Issue No 8 Maintaining Professional Standards

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A leader
steps forward
Dr Ruth Mitchell
Trainee neurosurgeon, award-winning
researcher, anti-bullying champion
Testing patients
five complaints in four years
Going too far
caring acts can compromise
Medicine is a team sport
collaboration matters
Make a note
it’s your best defence
Contact us CONNECT WITH US
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Great Expectations
maintaining professional standards
As doctors, we have been trusted, valued the second time in the last few months, I
and respected members of the community am very proud to be congratulating our
for centuries. Although that trust is outstanding defence team on winning
still there with the public, the modern an award. This time Avant Law has won
world is demanding even more from the Australia – Law Firm of the Year (Medical
profession, and these new expectations and Indemnity Insurance) at the ACQ Global
professional standards are being formalised Awards. Our solicitors are some of the
through regulation. best medico-legal experts in Australia
and are an integral part of our wider
The profession has always demanded high defence team. Their insights and advice
standards of its members, and in Australia assist doctors every day both through this
the public can be confident they will receive publication, our advisory phone service
a high quality of care. However, as we noted and when members make a claim. It is a
in our last issue, we are seeing a rapid great comfort knowing these dedicated
increase in complaints about doctors, across resources are there should you need them,
all states and territories, a trend mirrored in which is why we invest in providing the
many Western economies. Our reputation best advice and defence possible.
Professor Simon Willcock
has been challenged by high-profile
instances of poor healthcare provision that The protection Avant provides to members
have attracted significant negative publicity. has been expanded beyond professional
indemnity to include personal protection
Consequently, there are demands from and business cover for practice owners.
the broader community for ever greater Included in this issue are articles to assist
professionalism and higher standards you in understanding these sometimes
from providers. In response, colleges have complex financial services to help decision
introduced programs to support their making around these areas of protection for
members’ professionalism. you, your business and your family.
In this issue we look at how members have I hope you find reading this issue both
come under scrutiny for being perceived to interesting and informative, and please
have fallen short of what was expected of send us any comments or suggestions you
them by patients, employers or regulators. may have.
The professional standards that were
acceptable yesterday aren’t necessarily
acceptable today. The examples noted are
good reminders of the need to maintain
best practice even in difficult situations,
and how we are able to defend members to
achieve the best possible outcome.
Central to delivering a high quality Professor Simon Willcock
defence of members is Avant Law. For Avant Mutual Group Chairman
Connect | Issue 08 | avant.org.au/publications 1

14
Cover story
14 Inspiring change
Leading from the frontline
Two young doctors inspire others to stand up rather than stand by. Dr Ruth Mitchell
plays a pivotal role in stamping out workplace bullying and harassment and addressing
the gender gap in surgery. Dr Murray Haar wants to inspire more Indigenous young
people to take up medicine. Both are making waves in their respective fields.
2 Connect | Issue 08 | avant.org.au/publications

Avant Mutual | member
MEDICO-LEGAL FEATURES
06 Testing patients: say no to get the best result
Doctors regularly meet with difficult and demanding patients who,
despite a practitioner’s high integrity and best efforts, often complain
06
when they don’t get what they want. We examine this common
dilemma and hear from one doctor about his distressing experience.
10 Medicine is a team sport: collaboration matters

Your manner and the way you interact with patients and colleagues
affect patient outcomes and complaints. From the unapproachable
supervisor to the doctor requested to work on communication style –
what can we learn from recent examples?
12 Make a note: it’s your best defence

With 12% of member claims relating to standards of documentation,
we draw on recent cases where doctors’ medical record keeping was
scrutinised – one in a Coroner’s investigation and another by Medicare.
16 Communication breakdown: the art of maintaining trust
10 Doctors are constantly meeting patients and co-workers with

diverse language, culture and communication styles. We look at
recent cases and speak to an expert about giving best patient care
when faced with these challenges.
20 Going too far: caring acts can compromise

Altruism is a foundational trait shared by doctors. Naturally you want to
help your patients but it can be easy to drift over the lines that shouldn’t
be crossed.
22 Private lives: know what’s shareable

Privacy is always a hot topic for doctors. Recent high-profile data
breaches and the life insurance inquiry have firmly returned it to the
16
public eye as well. Often though, patient privacy is in the hands of
others. Our experts cover what doctors need to be aware of.
ALSO IN THIS EDITION

04 Raising the standard: an environment that demands more
05 Regulation nation: striving for policy fairness
24 Expensive mistakes: increasing quality not penalties
25 Taking care of business
22
26 Good advice is medicine for the soul
27 As a doctor, there’s a lot riding on your good health
28 States of the nation: local medico-legal matters
All names in the case studies have been changed and any relation to actual people is purely coincidental

Raising the standard
An environment that demands more
Dr Penny Browne MBBS, FRACGP, MHL
Avant Senior Medical Officer
After many years’ experience as a clinician I still encounter ‘firsts’ all the medical needs, many of us are seeing higher volumes of patients and we
time. Last week it was a patient with terminal cancer asking me how to are subject to increased scrutiny.
access medicinal cannabis. This dynamic practice environment is putting demand on our
While the foundations of professional care are still fundamental, the professionalism and behaviours. The bar is being raised, which is reflected in
environment in which we work seems to be changing almost by the the increased number of complaints to regulators and calls to our Medico-
minute. Our communities are becoming more diverse with higher legal Advisory Service. Doctors seek support and access to a range of
expectations of our care, our ageing population has more complex expertise to help them navigate the challenges.
Complaints process
20+ regulatory bodies
Greater scrutiny and more ways for
Mandatory reporting
patients to complain about doctors.
9 new or
revised PRO 6.6m
collaboration F Australians born overseas1
professional standards, guidelines
and codes, so staying up to date diligence
integrity Culture, communication style and
ESS
has never been more important. altruism expectations may differ between
trust
confidentiality
IONALISM
colleagues and patients.

collaboration
altruism
Chaperoning
trust confidentiality
integrity
1 in 5 Revalidation
Up to diligence has multiple chronic
$1.8m
in penalties
conditions1
As patients have more conditions
they are seen by a wider range of
Organisations and individuals practitioners requiring excellent
breaching privacy laws face heavy communication and cooperation to
fines, meaning doctors and their deliver the best patient outcomes.
staff need to understand and
implement safeguards.
Increased calls to our Medico-legal Advisory Service on professionalism-related matters
12% 29% 20% 43% 17%

Complaints about Employment matters †
Confidentiality †
Doctor-patient Medical records†
doctors† relationships†
Increased need for support†

There are more patients having more procedures from more practitioners so perhaps it’s no surprise we are seeing more doctors reaching
out to us for help. But the nature of the issues members are contacting us about, is more than legal issues relating to clinical treatment,
and highlights how the environment is impacting medical practice.
Australian Institute of Health and Welfare, aihw.gov.au/workforce/medical/who

1
Increase in call frequency (per 1,000 members) based on 2016 compared to the average of the previous three years
†

Regulation nation
Striving for policy fairness
Georgie Haysom BSc, LLM, LLB
Head of Advocacy
The following topics are some of the national issues affecting the profession today. It’s our firm view that
mechanisms to ensure professional skills and patient safety should not come at the expense of doctors’ health and
wellbeing. We work with partners including the AMA, professional colleges and associations, and with the regulators
to press for changes to healthcare policy and systems that will create a safer environment for doctors and patients.
Complaints process review place in Western Australia. We will be taking working to ensure that any changes
advantage of the current focus on this issue introduced as part of the MBA’s proposed
The current senate inquiry into the complaints to renew our push for mandatory reporting revalidation model do not unnecessarily
process under the Health Practitioner Regulation amendments to be included in the second increase the pressures on doctors.
National Law is the second in two years to round of reforms to the Health Practitioner
consider the medical regulatory framework Regulation National Law. We shared our
and complaints processes. Last year’s inquiry position paper with professional colleagues to
looked at the use of the complaints process help clarify the complex issues and support Medicinal cannabis:
to bully and harass colleagues. This year’s the current push for change.
inquiry looked at complaints mechanisms the reality
more broadly. We highlighted to the inquiry Doctors in New South Wales,
some of the ongoing concerns we have
Amendments to the National Law
Queensland and Victoria can now
with the complaints process, including Two years after the Snowball review of the prescribe medicinal cannabis to
the significant long-lasting and negative National Registration and Accreditation certain patients. There are significant
impact the process can have on doctors. As Scheme, a draft amendment Bill has been barriers for doctors to prescribe
well as making submissions to inquiries, we presented. Proposed amendments will be this still unapproved treatment,
have been using our influence to support released for consultation mid-year, including however. As with other areas of
regulators’ programs designed to improve the a requirement that doctors (or insurers) legislation, doctors have a complex
complaints process and minimise the impact disclose details to AHPRA of civil claims network of state and Commonwealth
on doctors. The Australian Health Practitioner made against them. legislation to navigate. We’re
Regulation Agency (AHPRA) and the Medical preparing guidance for doctors
Board of Australia (MBA) have noted the report Revalidation recommendations available on our website soon. In the
published 10 May 2017, and will now consider meantime we recommend doctors
its 14 recommendations.
imminent
continue to exercise care and skill
The MBA’s Expert Advisory Group is currently when prescribing and to call Avant
Mandatory reporting back preparing its report and recommendations if in doubt. The Therapeutic Goods
in the spotlight due mid-2017 following its interim report Administration website has a guide for
and consultation process. The proposals healthcare professionals: tga.gov.au/
There is renewed focus on stress levels in the
encompass enhanced CPD, including a access-medicinal-cannabis-products
medical profession after the tragic deaths of
greater emphasis on peer review and audit.
three young doctors. We continue to express
strong support for the national adoption of We support continuous performance
the treating practitioner exemption from improvement, and as the MDO representative A list of Avant submissions and position papers
mandatory reporting obligations currently in on the consultative committee, we are is available at avant.org.au/advocacy
‘Chaperoning inconsistent with expectations’, Paterson report

The Paterson report on the use of chaperone conditions by the Medical Board, where doctors have been the subject of allegations of sexual
boundary violations, was published in April. The overall finding of the review was that the chaperoning mechanism is no longer consistent
with community expectations. AHPRA and the Medical Board have accepted the report’s 28 recommendations which can be viewed on
their website: medicalboard.gov.au. We don’t agree that chaperoning is of limited effectiveness in protecting patients and we continue to
apply their use as an interim measure in appropriate cases.

