366 0250

Queensland … 07 3833 4352

Tasmania and Victoria … 03 9495 6011

WA … 08 9321 3098

New Zealand … 0800 471 2654

Lifeline on 13 11 14

beyondblue on 1300 224 636

Some private hospitals are safer than others – but we don’t know which

The recent jailing of British breast surgeon Ian Paterson after performing multiple unnecessary operations has highlighted the issue of hospital safety.

Paterson’s unnecessary surgeries included some performed in private hospitals, which prompted UK doctors to call for private hospitals to report similar patient safety data as public hospitals, including unexpected deaths and serious injuries.

This example shows how little we know about patient safety and quality in our private hospitals, not only in the UK, but also in Australia.

What do we know about hospital safety and quality?

In Australia, one of the best places to look for information on hospital safety and quality is the MyHospitals website, a commonwealth department site run by the Australian Institute of Health and Welfare.

The Australian Institute of Health and Welfare is provided with data about every patient treated in an Australian hospital, both public and private. Using that data, you can look up measures of safety and quality, as well as emergency department performances. You can compare public hospitals on all the performance measures, but private hospitals are excluded from the performance reports.

Further reading: Which are better, public or private hospitals?

Another good source is the New South Wales Bureau of Health Information, which allows you to compare information about the safety and quality of public hospitals in NSW. Private hospitals are not included.

Private hospitals are not all the same

Private health insurance allows you to choose your treating doctor and the hospital at which you’re treated. But how do you choose the right hospital, or the safest one? As our research shows, not all private hospitals in Australia are equal.

In 2009, the Australian Health Insurance Association (now called Private Healthcare Australia) asked me and my colleagues to look at the outcomes of care in private hospitals. We looked at death rates and the numbers of people who died during their stay in hospital, and a range of other safety and quality outcomes.

We were given access to three years of detailed data from a national sample of patients treated in 58 private hospitals. We did not know the names of the hospitals, nor patients’ names.

Our research showed some private hospitals were safer than others, but from the data we analysed we couldn’t tell which.
from www.shutterstock.com

Many kinds of hospital outcomes, such as the likelihood of dying in hospital, or contracting a serious infection, are influenced by factors such as a patient’s age, and the range of conditions that brought them to hospital. We tried to take those factors into account and published our findings on the Private Healthcare Australia website.

We found a group of hospitals that, each year, seemed to have much lower death rates than average for all the private hospitals. Those, or other hospitals, also had lower than average rates of a variety of non-fatal incidents. There was also a group of hospitals that each year had higher than average death and adverse event rates. The greater than average death rate group included hospitals where death rates were consistently up to 90% higher than average.

If you are choosing a hospital, you’d want to know which hospital was which. But that information is not publicly available. You’d also want to know if there were more recent statistics, but there is no reported follow-up study. Without better public access to such facts and figures, we’re still in the dark.

What do other countries do?

Other countries do things differently. In the US, several groups provide extensive and detailed information on a range of hospital safety and quality outcomes for almost all US hospitals, including private hospitals. The groups, which do not always agree, include commercial (Healthgrades) and not-for-profit organisations (The Leapfrog Group), and public and government bodies (such as Medicare Hospital Compare).

And in England, it is easy to look up the Care Quality Commission’s detailed reports about public and private hospitals. The reports provide an easy to read, “blow-by-blow” account of their inspections of all types of hospitals, and make a variety of judgements on what they find. They are backed up by detailed statistical reports, but only for public hospitals.

Why don’t we do this in Australia?

A representative from the Office of the Australian Information Commissioner tells me that, provided individuals are not identified, there would be no breach of privacy if private hospital safety and quality data was made public. And no-one from a state health department has yet been able to say whether such a publication would be against any law.

Private Healthcare Australia, the peak body for health insurers, says it represents:

over 12.9 million Australians who choose better quality health care services and to put their health care needs first.

Private hospitals and private health insurers are in competition with each other for the 12 million or more Australians covered by some form of health insurance. So, it is in their commercial interests to avoid bad publicity.

The ConversationSurely it is the role of both state and commonwealth governments to balance these commercial interests against the public’s right to know which hospital is providing safe, high-quality care.

David Ben-Tovim, Professor, Clinical Epidemiology & Process Redesign, Flinders University

This article was originally published on The Conversation. Read the original article.

Seven keys to dealing with adverse events

Someone dies unexpectedly on the ward; a baby is born with a severe abnormality; a surgical patient wakes up with paralysis – so many things can and do go wrong in the daily life of a hospital. Nearly half a million adverse events occur every year in Australian healthcare, so it’s likely that you’ll one day find yourself dealing with a patient who has been harmed under your care.

Although clearly the first priority in such circumstances are the patients themselves, doctors too can find themselves traumatised when something goes badly wrong. Managing doctors’ mental health after serious adverse events is extremely important and often overlooked.

Common responses when things go wrong are shock, disbelief, guilt and shame, along with a loss of confidence in your abilities as a practitioner. Some doctors can even develop PTSD symptoms or suffer survivor guilt. Reactions can be more extreme with patients with whom we feel a closer connection, which is why establishing some separation is important to maintaining your ability to be effective.

The reactions to avoid are denial, obsessively going over the events in your mind, worrying about things you can’t control and isolating yourself from those who can help.

Open disclosure with the patient harmed or the patient’s family is a crucial process. This needs to be honest as well as consistent over time, with a primary point of contact. You need to have all the information at hand before starting this process, and be honest about what is not known. Avoid speculating or elaborating to try and comfort the patient or family, and let them know what more is being done and when.

Express sympathy, and offer to listen if they feel like talking. Ask how you can help in other ways. Saying nothing can be misconstrued as rejection, or reinforce the notion of a “code of silence” around the event.

Here are some keys for coping after an adverse event in your professional life:

  • Look after your physical health; make sure you’re getting enough sleep and exercise;
  • Don’t obsess about the adverse event, and make sure you debrief after the incident;
  • Try stress reduction techniques such as yoga or meditation;
  • Take an active role in the open disclosure process
  • Learn from the incident and consider what you can proactively do to prevent the same thing happening again;
  • Seek advice from your GP if you’re concerned about how the incident is affecting your health;
  • Contact a medico-legal advisory service about how to handle the event and notify your insurer.

Sources: Avant and Stanford Medicine

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.