Code of Conduct changes spark 700 submissions

THE Medical Board of Australia has been inundated with submissions on the proposed update of the doctors’ Code of Conduct, receiving about 700 submissions and counting.

One day before the closing date of the consultation on Good medical practice: a code of conduct for doctors in Australia (June 2018), a spokesperson for the Board said it welcomed the “massive” number of submissions.

“The Board is very grateful for the response that it has received [to date], with submissions coming from the medical community and organisations, as well as individual medical practitioners,” the spokesperson said. “Some of the responses are very thoughtful.”

In June, the Board invited the profession to provide feedback on the proposed changes. The Board said it was “not proposing significant changes” to the current code, and any impact on practitioners was expected to be “minor”.

Key changes included:

  • strengthened guidance about discrimination, bullying, sexual harassment and vexatious complaints;
  • changes to the section on culturally safe and sensitive practice to be clearer about the responsibilities doctors have to provide care that is culturally safe and respectful and to support the health of Aboriginal and Torres Strait Islander peoples;
  • expanding sections on professionalism and patient safety; and
  • new guidance on career transitions for doctors.

In a letter to the Board, published on the Australian Medical Association (AMA) website, AMA President Dr Tony Bartone raised “significant concerns” about the tight timeframe of the consultation period. He wrote that even seemingly minor changes were important and required sufficient time for consideration and response. The Board subsequently extended the consultation period from 3 August to 17 August.

In his letter, Dr Bartone expressed several other concerns about the proposed changes, including the use of “vague, ambiguous” statements in the code, as well as possible “overreach” by the Board in respect to a section calling for doctors to consider the effects of their comments and actions “outside of work, including online,” on their professional standing and on the reputation of the profession.

“The intention of this statement is unclear and may be considered by some doctors to be a significant overreach of the Board’s authority. It could be interpreted as trying to control what doctors say in the public arena by stifling doctors’ right to publicly express both personal and professional opinions while also undermining doctors’ contribution to the diversity of public opinion, debate and discourse,” Dr Bartone wrote.

“It would be unprecedented for a regulatory authority’s Code of Conduct to attempt to control a doctor’s public expression of opinion in a context which may not impact on the standard or quality of direct patient care or the wider health system nor reflect a lack of medical professionalism.”

In the RACGP’s submission, President Dr Bastian Seidel said the College was supportive of most of the changes to the code, however it identified several issues that required further consideration before the code was finalised.

In relation to the section that states that “recognising the impact of fatigue on your health and your ability to care for patients, and endeavouring to work safe hours wherever possible”, the College said it was important to also recognise the system and institutional influences on a doctor’s ability to manage their own fatigue.

Dr Seidel also wrote in the submission that the College had previously raised frustrations regarding the code’s inability to identify health practitioners’ responsibilities for follow-up of health services or tests they have ordered. He said this was particularly concerning for GPs who, as central co-ordinators of care, often referred patients to other health professionals.

“Responsibility for the timely review and action on tests and results ultimately rests with the health professional who ordered the test. However, expectations of who is responsible for follow-up can become blurred – especially if the patient’s interaction with the secondary service is ad hoc,” Dr Seidel wrote.

“The code should explicitly outline that medical practitioners have responsibility for following up the health service they initiate. This will ensure that GPs are not expected to follow up tests (or other services) that they may not be aware of.”

Writing in Croakey on 9 August 2018, Professor Stephen Duckett, Director of the Health Program at the Grattan Institute, pointed to several gaps in the proposed code, and suggested the addition of subsections to address concerns of overdiagnosis, overintervention and patients’ out-of-pocket costs.

“Doctors, especially GPs, should be aware that some patients may face financial difficulty in paying for the tests they order, the prescriptions they write, and the specialist referrals they make. Patients can be faced with invidious decisions about which prescriptions to fill or which diagnostic tests to have,” Professor Duckett wrote. “The Code of Conduct should require doctors to consider this issue.”

Professor Richard Murray, President of Medical Deans Australia and New Zealand, said that the changes to the code were part of a national and international trend to more explicitly specify the expectations of professional behaviour of medical practitioners and other health professionals.

“That’s something that we strongly support in the business of medical education and training,” said Professor Murray, who is also Dean of Medicine and Dentistry at James Cook University.

“There is a continual evolution of these documents, often in relation to new thinking or new insights around what should be explicit in such statements. Many of the [areas] that are being strengthened in the code – issues around professionalism, bullying and harassment, and patient safety – are all on our agenda.”

Professor Murray also welcomed the draft code’s recognition of medical practitioners’ professional obligation to teach, supervise and assess students and junior doctors.

“This is a strong tradition in medicine, so making that an explicit expectation in the Code of Conduct is something that we welcome,” he said.

Professor Murray said that a clear Code of Conduct was crucial in reinforcing the “social contract” between medical practitioners and the community they served.

“A medical practitioner is granted by society the privilege of having a protected status and title, working in a field where there is a lot of reliance on self-regulation, and, in return, society is absolutely entitled to expect altruistic service where the patient and community come first,” he said. “So, we strongly support the code’s role in supporting the profession to honour that contract.”

The Board spokesperson said it would be some time before the updated code would be finalised.

“Due to the large response, [the Board is] going to take time to consider each response,” they said. “It’s important not to rush this. The Board wants to be sure that all responses submitted are considered and any concerns raised are taken on board.”