Testing patients
Say no to get the best result
Helen Turnbull BA, LLB

Special Counsel – Professional Conduct, Avant Law, NSW
For the most part, the relationship between a doctor and patient is a very rewarding
interaction. However, dealing with trying patients is an inescapable challenge which can
test the integrity of this relationship.
Every day our doctors meet with difficult and demanding patients. Some can be deceptive and pushy. They insist on
antibiotics for a sore throat. They want oxycodone immediately to resolve back pain. They want to go on some form
of care plan where they don’t fit the criteria because it’s free. It’s really hard to deal with these types of patients and
often even when you try your best, they complain. Notifications to AHPRA increased 18.3% last year however, 71% of
these resulted in no further action1. But even these notifications have a significant impact on the doctor and require
defending rigorously.
An example of this is Dr Smith* who had five complaints from patients in the last few years each touching on
communication. When we met for the first time, I was expecting a rather abrasive or abrupt doctor. I imagined he
was one of those doctors who didn’t ‘suffer fools gladly’ and was prepared to say so. When he walked in though, his
gentle nature was immediately apparent.
I was confused about this pattern of complaints against him which indicated he was not handling patients well.
Or was that right?
*Names have been changed

1
ahpra.gov.au/annualreport/2016

18.3% increase in notifications to AHPRA1
The five complaints

Dr Smith has been practising for nearly 20 years in the same low socio-economic area. The spate
of complaints came up after Dr Smith started out as a single practitioner on a main street with
just himself and the receptionist on premises. He believes this made some people think he was an
easy target if they’d been denied prescriptions at the big medical centres close by. He doesn’t turn
patients away even when he knows they’re drug users because in his words, ‘They are still a human
being who needs help and could have something else that needs my medical attention’.
Two of the five complaints were from known drug and alcohol misusers. But the other three were
from patients presenting with a herniated disc, a fractured wrist and a broken collar bone.
The first two requested further investigations into their conditions before asking for pain
medication in the meantime. The other three demanded pain medication and insisted that
other therapies had not worked, each refusing to accept Dr Smith’s advice to seek help from pain
management professionals.
All five patients were verbally abusive – one was physically abusive and subsequently convicted
of assault – when Dr Smith declined to prescribe what they asked for. In each case, Dr Smith kindly
explained to his patients why he disagreed with their request. He recommends to all his patients
with pain management issues to do physiotherapy or see a pain specialist, if appropriate, and of the
other ways to manage pain.
Dr Smith detailed discussions in his medical notes including when he had phoned other
healthcare providers for copies of scans or discharge notes, for example. Considering the trend
of complaints relating to communication issues, Dr Smith welcomed Avant’s suggestions to
undertake education activities and incorporate new communication techniques into his usual
practice, which he feels is helping. There were a number of other initiatives Dr Smith took which
allowed him to satisfy the regulator that he was an earnest, caring GP committed to improving
the way he deals with difficult patients.
Same outcome every time – no further action

The regulator’s finding in each of the complaints against Dr Smith was for no further action to be
taken. Dr Smith contacted Avant each time he was notified of a complaint. We supported him to:
• write his response to each complaint with an honest account of each situation
• gather reports and referrals from other healthcare providers to support his account, along
with related medical records and his CV, in his response to the regulator
• undertake educational activities such as completing webinars, participating in one-on-one
sessions with our risk advisors and doing further reading of Avant materials on managing
difficult patients
• introduce communication techniques to articulate his empathy, for instance reflecting back
the patient’s concerns in their words
• leverage his local professional network and attend talks at the hospital about treating drug
seekers, since this is a community issue.

Ending doctor-patient
Tips for prescribing drugs of dependence relationships
Another common dilemma doctors face,
when dealing with difficult patients, is
knowing when and how to end a therapeutic
relationship. This is the topic of our second-
Professor Greg Whelan AM, MBBS, MD, MSc, FRACP, FAFPHM, FAChAM most downloaded fact sheet.
Senior Medical Advisor and Claims Manager, VIC
Professional integrity is essential for an effective
doctor-patient relationship and there are a
Take your time number of ways that it can be compromised,
When presented with a patient seeking drugs of dependence, inform them: such as patients being aggressive, refusing
to take advice and sexually propositioning a
• you will need information from their previous doctor doctor. The following story is a typical scenario
• a comprehensive assessment will need to be performed to create an appropriate of where a patient seeks contact with a doctor
plan which can take several visits outside the treating relationship.
• if already receiving opioids for eight weeks or more, a permit will be required before
further prescribing I’m not looking for a tennis partner
• any prescribing will be a trial of treatment, that is, not forever
• shared care may occur but there will be only one prescriber. Anna*, a 40-year-old woman, presented to our
dermatologist, Dr Harris*, concerned about a
It’s best to involve a multidisciplinary team where feasible. These can be the family doctor, mole on her face that she wanted removed.
pain specialist, psychiatrist, appropriate specialist (orthopaedic surgeon for example) and Anna begins by remarking at the photo on Dr
addiction medicine specialist. Harris’ desk of him playing tennis with his son.
Anna goes on to say that she loves tennis, asking
Minimise risk where he plays, which is only a suburb away. She
• Have a policy for prescribing drugs of dependence and have this on display: either in says maybe she’ll see him there one day.
your waiting room, front window and, or, on your website. Dr Harris starts the consultation, proceeding
• GP registrars should not be given the care of patients with complex problems being to examine her, talk through the procedure,
prescribed drugs of dependence without very close supervision – this may require recovery and so on. Ten minutes after the
‘sitting in’. consultation ends, he gets a text on his mobile
• In a clinic with a number of doctors, rotate the prescriber if possible. phone from Anna (he’d given it to her to use
• For patients on drugs of dependence long-term, change the professional carer (must if she had any questions about the surgery)
be experienced) every six months or so. asking if he’d like to catch up for a tennis
• Use referrals for second opinions. match tomorrow and get a coffee. Dr Harris
• Consult with colleagues and discuss at staff meetings. replies, ‘Thanks for the kind offer but I’m your
doctor and we must keep our relationship
See our factsheet online Navigating the prescribing of drugs of dependence. professional’. She replies, ‘Okay’. That night
Visit avant.org.au/avant-learning-centre at 11.30, Dr Harris receives another text from
Anna, ‘I know you said no earlier but my
I’ve been practising for nearly 20 years and never had life balanced, look after myself, think positive thoughts
any complaints. From a very young age I wanted to study and remind myself that I wouldn’t change the advice I
medicine. I had family members who were doctors and gave those patients. I took comfort in that. I always advise
they encouraged me. I got into medicine to help people what is best for my patients but it’s not always what they
and I want to do the best by my patients. want to hear.
But when I got the second, third, fourth, fifth complaint, I I was glad with the way Avant helped me to improve my
was starting to feel really frustrated. practice through webinars and putting me in touch with
It begins to affect your personal life in little ways. You’re the local hospital which ran talks about managing difficult
waiting to hear from the regulator and until you know the patients, to help address this as a community.
outcome for sure, you worry. All-in-all I tried to keep my – Dr Smith*, General Practitioner

1
ahpra.gov.au/annualreport/2016

doubles partner for a match on Sunday has There is another text on the weekend though,
71%
cancelled – could you fill in?’. Frustrated now, ‘We won! I found a partner in the end. How
Dr Harris responds again by politely declining was your game?’. Dr Harris phones Avant and
and saying he has to be firm, ‘We are in a we give him the next step: write her a letter
treating relationship and it’s not appropriate’. which we help him draft, stating ‘I’ve been
The response from Anna is, ‘No problem. See advised by my defence organisation that I of complaints to
you soon’. need to maintain the professional boundaries AHPRA result in no
The next day however, the doctor receives
of this doctor-patient relationship. Any further further action1
communication you have with me outside
three more texts from her saying she still
our consultations will go through my practice
has not found a replacement tennis partner. Our next advice to Dr Harris is to terminate the
manager, that is, all texts and phonecalls’. The
Dr Harris calls Avant. We advise there are doctor-patient relationship since Anna can’t
letter is sent to Anna’s home address.
a couple of options at this point, one is to accept the boundaries he has laid out. We help
ignore the messages and another is to change When she receives the letter she phones the him draft another letter to Anna explaining
the communication channel in an attempt practice manager apologising profusely and that in the circumstances he doesn’t feel the
to reinforce the message with this patient asking that the message be passed to the relationship can be maintained to appropriate
– he should phone her to explain that it’s doctor. The next day she turns up at reception boundaries, and that he will refer her to a
inappropriate and that they must maintain with a bunch of flowers for the doctor to dermatologist colleague. The letter provides
professional boundaries. We give Dr Harris say sorry. Not knowing the background, the a list of five alternative practitioners and Dr
a script and do a role-play session over the receptionist on that day advises the doctor he Harris ends the letter by saying he wishes
phone as practice. We ask him to contact us has a patient in reception who would like to her well. She phones reception again but his
again if the texts continue. Dr Harris calls Anna see him briefly. As soon as he sees her, he feels practice manager now manages any contact
and she says she understands. as if he’s in deep trouble. from this patient.
Dos and don’ts of ending doctor-patient relationships

Do follow up your discussions with a letter to the patient. You
may wish to send a draft letter to Avant for review beforehand and
you’ll find a sample letter on our website.
Dr Joe Lizzio MBBS, LLB, FRACS Don’t forget to advise practice staff that your relationship with
Senior Medical Advisor, NSW the patient has ended and that they should not make appointments
for the patient after a specified date. Your staff should also understand
your obligations to render assistance in an emergency.
It’s hard and sometimes near-on impossible to say no to patients.
Do give the patient a reasonable deadline for finding a new
But it’s an essential skill for doctors to learn how to terminate a
doctor. Give them a list of practitioners in your area or refer the
consultation or relationship without distressing the patient. For
patient to the relevant medical college to look one up. Doctors
me, it came with time and practice.
in rural settings, where the availability is limited, face particular
What to do when ending the doctor-patient difficulties and may wish to seek advice from Avant.
relationship Probably don’t charge the patient to transfer records. Let the
patient know you will provide a copy of their relevant information
Do communicate openly. Aim to communicate in person if
to the new practitioner, with their consent.
possible. While you don’t have to give reasons, ideally you should,
and be honest and sensitive to the patient’s feelings. We routinely get calls to discuss ending relationships. It can also
be useful to discuss the situation with senior colleagues. If there
Don’t feel like you can’t end the doctor-patient relationship
has been a serious breakdown in the doctor-patient relationship,
during a terminal illness. It may be difficult but it may also
consider whether an incident report should be made to Avant in
become necessary. The patient is entitled to have continuity of
case of a future complaint.
care so as not to compromise their health. You must personally
transfer the care to the right practitioner who is available, willing For more information, see our online factsheet How to end the doctor-
and absolutely certain they can manage the patient appropriately. patient relationship. Visit avant.org.au/avant-learning-centre
Speak to the doctor yourself, don’t rely on a third party.

