‘You are not alone’

Former MIGA CEO Mandy Anderson shares her thoughts on the challenges and opportunities facing medical practice.

If medical results are generated by artificial intelligence and medical reports are constructed by Chat GPT and they are found to be inaccurate, who is responsible?

This is the type of question facing medical indemnity insurers, regulators, practitioners and patients in the unchartered territory of artificial intelligence (AI) applications in medicine, says medical indemnity specialist Mandy Anderson.

Having recently stepped down from her role as CEO and managing director of Medical Insurance Group Australia (MIGA) after 23 years with the organisation, Ms Anderson says the medical indemnity landscape is more complex than ever.

AI looms large on the horizon – as it does elsewhere – but managing the potential for harm and the implications for insurance are nowhere more difficult than for the medical profession, she says.

It is critical, she says, that regulators, key colleges and insurers in Australia seize this moment before AI becomes ubiquitous to set parameters around its use and clarify areas of responsibility and liability.

‘Radiology firms are already looking at using AI to assist with results and, in the US, some are using it to help with reports,’ she notes. ‘How do you make sure the information is right and, if it is wrong, who gets sued? How do you sue a machine – what if the machine has been wrongly calibrated, who is responsible?’ she asks.

Equally challenging are issues around quality assurance for cosmetic medicine and the changing nature of medical practice.

‘Regulation becomes particularly important in defining the scope of practice that is acceptable, the qualifications needed and the standards for the facilities where procedures are performed,’ Ms Anderson says. ‘The Medical Board and (Australian Health Practitioners Regulation Agency) Ahpra have done good work to date on this but there is more to be done.’

The medical indemnity sector is also grappling with the growing number and cost of claims, which is likely to result in rising premiums. This is partly driven by changing consumer expectations, Ms Anderson says.

‘When something goes wrong, people (now) want more and expect more, and cost-of-living issues mean they are more focused on that than they used to be.’

While data shows the more empathetic and understanding a doctor is towards a patient, the better the outcome if something goes wrong, time and financial pressures may mean they are unable to deliver the desired level of personalised care.

‘The average doctor would say, “I need more time”,’ says Ms Anderson.

In this environment, burnout and fatigue among doctors is a significant issue, she warns. ‘When we are dealing with an environment where there are resourcing issues, workforce shortages, burnout and fatigue, things will go wrong - and they do.’

Fewer practitioners are wanting to work fulltime and even fewer want the responsibility of owning a practice, she says. New

Anderson

models of work practice are being developed to manage risks associated with part-time work. Corporate models are evolving to ensure continuity of care around results and referrals, for example, she says.

Workforce challenges are even more significant in rural and remote practice. As a recent appointee to the Board of the Australian College of Remote and Rural Medicine (ACRRM), these challenges are front of mind for Ms Anderson.

‘Resourcing is a challenge for general practitioners generally and even more so for rural practitioners. The fact that obstetric services are no longer available in many rural communities is very concerning for the families impacted. Increased focus at state and federal levels on the provision of those services is so important to maintain critical services for rural and remote communities,’ she says.

Given the challenges that many doctors face, she says, it is important for them to understand the support available when things go wrong. Keeping abreast of guidelines and communication about regulatory changes from Ahpra and the Colleges, and accessing resources offered by your medical indemnity insurer are particularly important, says Ms Anderson.

Medical indemnity insurers such as MIGA provide a 24-hour service staffed by experienced internal lawyers who can provide advice, support and guidance.

‘If something has gone wrong or you are worried, ring and get help – the lawyers will guide you and provide support as well,’ she says. ‘It’s important for a doctor to be aware help is there and you are not alone when there are complaints and other problems.’