‘You can’t what?’ - managing and avoiding pitfalls when engaging GPs

Sep 16, 2016

A new GP’s first day of work may bring with it a few ‘surprises’ when they drop the bombshell that they cannot perform specific duties due to personal, religious or health reasons. We outline your legal obligations and provide practical tips to help you successfully manage or avoid these surprises in your practice.

“I can’t prescribe the oral contraceptive pill for personal reasons”

On her first day, Dr Smith advises the practice manager that she cannot prescribe the oral contraceptive pill for “personal reasons.” The practice manager is shocked, particularly because it was made clear during the interview that she was expected to see mothers and children.
In this situation, the practice manager should ask Dr Smith about the nature of her personal reasons. If the reasons are due to her religious beliefs, the practice should act cautiously in making any demands on her to prescribe the oral contraceptive pill as this may be considered unlawful discrimination.

The practice should consider any practical adjustments that can be made to accommodate the situation. For example:

  • the practice could ask patients when they book whether the appointment is for family planning purposes (this may not be practicable in many practices);
  • another GP at the practice could see Dr Smith’s patients who have requested a prescription for the oral contraceptive pill (this may cause complaints from patients about the waiting time); or
  • the practice could have a discussion with Dr Smith about how it can best manage her refusal to prescribe the oral contraceptive pill (for example, Dr Smith may be agreeable to doing visits to retirement villages as the main part of her practice).

Limitations on a GP’s usual practice may also arise in the context of:

  • refusal to prescribe the morning after pill;
  • refusal to give a referral for a pregnancy termination;
  • refusal to prescribe S4 and S8 drugs; and
  • refusal to complete a conscientious objection to vaccination form.

Future tips:

Rather than having to manage the situation when it arises, it is best to avoid the situation in the first place.
A practice could:

  • Consider amending the GP position description to specify that prescribing the oral contraceptive pill is a requirement of the position.
  • Specify the position requirements (including, for example, the requirement to prescribe the oral contraceptive pill) at the interview and ask if “there are any issues with prescribing.”

“I’m pregnant and I can’t see kids”

A few months later, Dr Wang commences employment at the practice on a part-time basis – and has a surprise of her own in store.

When she first arrives, she advises the practice manager that she is 18 weeks pregnant and non-parvo virus B19 immune. Therefore, she is unable to see sick children who might be contagious for the next six weeks.

The practice manager takes the immediate step of making a note in the booking system to ensure children are not booked in to see Dr Wang. However, she cannot guarantee that other patients won’t bring their children with them.

The practice then needs to keep the following issues in mind:

Discrimination laws

It’s generally unlawful for an employer or a supervisor to discriminate against an employee on the grounds of pregnancy or disability. The practice cannot dismiss Dr Wang because she is pregnant or has not previously advised them of her pregnancy.

Workplace health and safety obligations

The practice has an obligation (under legislation, common law and the contract) to ensure Dr Wang’s health and safety at work. This obligation may extend to the safety of the foetus.

Transfer to a safe job

A pregnant employee has a right to transfer to a safe job in certain circumstances. If no safe job can be found, the employee is entitled to unpaid leave.

In this case, the practice offered Dr Wang the opportunity to be absent during the period of risk and made it clear that it’s her choice, and their way of supporting her. Dr Wang agreed and a locum was brought in to cover that period.

If Dr Wang chose to continue working, the practice would need to proceed in light of medical advice from her treating doctor. A practice should not make its own clinical assessment of the situation.

“I can’t employ a female GP ever again!”

Understandably, the practice is unhappy about the situations that have transpired with the two female GPs and is tempted to refuse to employ female GPs to avoid potential problems in the future. The practice runs the risk of a discrimination claim if it decides not to employ a GP because she is female. Also, consider the benefits to patients of having female GPs in the practice.

If you need advice regarding contract or employment disputes, call Avant’s Medico-legal Advisory Service on 1800 128 268 or email nca@avant.org.au

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