Medicine is a team sport
Collaboration matters
A doctor counsels his practice manager about
some recent performance issues. She becomes
Juliette Paterson sulky and sullen at work and loses focus on her
The trainee
BA Comms, LLB
job. Her lack of attention causes her to mistype didn’t feel
Solicitor, Avant Law, letters which the doctor does not check comfortable
NSW properly and they are sent out with errors. contacting his
Everyone needs to be on the same side and supervisor.
The way you conduct yourself working toward the same goal. It’s obvious supervisor over his management. This
with patients, families and as and seems simple in principle, but can be very was in part because of a breakdown in
part of a team can impact different in practice. We look at some recent communication between the two. In helping
patient outcomes. scenarios involving our members to learn what the trainee with his response, we learned
doctors can do to protect themselves when that the supervisor had previously provided
Not only that, claims relating to employment collaboration turns calamitous. some feedback that damaged their working
matters increased 15% in 2015-16†.
relationship, and they had never resolved
A doctor snaps at a nurse during surgery.
Afraid to ask for help their differences.
The nurse ends up in tears and other team A recent case had our member, a trainee,
Ultimately, the patient’s outcome and the
members are focused on calming the nurse being asked to respond to an adverse
management may not have differed. But the
down rather than managing the patient. outcome for a patient who attended the
revealing concern was that the trainee didn’t
hospital following a fall in a nursing home.
feel comfortable contacting his supervisor
The patient’s condition declined overnight
15%
for his opinion.
while the trainee was on duty. Ultimately, the
patient died due to a bowel obstruction not The matter reinforces the need to resolve
identified in time. The hospital conducted differences quickly to prioritise patient safety
a ‘root cause analysis’ and the trainee was and also to ensure doctors continue to learn
increase in claims invited to provide his account. and seek advice from their superiors as
relating The trainee had been reviewing this patient
necessary and appropriate.
to employment^ and, despite concerns, did not consult the
No joke for colleagues

Another member, a seasoned physician, received a number of complaints from co-workers about her communication style. It was
alleged she used derogatory terms to describe co-workers and offended a co-worker with the use of sexual references. Although the
physician had been working in the public system for 40 years, and had an excellent clinical reputation, she was not up to date with
appropriate and current workplace behaviours.
The doctor’s response to the complaints was that she thought she was being light-hearted and sarcastic. After discussing the
complaints with her we encouraged her to provide apologies and assure the hospital administration this behaviour would not continue.
The hospital investigated and we helped her provide submissions and attended a number of meetings throughout the process.
The doctor was removed from her position and required to work in a different hospital. We assisted her in evaluating her behaviour,
including doing communication courses and engaging with the improvement plan set by the hospital. It was difficult for our
member to accept that the workplace had changed over time and she needed to be more aware of the perceptions of others.
Subsequently she has completely changed her way of thinking and admitted to gaining valuable insight during the process. ‘I think
that you guys have, to a large extent, done your job. I did not lose my job, and that is in part at least due to you helping me regain
my temper and self-control’. This process took about 18 months and had a significant impact on our member personally
and professionally.

Conflict in care: what to do
More at stake: poor patient
outcomes
An article published recently by The JAMA Network1
pointed to studies in the US that looked at links between
Harry McCay BComm, LLB
surgeons with a history of patients’ negative comments
and postoperative complications and malpractice claims. Senior Solicitor, Avant Law, ACT
It revealed a higher risk of complications among surgeons
whose patients more frequently noted issues with treatment, ‘Always try to interact with others in a courteous and friendly manner’ –
communication, respect, accessibility and billing. something we were taught as children but an axiom that also features
in the Australian Medical Association’s (AMA) Code of Conduct and
The study also noted disrespect and rudeness toward the Medical Board of Australia’s (MBA) Good Medical Practice: A Code of
other professionals affect willingness to share information Conduct for Doctors in Australia.
and seek help and, in turn, may affect both procedural and
diagnostic performance. One patient noted, ‘I witnessed a You may, or may not, be surprised by a recent example where a
tense exchange between Dr Z and a nurse. It was difficult to surgeon was greeted by an anaesthetist member of ours who had not
watch someone try to humiliate another person like that. I worked with that surgeon before. The surgeon, without looking at the
was embarrassed and it made me feel vulnerable’. It’s easy to anaesthetist, told him not to address him as he only spoke with surgeons.
see how the way doctors interact, moment to moment, can We have assisted members who have been the subject of inappropriate
have a profound impact, not only on complaints and claims complaints by their colleagues. For example, where one practitioner
but also on patient outcomes. or medical practice responds to a complaint by immediately notifying
the other person or medical practice to the same complaints body,
1
The JAMA Network, Use of Unsolicited Patient Observations to Identify for managing dysfunctional workplaces and dysfunction in working
Surgeons With Increased Risk for Postoperative Complications, 2017
relationships (breakdown in personal and professional relationships) or as a
way of dealing with competitive interests, turf wars or personal ill-feeling.
It’s very important before raising issues about, or with, colleagues to
Useful resources consider the principles of professionalism laid out by the MBA and
avant.org.au/avant-learning-centre AMA. Here are some starting points:
• Discuss your concerns directly with the person you are
Factsheet concerned about to get their point of view.
How to navigate difficult situations with your supervisor
• If not satisfied with that discussion, speak to a senior or peer
for guidance.
Webinar
Performance management - tips and traps • If you feel you need to take action, speak to the director of the
Dr House syndrome: the impact of disruptive doctors unit or go to the medical board (unless you have a reasonable
belief that your colleague is engaging in notifiable conduct,
The Doctor’s Health and Wellbeing section of the Avant giving rise to a mandatory reporting obligation).
website has a raft of information under ‘A healthy Seek advice from Avant before making a formal complaint for guidance
workplace’ to help navigate workplace related stresses, on what constitutes a notifiable conduct, how to phrase a notification
including guides to resolving workplace disputes. and avenues to resolve issues professionally. It could save years of stress
and legal dramas.
Factors in claims citing workplace behaviour issues†
52% 25% 23%

toxic unprofessional irresponsible excessive hours
behaviours unprofessional behaviours or workload
Behaviours towards colleagues and employees Refusal to cooperate with others, to follow May include a doctor who works very
that include degrading comments, inappropriate established protocols and guidelines and long hours, has multiple jobs, excessive
joking, bullying, verbal abuse, aggression, sexual ignoring others. Poor member of a team. Lack surgical load.
harassment or discriminatory behaviour. of insight of impact of behaviour on others.
Increase in claims per 1,000 members in 2015-16 compared to the average of the previous three years
^
Based on a sample of 3,110 Avant claims from 2015 and 2016

†

Make a note
It’s your best defence
Notes taken for Coroners so the patient was referred to the nearest base
Dr David Pakchung hospital. Before he could be transferred, he
MBBS, MHA, Dip RACOG,
investigation before clinical
deteriorated. Dr Williams did not review the
FRACMA, GCAppLaw findings added patient in the afternoon as she was not aware of
Senior Medical Advisor, his deterioration. There had not been time for Dr
Ideally medical records should be made at the
Head of Claims, QLD Williams to write up the patient’s notes after the
time of seeing the patient. However hospitals
are commonly frenetically busy settings, and end of her shift when he arrested. Dr Williams
in this case our member Dr Williams* had led the arrest team and resuscitated him. The
Good quality medical records are an extremely busy shift and her incomplete patient was transferred to the base hospital
essential to the proper ongoing medical records were taken for a coronial where he underwent the CT scan and was
care of patients, but are also investigation after a patient’s sudden death. diagnosed with an acute on chronic subdural
critical in the defence of any haematoma. Unfortunately he died.
claims made against doctors.

