Complaints under consideration

Medical Board of Australia Chair Dr Anne Tonkin says the Medical Training Survey has important results for clinical workplaces.

As chair of the Medical Board of Australia, Dr Anne Tonkin is the among the first to admit there are many myths and legends surrounding the regulation of professional standards.

Yet Dr Tonkin is quietly confident that when her term concludes at the end of 2024, the regulator will have significantly improved the complaints process experience for most health practitioners as well as patients and their families.

During her term of office, Dr Tonkin has sought to de-mystify the process –particularly around mandatory reporting and the recent measures to enable the publishing of the names of practitioners considered to be a danger to the public.

‘I’ve been working very hard to try and put a human face to the process that isn’t too scary,’ she says. ‘We’ve made a lot of progress in that direction.’

Many clinicians have expressed concerns that the rules around mandatory reporting mean doctors should fear sharing their mental health or addiction challenges with their general practitioners. But Dr Tonkin says nothing could be further from the truth.

‘One of my goals is to reduce the fear of mandatory reporting and have people understand that if they have a mental health issue of any kind the best thing is to get help early before the health issue becomes an impairment,’ she says.

‘We don’t need to know about health issues at all – we only need to know when someone is impaired to the point when they are a danger to the public.’

Patience in reiterating the message in a range of forums – from conferences to medical defence organisations – and with different parts of the profession has been the key to putting a human face to the regulatory process.

‘I’m trying to get that message out but there’s a lot of myth and legend out there and I’m trying to counteract it,’ she says.

The complaints process is not intended to be punitive, she explains, but the job of the MBA is to take action only if required to protect the public.

If a doctor has taken steps to ensure a mistake is unlikely to recur, the regulator needs to take no further action.

Also unfounded, she says, is fear surrounding the new amendment to the National Law to allow the names of practitioners to be published before a complaint has been finalised. Dr Tonkin says the provision is only likely to be applied where unregulated practitioners pose a threat to public safety.

She says that of the 6,000 complaints the Australian Health Practitioner Regulation Agency (Ahpra) receives each year, it is likely to be applied to fewer than five.

‘There are strict legal considerations about when you can do it and when you can’t; it would be taken very seriously. There seems to be a sense out there that everyone who gets a notification would be named and that’s absolutely not what it is going to be,’ she says.

She also denies that the complaints process is used as a weapon in professional rivalries and that the system is weighted against doctors.

The vast majority of complaints come from patients and their families, says Dr Tonkin, and there are measures in place to test the motivation of complaints by practitioners with sanctions for those using complaints maliciously.

Ahpra is also working hard to reduce the complaints process timeframes and a new IT system to be introduced in the next six months aims to help practitioners monitor the progress of complaints.

‘There are signs that the MBA’s partnerships to improve the culture of the medical professional are having traction, says Dr Tonkin. A key part of this has been the Medical Training Survey, which has been valuable in demonstrating the impact of poor culture in some organisations.

‘First Nations trainees are reporting bullying harassment and racism to the level of over 50% whereas the incidence among other trainees is around 33% or so,’ Dr Tonkin says. ‘(The survey finding are) making overt things that have been a bit covered up.’

The feeling at the recent Doctors Health and Wellbeing National Alliance, hosted by the Federal AMA, was that there is a willingness at high levels to do something to improve the culture of health organisations – valuing people and ensuring good working conditions to prevent bullying, she says.

‘There is a real sense that the time for talking is over and the time for doing is here. I’m really optimistic that we are about to see some changes.’

There’s still plenty more work to be done though, says Dr Tonkin. The challenge of regulation is to predict the next challenges to medical professionalism. Issues such as on-demand e-prescriptions, cosmetic injectables and artificial intelligence are already posing issues that will require regulatory attention.

‘Rules around professionalism haven’t kept pace with the changing business models,’ she says. ‘We must keep updating guidelines to help practitioners stay within the professional boundaries the profession needs.’