The Background:

Complaint letters have skyrocketed. This leads to many practitioners needing to defend themselves against unproven complaints, often where the patient has decided that it wants to punish a doctor for not giving it whatever it may want. AHPRA’s stance in my opinion appears to be that every complaint is against a “guilty” doctor. And if they will not confess and plead guilty they are obviously lacking insight and deserve a double penalty especially if they legally contest any of AHPRA's actions.

Not acceding to Inappropriate or dangerous requests from patients - often still leads to doctors being accused of failing to meet professional standards by AHPRA. Failing to give a patient amphetamine for their self-diagnosed adult onset ADHD can lead to punishments for inappropriate professional care, failure to provide care, and the old favourite- inadequate notes- and more.

Not acceding to obnoxiously insistent illegal requests from patients can lead to the doctor being accused of being rude to patients and hence breaching medical standards of professionalism by AHPRA. Good for a medical education punishment. An Educational Punishment may not be extremely expensive, but a mentoring punishment will be: probably up to 30K direct and the same indirect costs.

 

Placing your hand in a place where a patient may take objection, can be a career ender. To auscultate a heart or even worse to look at the physical signs of illness in a patient with a groin or gynecological complaint can be a career ender. Need to do a bimanual examination to sort out a complaint of pelvic pain. This may well be the final act of your career. One of my friends stated that he would rather be assessed by AHPRA for negligence in performing NO examination whatever, than face attempting to defend a complaint of inappropriate sexual conduct. Your hand was where, doctor?  And this affects women doctors as well. (Remember that gay men/ straight women probably will not be too happy with the examining hands of female doctors, as well).

Some legal and medical colleagues of mine insist every medical consultation should be video/ sound recorded as part of “your” own record.
Innocence is not an adequate excuse.

I have heard of the case of a doctor in emergency. (Current media). He had never been faced with a complaint ever before. A patient attended Emergency for atypical chest pain. The doctor as part of the extended workup did a breast examination. The patient complained-“Was permission for an examination obtained?” 

The request for permission and the response to this question was not documented. And even if it were, why bother to believe it anyway?  The doctor was immediately-suspended - prevented from working by AHPRA.  AHPRA had immediately concluded that he was a sexual offender. Career on the line! He decided that he was seriously going to consider not working rather than face any further action by AHPRA. I believe he was eventually given a suspension from work of two years.  Subsequently, I believe he then won his appeal against the AHPRA decision- but at considerable expense of time, effort and money. And at a cost of two years’ work.

I doubt if compensation was ever paid.
And the really sad thing is that most patients in this situation WANT to be examined - they want everything that modern medicine can give them. But doctors are becoming afraid to do it.

The new world order is not for doctors who are fragile psychologically or thin skinned. Each of these complaints when investigated exacts a severe psychological, financial and time toll on its doctor victims. Their families as well.

Complaints from flagrantly mad people are investigated with the same intensity as real problems. For example, I know of a psychiatric doctor who was accused of being a witch by a psychiatric patient. The investigation process was brusque and aggressive.  AHPRA was unable to validate this complaint in its investigations but still caused immense grief and triggered a lot of medical defence involvement in its defence. I would consider him lucky not to have been accused of being a warlock. AHPRA would have perhaps more justification in acting against the doctor if he were accused of this. But what does the accusation of being a “witch” mean in medico-legal terms. Where exactly is the malpractice, the need to defend the community, the need to maintain professional standards? 

In the long run, medical defence premiums for doctors will rise by thousands of dollars per annum with the AHPRA policy of full investigation of all complaints- even obviously vexatious complaints. And you - the fool- will pay for it all. The police do not investigate and action every single complaint, but bad mad AHPRA does.
If the government helped set up this debacle, they can bloody well pay for it.

So what we are facing is an automatic judgment of guilt, in a system of no appeal with “official” staff assisting in the optimisation of complaints. (AHPRA staff will help a complainant to write a complaint). Even the craziest complaints are treated as valid, with the doctor at fault, if not for the original complaint, then for whatever can be found. Doctors are losing the capacity to do their jobs. And your medical records are probably no good as well. (The punishment for this with education, mentorship and auditing could well set you back 30k+, not including your time and lost productivity).

 

 

Other complaints dealt with by AHPRA:
A child molester was describing his activities to a doctor in detail. The doctor told the patient that what he was doing was wrong. He earned a reprimand from AHPRA. Apparently it is not appropriate for a medical practitioner to tell a paedophile that it is wrong to molest children! I wonder what AHPRA would say about racial vilification and hate crimesperpetrated by patients. The doctor should be more understanding, perhaps.

A doctor was reprimanded when his staff objected to a patient entering their GP clinic, ignoring signs to not attend the practice if they had Cough or cold symptoms. The patient failed to wear a mask, then coughed and asked for a CoVid test. The doctor, absent for the entire encounter, was taken to task by AHPRA for refusing the patient access to the practice and being rude for asking them to leave the practice.

AHPRA routinely uses medical records assessments as a method of convicting doctors of inappropriate professional standards. Miss recording a Family History or an allergy, and you could win registration conditions such as compulsory education, mentoring and audits. This generates probable direct costs of the order of $30,000 plus the cost of your time and your productivity lost, (conservatively $30,000 - up to 60,000 depending how you account for it), as well.

 

 

So where does this get us?

AHPRA is a regulatory body entrusted with special powers and rights, charged with protecting the general public. This special position is UNASSAILABLE by doctors through legal avenues. There can be no dissenting opinions because the law says that AHPRA is always right.

So few appeals succeed that Medical Defence refuses to fund them.
However the underlying assumption is that AHPRA is doing an impartial and fair assessment of the complaints tendered to it. It is acting righteously in the pursuit of its duties.