Sound medical records outlining history,
examination, investigation, diagnosis and
12%
of claims relate to standards
The autopsy showed that he died from
complications of an acute on chronic subdural
haematoma, with compression of the right
lateral ventricle of the brain and evidence of
treatment can be the difference between the
herniation through the outlet in the skull.
quick closure of a complaint and a prolonged of documentation†
regulator, coronial or civil case, all of which can Dr Williams was concerned about the
A 41-year-old male was admitted to a country
take several years. incomplete medical record. Because of the busy
hospital with headache and vomiting. A
shift, she simply ran out of time to write up her
Cases involving delayed diagnosis of recently reformed alcoholic, he was diagnosed
clinical findings before the emergency and the
abdominal problems, such as appendicitis with alcohol withdrawal. Our member, Dr
director of nursing handed over the notes.
or from back pain including spinal abscesses Williams, took over the care of the patient
and cauda equina syndrome, or septic shock the next day seeing him in the morning and The hospital was investigated by the Coroner,
resulting in limb loss, are examples we’ve agreeing with the diagnosis. Concerned the who flagged a number of concerns. These
seen recently where medical records have patient reported having the headache for included failure to recognise the significance
been closely scrutinised. The following case one month, Dr Williams arranged for a CT of of the patient’s ongoing headaches (he
highlights the risk associated with not making the head to rule out a haematoma or other had presented at the hospital several
contemporaneous notes. cause. The local CT facility was unavailable times before – not seen by our doctor),
Changing the record
Amending errors
Andrew Vandervord LLB You can’t delete medical records but you can add to them.
Practice Manager – Professional Conduct, Hard copy records and electronic records each require a
Avant Law, NSW different approach.
Electronic records usually prevent a doctor from amending
The overriding aim of appropriate medical record keeping is for an entry once it has been entered and saved. This is where
continuity of patient care. However, medical records also serve a addendums are used.
very important secondary purpose; assisting practitioners to answer
questions about their provision of care. In some instances this may be Hard copy records will require physical alterations. For example, put a
to address a complaint, an investigation or claim for compensation. line through an incorrect entry so as to leave the original entry visible,
make the correct entry and date it.
A complaint or claim may arise from one consultation or from
consultations that took place years ago. Doctors will likely have no
specific recollection of their interaction with the patient except what is
Maintaining integrity
written in their medical records. In the medico-legal setting, doctors potentially face damage to their
credibility when their records are called into question.
The importance of appropriate medical record keeping both in the
provision of care and for medico-legal purposes can’t be overstated. A frank and open alteration of the record, which shows when the
So what happens when a doctor has made an incorrect or inaccurate alteration took place and why it took place, for example because of a
entry or ran out of time to document records? mistake or omission, is the best way of avoiding criticism.

†

failure of nursing staff to recognise clinical The practitioner was asked to attend an or under their name irrespective of who
deterioration and the lack of documentation. interview with Medicare to discuss the receives the benefit. Medical records are
Recommendations included recording statistical variance of servicing and to always your best defence, should you be the
negatives in history taking and the respond to the concerns. subject of a Medicare investigation.
formulation of differential diagnoses.
The practitioner contacted Avant and we
The Coroner ultimately found that the patient’s explained the Practitioner Review Program
outcome would unlikely have changed had process, assisted with the interview and
the situation played out differently. The case responded to the concerns. The review was Useful resources
highlights the fact that doctors can add to ultimately referred to Professional Services avant.org.au/avant-learning-centre
medical records. Doctors can add an addendum Review, a body independent of Medicare
to medical records to provide the evidence of which has the statutory authority to obtain Factsheet
due diligence, in Dr William’s case it was detailing a sample of medical records. Following Stay out of trouble with Medicare
the full neurological assessment she had done. review of the medical records and a further
See Changing the record box on previous page interview with the GP, no further action Article
for more information. We encourage doctors to was taken. Professional Services Review Tracking clinically significant tests
use electronic date and time stamping, such as was satisfied that despite the variance to
through email, to record when notes are added. her peers, the medical records justified the Case study
services provided and the applicable MBS Tragic case emphasises good clinical
Medical records best defence in criteria had been met. record keeping
Medicare investigation Medicare uses sophisticated tools and
eLearning course
Another member recently received notice compliance activities to monitor billing
On the record: medical records and
from Medicare in relation to chronic disease profiles and identify whether the data
documentation
management items and long consultations differs from particular peer groups. Doctors
which had been rendered at a rate different are legally responsible for services billed
to her peers. to Medicare under their provider number
The Avant team
More expertise.
More reputations protected.
We’ve got your back.
Dr Matthew Peters
Avant member
As a doctor, you’ve worked hard to build your reputation. And no other managers and local state specialists, our strength in defence is unmatched.
Australian MDO has more resources or experience to protect that reputation Which begs the question, why risk your reputation with anyone else? At
than Avant. We’re Australia’s leading medical defence organisation. With Avant, we protect over 57,000 doctors. Rest assured, we’ve got your back.
over 100 in-house medico-legal experts, lawyers, medical advisors, claims
Ask us about Practitioner Indemnity Insurance.
Find out more: 1800 128 268 avant.org.au

*IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice
having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy
wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. 1235 03/17 (0811)
Inspiring change
Leading from the frontline
that the college has taken up this challenge,
and online training in this area is now
mandatory for surgeons. We have contributed
to the development of that course, and also
a more in-depth face-to-face course which
is being piloted. We want to make sure that
everyone knows the rules about what is
acceptable behaviour, and that doctors are
equipped with a toolkit for those difficult
conversations when unprofessional behaviour
has to be addressed.
On gender imbalance
It’s a blight on our profession that medical
students still get told their surgical ambitions
are not compatible with their gender, and
those who perpetuate these views are a
danger to a sustainable surgical workforce.
Once medical students become junior
doctors, there is at times a bias in access to
good surgical experiences, and discrimination
against female residents requires real
leadership from every member of the team –
a real opportunity for male residents to speak
out when they see their female counterparts
being excluded, whether it be from theatre
opportunities or the like. Once women join
surgical training they are more likely to drop
out, and here the important leadership has
been from surgeons such as Rhea Liang,
who studied women leaving surgery for her
masters of surgical education. Asking women
Dr Ruth Mitchell was awarded On speaking up why they leave is so instructive, and we have
2016 AMA Doctor in Training of It can be extremely awkward speaking up to listen, and learn.
the Year Award for her leadership about something you’re not comfortable
in addressing bullying and sexual with. We have to be willing to make these
harassment in medicine. She was things awkward and sit with the discomfort. Those who
also recently awarded a grant by
It takes courage to speak out, but it gets so perpetuate these
much easier with time because people avoid views are a danger
The Brain Foundation. We caught saying ridiculous things in your company.
to a sustainable
up with her about being an I have to acknowledge as well that being
a relatively senior registrar in neurosurgery surgical workforce.
inspiring force for speaking out.
makes it far easier to speak out than when I
My Dad once said to me, ‘leadership is a was an intern or a medical student. I have to
lonely business’ and there is no question that use my position of influence wisely and for Achievement aspirations …
providing leadership in the face of bullying and the benefit of other people. I hope to achieve more than one thing, but
harassment can be very lonely. What I’ve seen
if I had to choose one: my goal would be to
and found very inspiring and effective is having
On building resilience see a surgical workforce as diverse as the
a colleague simply ask someone to rephrase a
communities we serve.
derogatory statement, saying, ‘I’m sure that’s One of the priorities for the Royal Australasian
not what you meant to say’. The evidence from College of Surgeons Trainees’ Association, Being part of the medical profession is a
the social sciences is clear – one single voice of which I chair, has been to ensure surgeons marvelous and honourable thing, and it needs
resistance can change the dynamic in a whole and surgical trainees receive formal training each of us to think about how to improve it
room, and can invite people to be their best on how to manage bullying, harassment and every day, in each patient encounter, and in
selves. The benefits for patients are so clear. sexual discrimination. I’m enormously pleased each interaction with our colleagues.

AMA scholarship winner, Dr
Murray Haar, was one of a record
number of Aboriginal doctors
graduating from the University
of New South Wales in 2014.
Dr Haar hopes to inspire other
Indigenous young people to study
medicine. We asked him about his
experiences being a natural (if not
reluctant) champion of Aboriginal
cultural awareness at an early
point in his career.
Understanding the Aboriginal

community
I feel that situations where a fellow healthcare
provider doesn’t show an understanding of
cultural awareness, and denies an Aboriginal
patient respect – either through ignorance
or malice – is an opportunity for education.
Any time someone lets a derogatory or
culturally inappropriate comment slide, we are
doing Indigenous people and their health a
disservice. It can be very difficult, particularly
when it’s a more-senior colleague who
has made the comment. We can use these
as opportunities for education, and NSW
Health has developed a pretty good model
in ‘Respecting The Difference’ which doctors Every year there are more and more
would be aware of. Indigenous doctors graduating, which is
amazing to see. It’s important for me to also
Useful resources
Including cultural information acknowledge the exceptional hard work of avant.org.au/avant-learning-centre
during handovers our elder Aboriginal colleagues who were

trailblazers, establishing themselves as role Factsheet
In terms of condensing complex information models and mentors to younger aspiring Avant’s FAQs on anti-bullying laws
into handovers, it’s probably not appropriate Indigenous doctors.
to leave out information or reduce complex
matters of culture. It’s important to recognise
that extra time is necessary and the workforce
of any hospital must appreciate this, and
that they ascribe to providing culturally safe Any time someone lets a derogatory or culturally
workplaces making clear that this takes more inappropriate comment slide, we are doing
time and requires specific education. Indigenous people and their health a disservice.
Inspiring a community
If I can achieve one thing in my career it won’t
be something I achieve on my own, but it will
be an achievement of all healthcare providers
to have a health service that is culturally
responsive and with a workforce that reflects
the diversity of the people we serve.

Communication breakdown
The art of maintaining trust
6.6
million Australians
born overseas1
Alison Fitzgerald LLB, BA(Jur), LLM

Head of Medical Defence Services, SA & TAS
Rapport with a patient is more easily built and maintained when you share a common first
language. With 6.6 million Australians born overseas1, doctors are constantly meeting people
with diverse language, culture and communication styles.
Our data shows that 30% of claims cited communication as a factor†. To explore some of the nuances involved with
communication issues, we’ve looked at cases where communication and cultural awareness have impacted doctor
and patient. We also spoke to one doctor with international work experience who champions greater awareness of the
cultural differences that can get in the way of giving patients the best of care.

