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    Issue 16

  • Small but significant

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    Reflection needed for a positive outcome

     
    Peter Walker

    Dr Peter Walker

    MBBS (Hons), BSc

    Risk Adviser, Member Advisory Services

    Avant
     
    Reflection needed main image

    A complaint made to a health regulator against you can be confronting and overwhelming. However, if dealt with appropriately the best outcome can be achieved, as one member experienced.

    A GP was working in a busy practice and saw a patient they had previously treated a year earlier for wound management after they were involved in a car accident. The patient presented with a painful ankle. No fever, headache or any other symptoms were present, and the doctor made a diagnosis of gout.*

    A few days later, the doctor received a copy of a discharge summary. Shortly after that visit, the patient had been hospitalised for meningitis. The summary mentioned the patient had previously had a splenectomy, which the doctor was not aware of at the time of the consultation.

    A complaint was made to the regulator by the patient citing adverse consequences of the doctor’s missed diagnosis.

    Performance scrutinised

    The Medical Council reviewed the complaint and decided to pursue it. They expressed concern the doctor had not undertaken an adequate examination or further investigations in a patient with a presumed first episode of gout, which would have likely revealed signs of sepsis. The doctor was invited to a performance interview to discuss their management of the case, as well as copies of the patient’s records.

    Understandably, the doctor became very stressed, both leading up to and during the interview. Following the performance interview, the Medical Council identified further concerns about the treatment provided, patient management, communication and medical record-keeping, and decided the doctor should undergo a performance assessment.

    A performance assessment is a day-long process in which a doctor’s performance is observed and assessed in person by a number of professional peers. The process is intended to be educative rather than punitive, with the stated goal primarily of protecting the public, and to assist doctors to practise at a satisfactory standard.

    However, it is not something that should be approached lightly. Doctors being investigated by the regulators need to work collaboratively with their lawyers and especially with the risk management team, to thoroughly prepare and be able to demonstrate to the assessors how they have made any necessary changes.

    Support throughout process

    In the lead up to the assessment, the Avant team worked closely with the doctor to prepare for the assessment. The legal and risk advisers provided individualised educational material to address the areas of practice that required improvement and provided emotional support.

    Despite being confronted by the criticism of the patient’s management, the doctor was an exemplary participant in the assessment. Through serious reflection and hard work, the doctor was able to remedy the identified areas of weakness, and demonstrate insight and improvement in their practice. The peer assessors praised the doctor after the performance assessment, and no further action was taken.

    Don’t take performance assessments lightly

    It’s important for doctors to take any correspondence received from a regulatory body such as Ahpra or the Medical Board, seriously, and to always seek assistance from Avant promptly, before responding.

    The possible outcomes of a performance assessment pathway are serious. They can include conditions imposed on a doctor’s registration, and even referral for immediate action which can result in suspension. The assessment process can last several years and include multiple interactions with the Medical Council. The impact this can have on a doctor’s sense of professional and personal integrity, and their reputation and ongoing financial security, can lead to serious psychological distress.

    Key lessons

    • This case highlights that the performance assessment process is fair but rigorous. It requires doctors being reviewed to commit to a significant and serious change in the way they practise. This includes completing education and upskilling in areas of concern to the regulator and improving their clinical records.
    • The best outcome is often achieved when everyone works together, helping the doctor to demonstrate insight and systems-based improvement.
     

    Useful resources

    Disciplinary stance on professional shortcomings and medical records
    Reflective practice explained
    What happens when you need our support
    Dealing with professional conduct complaints
    Visit the Avant Learning Centre

    *Some details in the case study have been changed.

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