 

So let‘s default to reality.
You are guilty whenever a complaint is made.
The slightest claim of inappropriateness is likely to see you instantly suspended and not working for 1-2 years. (You could achieve this by touching a groin, knee or chest).And this is a problem not just for the men.  
If the complaint cannot be proven, default to a medical records assessment to “prove” guilt for “something” and to earn a punishment (value 30-60k).
Judgments cannot be appealed through the courts process. 
Medical Defence Organisations refuse to fund any appeal. Going the court route always fails and at a very high financial / time / effort cost borne entirely by you.

 

It is inappropriate for a regulatory body such as AHPRA to have “BIAS”. It is expected by the medical profession that AHPRA will conduct its activities with fairness, reasonability and appropriateness. What occurs instead is a punishment metered out on the basis that the patient is always right.

One doctor reports that AHPRA failed to find any evidence of inappropriate narcotic prescribing in the context of a complaint. Subsequently AHPRA conducted a systematic investigation of every script for every patient for two years until a fault was found. The crime was a failure to seek a second opinion on the continued prescribing of an S8 within three months, around the time when the rules were changed allowing for twelve month review, instead of three month reviews. AHPRA can and did choose to use the three month standard as a basis of conviction even when not appropriate.

In this circumstance, AHPRA went beyond the scope of the complaint with activity and investigation focussed on finding fault at all costs and then inflicting its usual punishment of compulsory education, mentoring and audits.(As usual - with a cost to the practitioner of $30,000 plus time/productivity lost- probably another  $30,000).

 

Medicine is a complex profession whereby mistakes are made in clinical aspects and paperwork daily. A better administrative outcome is possible if every consultation were half an hour. The country cannot afford this largess.

Doctors should not be convicted for practicing in a “normally” responsible manner. A single mistake or a few is human nature. The aim of regulation is to address people who have decided that they will know NO boundaries- ever. The aim of regulation is not to allow everyone to be convicted on the whim of an unsubstantiated complaint to an organisation that prejudges your guilt with a yawn of disinterest. Such an organisation commits the crime of “Bias”.

 

 

 

 

 

 

Another issue is that there are probably too many rules if a doctor faces fines and convictions several times a day for breaching any one of a legion of restrictions.

Examples of rules:

Authority Script Restrictions,
S8 restrictions on need for review of appropriateness of prescribing
Restricted S4 rules even for drugs such as antibiotics (I doubt any doctor would even consider prescribing any antibiotic that  they did not believe was absolutely the best/most appropriate/  most necessary or most essential medication for the job).

Unofficial Prescribing Restrictions such as
GPs should not prescribe many different antidepressants to children,
GPs should not prescribe cough medicines available OTC or decongestant nosedrops to children.
All gloriously undocumented rules that never appear in any medical publications but that AHPRA has a lineup of professionals who did a weekend course on the matter ready to judge you guilty of.

The fact that these medications worked well and that the patients are grateful is no defence. Obviously AHPRA would say that - you are dangerous to the public,
lack insight and would punish you twice as much.

 

(I would say that many doctors have years of study and experience to know that a medicine is likely to work and to be safe working in specific circumstances. And if it works, giving a good outcome, that is an adequate defence. Yes there may be other avenues of treatment, but if a doctor's professional considered judgment gives a good result, how can you justify punishing them).

AHPRA can and will.

 

GPs cannot read ECGs so cannot charge for them.
Pathology and imaging funding/ rebate restrictions on ordering tests.
Etc.

A disclaimer by AHPRA that “ we understand how difficult these situations can become” means nothing  when used as an abrogation of responsibility by a callous aggressive  biased pack  of thugs , their protection enshrined in laws that brook no challenge or dissenting opinion of their actions. Its the sort of things Domestic Violence Perps say all the time. Yes they are sorry. But they keep on doing it anyway.

AHPRA routinely makes decisions and then investigates until something is found for which the doctor can be accused of being guilty. AHPRA loses any credibility as an impartial judge by its actions.

 

 

 

Could It Happen To You? Surely Not?

It couldn’t happen to you, you say. In talking to a medical defence representative, the rep mentioned that she put together learning summaries for about 20 doctors per week to submit to AHPRA. She was quite proud of her work, submitting the information to AHPRA in a format that the organisation liked. 

But just think about what she has just said. Assuming two main medical defence organisations in Australia, this means that about Two Thousand doctors per year are being given “education” conditions.

Remember that the patient does not need to be either sane or right to be judged correct. Any conviction by AHPRA may not even be in relation to the complaint made. AHPRA just keeps on searching for evidence of something wrong and then convicts you of this.

Two thousand doctors per year apparently are breaching rules and doing wrong. And they are too embarrassed to speak out. And the stupidity of the underlying complaints rarely emerges into public view. Good for AHPRA.

 

 

AHPRA has in my mind lost its halo of being a regulatory body concerned with the maintenance of Professional Standards. It is a BIASED prosecutory body intent on applying punishments and on forcing doctors out of the medical profession. And some doctors more than others.

It is creating an environment whereby doctors are afraid to examine patients and would rather be negligent not examining a patient rather than risk accusations of inappropriate behaviour with career ending consequences. Its actions far from protecting the public, are actually endangering the public and leading to a reduction of professional standards. The world and patients may be better off without these guardians of god knows what, from hell.

There are patients complaining about the effects of AHPRA's actions on their doctor as well. The system currently sweeps them under the carpet.

So the Call to Action

He picked up a bullhorn and jumped up on the hay
We are free roving med bovines, we run free today
We will fight for med bovine freedom
And hold our large heads high
We will run free with the Buffalo, or die
Docs with guns.

So what should we do?

Go forth, crash the gate in a great stampede
Tip over a milk truck, torch all the feed
Docs have fun.