1
Australian Institute of Health and Welfare, aihw.gov.au/workforce/medical/who
†

A matter of perspective: ordinary or offensive?
After a run-of-the-mill consultation with a woman presenting with suspected bacterial vaginosis,
Dr Wilson* found himself responding to a complaint to the regulator, and a possible criminal
charge for assault.
Dr Wilson and his patient were from different cultural backgrounds. He asked a series of
questions, routine to him, such as when was her last menstrual period and when did she last
have intercourse? A urine sample taken at the time indicated leukocytes were present. During
an abdominal examination she complained of tenderness. The doctor explained this could be
a sign of a bladder or vaginal infection and that a vaginal exam would help determine this. He
explained the process to his patient, said he would call a nurse as chaperone and she said, ‘Okay’.
The physical examination was quick. Finding nothing serious, the doctor recommended a blood
test and said he would send the urine for analysis for a possible urinary tract infection.
Shortly after, the doctor was notified the patient’s husband had complained to the regulator
about the questions into her sex life, and saying the intimate examination was unwarranted. The
patient also claimed the doctor had asked about her religion.
The doctor contacted Avant and was assigned a senior claims manager, a senior solicitor and
senior medical advisor. We also sought advice from a criminal law expert to clarify any risk of self-
incrimination in providing information to the regulator if it was judged the internal examination
was not clinically justified, and if there was a risk criminal charges could be laid. We supported
the doctor in preparing a response, outlining the clinical justification for his actions and evidence
of his good practice in obtaining consent and calling on a chaperone. He denied having asked
about her religion and asserted that the personal questions were clinically relevant. A statement
from the chaperone was included.
Ultimately, the regulator accepted this, saying the reason for the vaginal examination was
explained to the patient, her consent was obtained and clinical notes were consistent with the
statement. No further action was taken by the regulator and no criminal charges were laid.
What could have been done differently?

Visiting a doctor can be intimidating for anyone, particularly when intimate exams are involved.
It’s hard to say if a more proactive approach to cultural awareness would have helped in this
case, but it is a reminder for doctors to be alert to any subtle cues from patients, Australian-born
or otherwise. Watch for indirect messages and any body language that may indicate a patient
is uncomfortable or that they don’t understand. Remember, if English is their second language
they may be too embarrassed to say they don’t understand.
30% of claims relate to communication†

are cognisant with those cultural issues,
and sometimes I have a bit of a chat with
the patient, even unrelated to the medical
Dr Prabhath Wagaarachchi problem, just to gain an understanding
about their culture. If you make an enquiry
Head of Gynaecology, Women’s and
like that it can be fascinating how some
Children’s Hospital Adelaide
people react to certain communication
styles and situations.’
So distressed,
she cancelled
the procedure.
Dr Wagaarachchi gives an example of

how hospitals need to be flexible about
accommodating cultural needs.
Avoiding patient distress

An Arabic woman who spoke little English
was having surgery for a cancerous lesion.
Her husband, who spoke fluent English,
had accompanied his wife throughout her
specialist appointments and preparation
for surgery. However, while she was
waiting in the holding bay for surgery
dressed in only her hospital gown, she
became very anxious and uncomfortable
because her husband was not allowed to
be with her in the operating theatre. So
distressed, she cancelled the procedure
then and there in the holding bay.
What was lacking here was some empathy,
sensitivity and perhaps a discussion with
the hospital’s administration to see if an
exception could be made. The hospital did
Adaptability the key to communication woes change their policy to allow close family
members into the operating theatre at the
Dr Prabhath Wagaarachchi has worked internationally in a number of discretion of the clinician.
places including Sri Lanka, Australia, the United Kingdom and Africa.
He believes the most important tool a doctor has to traverse language
barriers is adaptability.
‘Australia is very multicultural and regardless and figure out the best way of approaching
of your nationality, if you are a doctor patients in order to offer them the best
you need to be sensitive to, and aware of, possible care’.
differences in culture and communication,
and change your approach when dealing ‘The key word here to me is adaptability.
with patients from other cultures.’ Doctors need to be able to adapt themselves
to the type of patients and situations that
Dr Wagaarachchi believes that cultural they are dealing with on a daily basis.’
barriers – including different languages,
customs and taboos intrinsic to the patient’s He acknowledges that for a doctor to be
culture – can get in the way of offering competent in treating patients from different
patients the best care. He says, ‘In order cultures you need to know a bit about
to tackle these situations doctors need to their culture. ‘In some situations you need
firstly be aware of those cultural differences to seek help from other colleagues who

Patient not confident in or doesn’t Not just about language
understand English?
It’s common for relatives or friends to act as interpreters in
medical consultations with patients of non-English speaking
backgrounds. While this may be convenient, there can be Sonya Black LLB, B.Com
serious disadvantages for our patients, not to mention Special Counsel – Employment
embarrassment about sensitive information. Avant Law, QLD
Further, it’s not uncommon for family members to keep secret
information they think would be too upsetting for a patient. Miscommunication isn’t limited to problems with language.
One third of healthcare practitioners in Australia are trained
Professional medical interpreters on the other hand will have a overseas, nearly half of these are from native English-
better understanding of medical terms, are more objective in speaking countries1. Inevitably, this variety in social
their choice of language, and will be bound by duty to pass on norms and communication styles finds its way into the
all information and are bound by a confidentiality agreement. Australian discourse.
For instance, we recently acted for an American doctor
who worked in regional Australia. He had a very direct
communication style, spoke loudly and had no time for small
Cultural sensitivity tips for doctors talk. He received a number of complaints from patients and
co-workers about his approach but could not understand why
they were complaining. Unfortunately, his communication style
Use all the resources at your disposal. Use an interpreter if you
1
was culturally different to the laid back style preferred by many
are finding it difficult to communicate with the patient, use
regional Australians.
diagrams and patient handouts to explain the treatment or
procedure. If appropriate, involve family members in making When conflict arises, it might be the result of cross-culture
clinical decisions. communication difficulties. A person’s conduct and
communication style may be culturally driven and more
acceptable in their home location. However, it may not match
Learn from your colleagues and peers, and most importantly cultural norms in Australia and this is where problems can arise.
2
from your patients themselves. For example, having an
aihw.gov.au/workforce/medical/who
1
informal chat with a patient can help you to understand their
culture and sometimes reveal some fascinating insights which
may help with their care.
Inevitably, this variety
3
Show empathy and be sensitive to cultural diversity when in social norms and
managing patients and appreciate that people from other
communication styles finds
cultures may have different beliefs and expectations to you.
its way into the Australian
discourse.
4
If you are performing an intimate examination, regardless
of the patient’s nationality or gender, you should exercise
appropriate care and consider having a chaperone present.
Useful resources
avant.org.au/avant-learning-centre
In 2015, a quarter of physician Factsheet
25%
claims relating to complaints to Use of interpreters
regulators noted attitude, manner
Video
or lack of empathy as factors† Chaperones: intimate examinations and cultural sensitivities
eLearning course
Effective communication

†

Going too far
caring acts can
compromise
Dr Kelly Nickels MBBS (Hons), FRACGP, M Hlth & Med Law

Medical Advisor, VIC
Doctors see their fair share of people in difficult

situations. As a caring profession there is an
expectation to help individuals. However, it can be
one small act that tips altruistic behaviour over the
acceptable boundaries. From treating family members
to offering a patient a lift, we regularly have doctors
coming to us for help after finding their attempts
to help have compromised their professionalism.
Care for the elderly

Dr Brown* was highly regarded as a caring and dedicated practitioner,
known to work long hours and for spending a lot of time with his
patients. One elderly patient he had been treating for many years
developed mild impairment due to dementia. This was creating a difficult
and at times confrontational relationship with his son, who he lived with.
The son was finding it increasingly hard to manage his father and was in
desperate need of respite care for him. Dr Brown had known this elderly
patient for a long time and he felt that if it was only for a short period,
he would like to help out. He offered the spare room in his home for the
father to stay.
After a few weeks, the doctor discussed returning the elderly patient
to the care of the son. However, the son felt he couldn’t care for his
father any longer. The son thought that having the father stay with the
doctor had increased the patient’s aggression and the doctor had not
helped matters at all. He questioned the doctor’s motives and became
convinced that the doctor was after the elderly patient’s money and
complained to AHPRA.
The doctor was mortified his attempt to help a family in need had turned
into a complaint. He had talked through the situation with a couple of
colleagues and in hindsight, saw that his actions were not the ‘done
thing’. He phoned Avant. We set about discussing boundaries with the
doctor and pointing out that boundary violations are not confined to
Although at the time he

considered his actions were in the
best interests of the patient, the
doctor now recognises how things
can go terribly wrong.

sexual relationships. Rather, it’s a complex issue that can include business
dealings with a patient, borrowing money from a patient or even
pushing religious beliefs onto a patient. We discussed that when you play
How could this be perceived?
with the foundations of the doctor-patient relationship, no one knows
where they stand. The dynamics change: in this case the son might have
been wondering what the father was saying to the doctor about him, or
questioned if he needed to pay the doctor?
Nicole Sher BA, LLB
We supported the doctor while the complaint went through the
Solicitor, Avant Law, NSW
regulatory process and assisted him in writing his response. It included an
upfront apology from the doctor. He advised the regulator that he had
We recently had a member phone for advice about lending
also written a letter of apology to the son. AHPRA recognised that this
a former patient money. Although the doctor had not
was an empathetic doctor who had made a poorly judged decision but
maintained any sort of relationship with the former patient, the
who otherwise had no complaints in the past. The regulator deemed he
doctor became aware that her circumstances had changed.
showed remorse and had insight into his actions and for all these reasons
She was now living in a refuge with her two young children.
decided no further action was to be taken.
Concerned, the doctor contemplated lending her a few
Although at the time he considered his actions in the best interests of thousand dollars to help out.
the patient, the doctor now recognises how things can go terribly wrong
Our general advice is to avoid any financial arrangements
and others can perceive things quite differently.
with patients as it extends the relationship beyond doctor
and patient and could be seen as a way of coercing either
party to do something.
How would this be viewed by my
peers or a professional body? Being mindful
Examples of situations that may be misconstrued by the
patient include:
A cautionary tale: patient with anxiety • giving a patient a lift home in the car
A doctor was treating a patient with anxiety. To help her manage her • seeing patients outside the surgery without a clinical reason
condition he emailed her some articles and films he thought would help • telephoning the patient without a clinical reason
her understand her disorder. In reply, the patient opened up about her • having personal transactions with patients, such as
personal life and asked about the doctor’s family and other aspects of lending money
his personal life. The patient’s aunt saw some of the emails and felt the • conducting non-emergency consultations outside
doctor was grooming the patient for an inappropriate relationship and normal surgery hours
complained to the medical board. When an explanation was given, the • having conversations with patients of a personal nature.
board took no punitive action. The doctor could have avoided the stress
If in doubt, ask yourself: how would this be viewed by my peers
of a disciplinary process by recognising some of the warning signs. When
or a professional body? And don’t forget you can always contact
the patient tried to encourage more personal sharing, the doctor could
Avant for guidance.
have firmly but kindly indicated it was important not to blur boundaries.
Factors noted in claims citing boundary transgressions† Useful resources

avant.org.au/avant-learning-centre
Aggression towards patient

22% 33% Sexual transgression
eLearning course
Managing boundary issues for patients
Inappropriate examination
with mental health issues
8% Treating family member/friend
Inappropriate friendliness Article
10% Other including discussing religious views Blurred professional boundaries results
15% in consultation, violence towards patient,
12% lending/borrowing money
in doctor email privacy breach

†

Private lives
Know what’s shareable
Chad Edwards- the need to have a contraceptive procedure Life insurance inquiry
such as a vasectomy. This led to the revelation
Smith LLB, B.Nurs that he’d had an affair. Naturally, he was very
shines light on medical
Head of Medical unhappy about the result being shared with record sharing
Defence Services, his wife. The issue of providing medical records to life
WA & NT
insurance companies recently came to the
Unlawful oversharing fore with headlines such as, ‘Insurers tell life
Changing privacy laws, medical insurance inquiry that doctors are sharing full
Another case similarly demonstrates
medical histories’1. It was reported during the
data breaches and a recent the importance of having staff sign and
parliamentary inquiry into the life insurance
understand confidentiality agreements. A
parliamentary inquiry into life industry that some doctors were voluntarily
person used to work at a medical practice as a
insurance practices, has put the receptionist but left her job.
sharing some patients’ entire medical history,
issue of confidentiality back into even when they had only been asked for
One evening, her son came home and told information relevant to the claim.
the spotlight for doctors. her he was going out that night with Jane
We often hear from doctors who have been
Healthcare professionals are responsible for Jones*. The former receptionist told her son
asked to provide all of a patient’s medical
looking after some of the most sensitive he should have nothing to do with her. When
records. With life insurance companies, this is
information about patients. This extends he asked why, she said that Jane had had an
typically when the patient makes a claim on
beyond medical records to clinical images STI and had been treated for a mental health
their policy or a beneficiary makes a claim on
and discussions in consultations. Doctors and condition. This was known to her because of
a life insurance policy.
other employees need to understand their her work as a receptionist.
obligations in an ever-more connected world. Many of the medical records won’t be relevant
The son then called Jane and said not only
to the claim at all. Yet it’s likely the insurer
was he not going out with her but, because
is investigating whether there were other
Call causes relationship she didn’t tell him these matters herself, he
impacting illnesses relevant to the claim or
breakdown was going to post them on Facebook, which
even if there was a pre-existing condition.
in fact he did. Jane’s mother then complained
An Avant member performed a vasectomy on to the practice that its former employee had
a male patient who was married. The patient breached her daughter’s confidentiality.
was advised to have a sperm test sometime
The practice called Avant’s advice line and Useful resources
after the procedure to check that it has been
discussed a number of options, the first of avant.org.au/avant-learning-centre
successful, and to use contraceptive measures
which was to advise the former employee
until advised of the results.
that unless her son immediately took the Fact sheet
He had the test at the appropriate time and offending post down, the practice would seek Privacy essentials
the result came back indicating the procedure a court injunction with costs. This threat was
had been successful. Our member asked his sufficient to get the post taken down which Video
receptionist to call the patient and advise that satisfied Jane and her mother. Managing requests for medical records
the procedure had been successful and the
Privacy policies, procedures and employee
patient could stop using contraception.
training are essential to protect yourself from Case study
The receptionist rang the nominated number unlawful data breaches. Think twice before providing
and it was answered by the patient’s wife. information to police
The receptionist thought that it would be
okay to pass the message on to the wife more than
1,000
considering the close relationship she was in
with the patient. Unfortunately, this caused
a massive relationship breakdown between
the patient and his wife as she’d had a
hysterectomy two years before he had the calls to Avant in 2016
vasectomy. She wanted to know why he felt about confidentiality
1
Sydney Morning Herald, 4 March 2017

Has an insurer requested your
New privacy laws start February 2018
patient’s medical records?
We often hear from doctors who have been
asked to provide all of a patient’s medical
records where there is a claim on an insurance Paul Tsaousidis BA, LLB
policy. Doctors must bear in mind they Head of Practice – Legal, Privacy Expert
can only release confidential information Avant Law, NSW
with the patient’s consent, and in the case
of a deceased patient, that their duty of The Australian Government passed the Privacy Amendment
confidentiality survives the patient’s death. In (Notifiable Data Breaches) Bill 2016 in February to establish a
this instance you need to ensure appropriate mandatory data breach notification scheme. The legislation
consent is obtained from the executor of the covers private sector health providers.
patient’s estate.
The mandatory notification requirement will apply to ‘eligible
Doctors should consider the following before data breaches’, described as where ‘a reasonable person would
sharing full medical records: conclude that there is a likely risk of serious harm to any of the
• Has the insurer provided you with a affected individuals as a result of the unauthorised access or
written authority from the patient or unauthorised disclosure’ of personal data.
appropriate person? ‘Serious harm’ could include serious physical, psychological,
• Review the authority carefully. Never emotional, economic and financial harm, and serious harm
produce more than what the authority to reputation.
requires. Producing more than required
The new legislation does not mean every data breach is subject
would breach the patient’s privacy!
to mandatory notification. Minor breaches that are quickly
• Check the date of the authority. As a rectified and where the individual affected suffered no serious
rule of thumb if it’s more than 12 harm will not require notification.
months old it is prudent to request an
However, if there is an eligible data breach, the doctor or
updated authority.
medical practice must notify all individuals whose data were
• Is there any reason not to produce some affected by the breach and the Officer of the Australian
or all of the records? You should consider Information Commissioner (OAIC).
whether there are possible exemptions
under the Privacy Act 1988 (Cth). For The OAIC can order public or personal apologies, compensation
example, would anyone be seriously payments or enforceable undertakings. Serious or repeated
harmed by providing access or someone breaches can be referred to the Federal Court, which can
else’s privacy breached? If so, redaction impose civil (financial) penalties.
of the records may be required. The OAIC will guide a transition process from voluntary to
• If the authority request all the patient’s mandatory notification during the next 12 months, working
health information and the claim is with government agencies, business, the health sector and
for some discrete injury and there are consumers to make sure all personal information is held securely
records totally unrelated to the claim and responses to serious data breaches are transparent.
or you feel the patient may not have For more information see our news article online, Are you
an appreciation of the extent of the ready? Mandatory data breach notification.
authority, if possible check with the Visit avant.org.au/avant-learning-centre
patient that they are happy for their
entire health information to be released
to the insurer.
Access by insurers to patients’ medical
records can be a complex issue for medical
practitioners. If in doubt, call Avant’s Medico-
legal Advisory Service for advice.

Expensive mistakes
Increasing quality not penalties
expect they too will soon no longer pay for in healthcare that leverages the collegiate
adverse events. strength of the medical community.
Peter Aroney There is no doubt that the cost of funding
BComm, ACA In 2013, Avant invited Dr Gerald Hickson,
CEO complications is significant and any a world-recognised expert on promoting
Doctors’ Health Fund opportunity to reduce these costs is attractive professional accountability among doctors
to private health insurers. While it may seem and Professor at the Vanderbilt University
logical that the funding responsibility for School of Medicine in Tennessee, to present
adverse events should be with those who
In April 2016, the Council to our members about delivering a culture of
are best placed to manage the risk (that is, safety through the Vanderbilt model.
of Australian Governments hospitals), the Australian Commission on
announced proposed hospital Safety and Quality in Health Care (ACSQHC) Collaboration is at the heart of this model,
pricing reforms to reduce public found no material impact on the outcomes from the development of risk-adjusted
of care from the introduction of payment clinical data through to the network of peers
hospital funding for unnecessary
systems incorporating a quality component. working with hospital administrators and
or unsafe care and readmissions doctors to implement responses to the data
Similarly, the AMA’s submission to the Australian
to improve patient safety. These insights. It enables those doctors who are
Competition and Consumer Commission’s
come into effect 1 July 2017. Report to the Senate on private health insurance in
outliers to self-correct.
The proposed reforms include an adjustment March 2017 noted this approach has unintended The value of such a program is recognised
to the amount the Commonwealth consequences including: by Ramsay Health Care Group, who is
contributes to public hospitals for a set of • private hospitals may no longer accept implementing this model across its network
agreed hospital-acquired conditions. the more complex and therefore higher of Western Australian hospitals.
risk cases
No payment for adverse events To protect clinical freedom and avoid the
• adverse events will be hidden from the
unintended ethical consequences of cherry-
The Commonwealth’s hospital pricing reforms data, thereby undermining continuous
come after Medibank Private introduced a picking low-risk patients, it takes a community
improvement processes currently
model with Calvary Health Care which could operating in the healthcare system. of stakeholders sharing information and
see, subject to an independent clinical review working together to create a culture of
However, the ACSQHC did find evidence for
process for situations where responsibility for safety emphasising a non-punitive feedback
the impact of providing relevant and timely
adverse events was unclear, non-payment of 165 loop, transparency for doctors about their
data and information for driving safety and
adverse events that it believes are preventable. performance and access to training.
quality improvements.
Recently, Medibank said its approach had As doctors, you are best placed to ensure the
reduced ‘hospital-acquired complications’ in
A collaborative approach safety and quality of healthcare by engaging
some facilities by as much as 30%. Following At Doctors’ Health Fund, we continue to with private health insurers through your
suit, both HCF and Bupa have said they support an approach to safety and quality hospitals, peers, stakeholders and colleges.
Doctors’ Health Fund is different to other health insurers

üü We protect your needs as a consumer and as a medical professional with our unique
Top Cover hospital paying up to the AMA list of fees
üü We advocate for clinical independence and freedom of choice
üü We support only medically-evidenced treatments
üü We provide personal and professional service with a member satisfaction rating of 96%*
üü We are owned by doctors – operating for over 40 years and part of Avant
Switching is easy and takes 10 minutes. Call us on 1800 226 126 or visit doctorshealthfund.com.au
*The Doctors’ Health Fund Satisfaction Research Report 2017.
Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including
waiting periods, limitations and exclusions) of the individual policy.
Taking care of Introducing
business Avant Business Insurance.
By doctors, for doctors.
Dr Peter Walker MBBS, BSc

General Practitioner & Senior Risk Manager, NSW
After many years of medical training and clinical experience many doctors
look to fulfil the dream of running their own business. Being an expert in
medicine, though, does not automatically translate into having the knowledge
and skills to run a successful business.
Dr Nicola Denton
From the 2015 Avant member survey, 39% of fellowed doctors who responded Avant member
were owners or partners in a practice. Motivations for doctors starting their
own business include the desire for clinical and financial independence, being
able to implement innovative practice systems and the prospect of greater
financial reward from a successful and well-run practice. Balanced with the
satisfaction and self-determination that comes from being your own boss, are Avant Business Insurance is designed to
the challenges of extra admin, regulatory compliance and managing staff. A fit with your practitioner and practice
recent US happiness survey found more self-employed doctors are satisfied
indemnity for comprehensive cover
with their work than employee doctors – 63% versus 55%1 – so, clearly, the extra
effort pays off.
Robust systems and processes Insurance for your practice:

The key to successfully setting up a business is knowing what you need to know. Avant Practitioner Indemnity
For a doctor transitioning from hospital-based training and work, or from working to protect individual healthcare
as an employee or contractor, almost everything will be new. Having good professionals working in the practice.
advice is essential to establishing a professionally-run medical business. There are
myriad systems and processes to establish, not to mention legislative compliance.
Accounting, billing and Medicare systems are needed to manage the finances. Add Avant Practice Medical
Computer systems and IT infrastructure are essential to manage appointments Indemnity to cover claims against
and medical records including privacy, security and back-up. Add to this the practice entity and actions of staff
contingency planning to avoid interruptions to business should you need it. providing healthcare in the practice.
Top it off with new Avant Business

Employment and staffing Insurance with options to cover the
Avant saw a 15% increase in claims for employment matters in 2016. practice’s property, loss of revenue,
Experience managing junior doctors is different to coordinating resources income or profit, and liabilities#.
and staff with varied roles and responsibilities, all the while complying with
layers of government regulation. Contracts that clearly define roles, protect
the business and don’t contravene employment laws are essential.
For comprehensive cover for your
Going public
practice, call Avant today.
As well as looking after patients in consultations, practice owners also have a
responsibility for their safety anywhere on the premises. This goes for staff too.
avant.org.au 1800 128 268
Useful resources
If you already have, or are looking to start a practice, there are

plenty of places to get necessary guidance and support. Here are
some useful resources: IMPORTANT: Professional indemnity insurance products and the Practice Medical Indemnity Policy are issued by
Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. Avant Insurance Limited arranges Avant Business
avant.org.au/resources/start-a-practice Insurance as agent of the insurer Allianz Australia Insurance Limited ABN 15 000 122 850, AFSL 234 708. If
you purchase this insurance, Avant Insurance Limited may receive a commission from Allianz Australia Ltd.
doctorconnect.gov.au The information provided here is general advice only. You should consider the appropriateness of the advice
having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to
hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and
consider the policy wording and PDS, which is available at avant.org.au or by contacting us on 1800 128 268.
1
www.medscape.com Employed Doctors Report 2016: Who’s Happier—Employed or Self-employed Doctors? by #
This information is a brief summary only. Policy terms, conditions, limits, eligibility criteria and exclusion apply.
Leigh Page, June 15, 2016 For further details please refer to the Product Disclosure Statement and Policy Document. 1082.3 03/17 (0818)
Good advice is
medicine for the soul
Kate Gillman BA, LLB

Head of Avant Medico-legal Advisory Service
Healthcare provision requires a complex mix of skills, knowledge and experience, any one of which
can be challenged at any time. Having good quality advice you can rely on is a great comfort, as my team
and I hear every day.
Our experience helping members Here to help you

Last year the Medico-legal Advisory Service Over the past year, one in four of Avant’s
handled over 18,000 calls from members medical practitioner members called us
and their practice staff, across a wide array for immediate advice while managing an Avant Medico-legal
of matters, as the chart below shows. Every adverse situation. The increasing complexity Advisory Service
call is unique and personal for the member, of the environment doctors work in and
which is something we never forget. But for greater demands from patients and society in Expert advice whenever you need it,
our team of medico-legal advisors, we have general, are making the practice of medicine 24/7 in emergencies.
usually experienced similar situations many much more challenging. Getting good advice
times before and can use this to help doctors early provides a great deal of comfort to our
Contact us
manage their situation. callers, as evidenced by respondents to our Call 1800 128 268
annual member survey rating our advice line
From these experiences we have developed
Avant’s most valued service. Visit avant.org.au/mlas
factsheets on more than 100 topics which

can be provided to callers as a form of written We are always looking to make this service Email medicolegalenquiry@avant.org.au
advice to follow up from the discussion. even better and welcome suggestions if there
These factsheets are available on our website is a subject you would like us to provide advice Fax 1800 228 268
and include commonly raised topics such as about on our website. You can email us at
providing medical records to third parties, medicolegalenquiry@avant.org.au
repeat prescriptions and SMS messaging. or call us on 1800 128 268.
Subject of calls to the Avant Medico-legal Advisory Service (2016)
14% Complaints received by doctors Coronial

22% Clinical treatment Concern about other healthcare professional
1% Medical records Medicare
1%
2%
14% Patient relationships Capacity
2% Confidentiality Consent
3% Employment Diagnosis
4% 11%
5% Court documents Other (including calls from practices, policy
6%
7% 8%
queries and follow-up calls on existing matters)

As a doctor,
there’s a lot riding
on your good health
Your patients depend on you and your good
health to look after theirs. But what’s the back-
up plan if you’re unable to do that due to illness,
injury or death?
In your profession you would often see patients whose lives are
changed in an instant, sometimes forever. Like patients, doctors are
not immune to these unexpected events. While as a doctor you are
exposed to the same frailties of life, your vocation does present some
unique risks which can affect your ability to work and provide for
yourself and your family.
And if you run your own practice, you may also have business
partners or employees also relying on your ability to work, as you
would rely on theirs.
Life insurance can cover five areas

Life insurance, also referred to as personal risk insurance, is an umbrella Dr Matt Doane and family
term that refers to a number of different types of cover that will help
you and your loved ones manage the financial impact if you pass Trauma cover: in the event you are diagnosed with a critical illness
away or become ill or injured and are unable to work. such as cancer or experience a heart attack or stroke, you will receive
a lump sum payment. This can help you replace any lost income,
There are five types of personal risk insurance every Australian doctor provide for medical costs, allow you to take time off work to recover
should understand and consider whether they are appropriate for and support childcare needs.
them. These are:
Practice expense cover: provides a regular payment to cover
Income protection: provides regular payments to you, should you practice expenses, should you be unable to work in your practice due
be unable to continue performing in your occupation, due to illness to illness or injury. This typically covers practice expenses including
or injury. It will help you replace your income until you can return to rent, leases, loans, utility bills, salaries of non-income producing staff
work or up to age 70 and also provide financial resources so you can and the net cost of a locum to perform the work you normally would.
still afford to continue contributing to your superannuation fund and
your retirement security is protected.
Life insurance tailored for doctors
Life insurance: this is a lump sum payment made to your nominated
You, your family and your patients depend on your good health, which
beneficiaries in the event of your death. For example, this lump sum may
you can protect.
help you to clear debts or in your absence, provide funds for children’s
schooling and an income for your family. Whether you need help understanding the insurance options
available to you, have a question regarding a particular cover or have
Total permanent disablement (TPD) cover: provides a lump
complex circumstances that require professional analysis and detailed
sum payment in the event that you are no longer able to practise in
personal advice, Avant Mutual Financial Services can help.
your speciality due to permanent illness or injury. This may provide
financial resources for meeting ongoing medical costs and paying off Phone 1800 128 268, email lifeadvice@avant.org.au or
debts such as your mortgage. visit avant.org.au/life for more information.
Avant Mutual Financial Services is a registered business name of Doctors Financial Services Pty Limited ABN 56 610 510 328 (DFS), AFSL 487 758. The information provided
here is general advice only and has been prepared without taking into account your objectives, financial situation and needs. You should consider these, having regard to the
appropriateness of this advice and the policy wording and/or PDS for the relevant product (available by contacting us on 1800 128 268 or lifeadvice@avant.org.au).
States of the nation
Local medico-legal matters
There have been several amendments to state and territory legislation recently
that impact doctors. We have also seen some emerging trends in matters that
we are supporting members on. Avant’s medico-legal experts in each jurisdiction
highlight these local issues.
WESTERN AUSTRALIA NORTHERN TERRITORY

Joanne Girgenti, Senior Solicitor, WA Morag Smith, Senior Solicitor, Avant Law, WA & NT
New medicine and poison laws introduced in January in WA will Under the Northern Territory’s (NT) Motor Vehicles Act, all
help doctors prescribe controlled drugs more safely and better doctors in the NT must report patients they reasonably
identify and regulate doctor-shopping patients. The Medicine believe are ‘physically or mentally incapable of driving’ to the
and Poisons Regulations (WA) 2016 establishes a legal framework Motor Vehicle Registry (MVR). This is unlike the legislation in
for the transfer of information around prescribing and dispensing most other states, which obliges only the patient to report.
controlled drugs such as morphine and dexamphetamine, This often puts doctors in the tricky position of having to
through the use of real-time reporting systems. balance their duty of confidentiality to the patient, with their
obligation to report.
We regularly support members with issues around
prescribing and managing drug-dependent patients. Our medico-legal advisors often provide advice to members
Under the new regulations, doctors are required to keep who must undertake the difficult task of reporting a patient
more detailed information regarding the supply of S4 and as being unfit to drive. Doctors should always communicate
S8 medications to patients. The legislation also enhances their concerns about fitness to drive with the patient before
doctors’ powers to manage ‘doctor shoppers’, imposes reporting them to the MVR and document this discussion
greater penalties for prescribing to drug-dependent patients with the patient, the findings and reasons for concern.
and outlines when a pharmacist must cancel a script.
VICTORIA
SOUTH AUSTRALIA Dr Kelly Nickels, Claims Manager and Medical Advisor, VIC
Megan Prideaux, Senior Solicitor, Avant Law, SA
In a controversial move, Victoria could be the first state to
The Health Care (Miscellaneous) Amendment Act 2016, meant to legalise voluntary physician-assisted dying for terminally
commence on 1 July 2017, has been delayed until 1 May 2018. ill people. The move follows the Victorian Legal and Social
This is because stakeholders expressed concern with the Issues Committee’s Inquiry report into end-of-life choices,
wording of the subordinate legislation, the Health Care (Private recommending the introduction of assisted dying legislation
Day Procedure Centres) Variation Regulations 2017. in Victoria. A discussion paper has been released about
the proposed legislative framework. Avant has not taken
The changes prohibit ‘prescribed health services’ being
a position on voluntary-assisted dying, but has made a
carried out in private day centres unless the centre is
submission arguing that any legislation should incorporate
licensed. This was to include procedures that involve the
sufficient protections for doctors.
administration of general, spinal, epidural or local anaesthetic,
or intravenous sedation (but did not apply to the use of The Victorian Parliament is planning to vote on the legislation
conscious sedation or the administration of local anaesthetic in the second half of 2017. The legislation could have
by GPs or dentists). This would have prevented specialists and significant implications, particularly for GPs, oncologists,
other health practitioners from performing minor, low-risk or palliative care and intensive care physicians. If the legislation is
minimally invasive procedures at unlicensed premises such as passed, it should protect doctors’ rights whether they choose
private rooms, contrary to the intention of the government. to participate or not.
SA Health has taken these concerns on board, and it’s likely
the NSW approach (see opposite page) will be adopted.

QUEENSLAND NEW SOUTH WALES
Selina Hunt, Head of Practice – Legal, Avant Law, QLD Stephanie Penney, Practice Manager, Claims, NSW
Queensland’s Office of the Health Ombudsman (OHO) was New laws, which came into force in March 2017, impact medical
established to improve the management of healthcare practitioners performing cosmetic surgery in NSW. Any facility
complaints in Queensland. However, in our experience, the where cosmetic surgery is done is now subject to the same
system has led to some duplication and longer timeframes. licensing rules as other private health facilities.
A Queensland Parliamentary committee examined the The regulations were tightened up to protect patient safety
operation of the OHO in an inquiry last year. We made and mean certain cosmetic surgery – which previously may
a submission and gave evidence to the inquiry. We have been performed in unlicensed ‘day surgeries’ – can now
recommended the adoption of a joint consultation process only be performed in licensed cosmetic surgery-class private
for health service complaints between AHPRA and OHO health facilities.
and integration of their processes to improve efficiency and
Facilities must now comply with general licensing standards
timeliness of complaints handling, for early clinical input into
for all private health facilities and anaesthetic standards
complaints to ensure matters can be dismissed at an early
in accordance with Australian and New Zealand College
stage, where appropriate.
of Anaesthetists’ recommendations for administration,
The committee released a report last year containing monitoring, recovery and staffing.
recommendations which reflected, to a large extent, the issues
Members need to ensure that facilities where cosmetic surgery is
we had raised. We expect that the Queensland Government will
undertaken are licensed under the Private Health Facilities Act 2007
consider amendments to the legislation mid-year.
(NSW) and Private Health Facilities Regulation 2010 (NSW).
Cosmetic surgeons should also update their policy and
procedures, patient information brochures and advertising
material to reflect the changes in their practice.
TASMANIA
Alison Fitzgerald, Head of Medical Defence Services,
TAS & SA
Amendments to the Mental Health Act 2013 will provide clarity Australian Capital Territory
around the involuntary assessment and treatment of people
Harry McCay, Senior Solicitor, Avant Law, ACT
with mental illness in Tasmania.
Being based in Canberra and having a strong relationship
The Mental Health Amendment Bill 2016 streamlines the process
with organisations such as the AMA ACT, Avant has a good
doctors must follow when making an assessment order.
understanding of issues affecting ACT doctors. Recently, we have
Currently, doctors must possess an application before an
noticed an increase in patient suicides in the ACT, resulting in
assessment order can be made, which can lead to delays in
more doctors requiring our support in coronial investigations.
the assessment of critically unwell patients. The Bill addresses
There were 44 active coronial claims for Avant members
this issue by allowing doctors to make an assessment order
between November 2016 and January 2017 in the ACT.
without an application. The amendments also remove some
of the authorisation requirements in relation to treatment in
urgent circumstances and require the mental health tribunal to
review a treatment order within 60 and 180 days after it’s made.
Treatment orders were previously reviewed within 30 and 90
days. But feedback suggested there was often little change in
the patient’s condition or treatment needs between an order
being made and the 30-day review. Feedback also suggested
that the reviews are resource intensive and the time required
from clinicians to prepare and attend hearings can unreasonably
impact on the time available to provide adequate patient care.
The Bill is expected to be introduced soon and should simplify

the authorisation process for doctors, particularly those in
remote areas.

Avant Life Insurance. By doctors, for doctors.
Dr Matt Doane
and family
Australia’s most comprehensive

life insurance protection for doctors*
*As assessed by the expert life insurance research company DEXX&R
Dr Matt Doane
Avant member
Because we understand a doctor’s insurance needs are unique, we have developed a comprehensive suite of life insurance products
especially for doctors, which include:
• cover for a doctor’s chosen specialty even if they can perform other medical duties
• flexibility to adjust coverage when personal or professional milestones occur without requiring additional medicals
• an Australian first – litigation support to supplement a member’s lost income should they be subject to a medico-legal event
• doctor-specific benefits to protect the risks practice owners face.
And much more... You can find a list of all the features and benefits at avant.org.au/life
Don’t wait until it’s too late. Make sure you are covered for the unique risks you face as a doctor. Call us today.
To find out more, contact Avant Life Insurance:

1800 128 268
avant.org.au/life
“Avant Life Insurance” is a registered business name of Doctors Financial Services Pty Ltd ABN 56 610 510 328 (DFS). Life risk insurance products are issued by NobleOak Life Limited ABN 85 087 648 708 AFS Licence
Number 247 302 (NobleOak). General insurance products and this brochure are issued by Avant Insurance Limited ABN 82 003 707 471 AFS Licence Number 238 765 (Avant). DFS provides administration services
in respect of your insurance cover on behalf of Avant and NobleOak. Cover is subject to approval, and to the terms, conditions and exclusions of the plan. The information provided here is general advice only and
has been prepared by Avant Insurance Limited without taking into account your objectives, financial situation and needs. You should consider these, having regard to the appropriateness of this advice and the
product disclosure statements for the relevant product, which are available by contacting Avant on 1800 128 268 before deciding to purchase a plan with us. 1334 03/17 (0798)

Issue No 8 Maintaining Professional Standards

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South Australia Office

Western Australia Office

Connect | Issue 08 | avant.org.au/publications 1

2 Connect | Issue 08 | avant.org.au/publications

10 Medicine is a team sport: collaboration matters

12 Make a note: it’s your best defence

16 Communication breakdown: the art of maintaining trust

10 Doctors are constantly meeting patients and co-workers with

20 Going too far: caring acts can compromise

22 Private lives: know what’s shareable

ALSO IN THIS EDITION

Connect | Issue 08 | avant.org.au/publications 3

colleagues and patients.

Increased calls to our Medico-legal Advisory Service on professionalism-related matters

12% 29% 20% 43% 17%

Increased need for support†

Australian Institute of Health and Welfare, aihw.gov.au/workforce/medical/who

4 Connect | Issue 08 | avant.org.au/publications

‘Chaperoning inconsistent with expectations’, Paterson report

Connect | Issue 08 | avant.org.au/publications 5

Helen Turnbull BA, LLB

*Names have been changed

6 Connect | Issue 08 | avant.org.au/publications

The five complaints

Same outcome every time – no further action

Connect | Issue 08 | avant.org.au/publications 7

*Names have been changed

8 Connect | Issue 08 | avant.org.au/publications

Dos and don’ts of ending doctor-patient relationships

Connect | Issue 08 | avant.org.au/publications 9

No joke for colleagues

10 Connect | Issue 08 | avant.org.au/publications

Factors in claims citing workplace behaviour issues†

52% 25% 23%

Based on a sample of 3,110 Avant claims from 2015 and 2016

Connect | Issue 08 | avant.org.au/publications 11

claims made against doctors.

Changing the record

*Names have been changed

12 Connect | Issue 08 | avant.org.au/publications

The Avant team

Find out more: 1800 128 268 avant.org.au

14 Connect | Issue 08 | avant.org.au/publications

Understanding the Aboriginal

during handovers our elder Aboriginal colleagues who were

Connect | Issue 08 | avant.org.au/publications 15

Alison Fitzgerald LLB, BA(Jur), LLM

*Names have been changed

16 Connect | Issue 08 | avant.org.au/publications

What could have been done differently?

30% of claims relate to communication†

Connect | Issue 08 | avant.org.au/publications 17

Dr Wagaarachchi gives an example of

Avoiding patient distress

18 Connect | Issue 08 | avant.org.au/publications

Inevitably, this variety

In 2015, a quarter of physician Factsheet

Based on a sample of 3,110 Avant claims from 2015 and 2016

Connect | Issue 08 | avant.org.au/publications 19

Dr Kelly Nickels MBBS (Hons), FRACGP, M Hlth & Med Law

Doctors see their fair share of people in difficult

Care for the elderly

Although at the time he