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Older male doctors face scrutiny

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Older male doctors who have been the subject of several patient complaints could be targeted as part of proposals to “proactively” identify those most likely to pose a risk to patients.

Members of the medical profession would be profiled on their propensity to provide sub-standard care as part of a two-pronged process to support quality care and protect patients set out by a group of experts advising the Medical Board of Australia on the revalidation of doctor skills and knowledge.

A discussion paper on options for revalidation, issued by the Medical Board on 17 August, proposed that doctors undertake a ‘strengthened’ CPD [Continuing Professional Development] program. Simultaneously, there would be a “proactive” screening process to identify and assess doctors who may be performing poorly and pose a risk to patients.

“CPD alone, however rigorous, may not identify the practitioner who may be putting the public at risk. A regulatory approach, however thorough, cannot reliably, single-handedly improve the quality of care provided by most competent doctors,” the Revalidation Expert Advisory Group said in a report which formed the basis for options canvassed in the discussion paper.

The expert group recommended that all practitioners undertake evidence-based, profession-led CPD activities that, in addition to attending conferences and workshops, would involve peer review of performance and medical records, feedback from patients, clinical audits and comparison of data with local, regional and national outcomes.

Medical Board Chair Dr Joanna Flynn said the intention was to keep the public safe and manage risk to patients, and “part of this involves making sure that medical practitioners keep their skills and knowledge up-to-date”.

The recommendations come amid concerns that regular reports of misconduct by a small number of doctors are undermining public confidence and damaging the reputation of the medical profession.

In an interim report to the Medical Board, the Revalidation Expert Advisory Group said international evidence showed that only about 6 per cent of doctors provided sub-standard care.

The group said it was critical to “develop accurate and reliable indicators” so that practitioners who were performing poorly and posing a risk to their patients could be identified and helped before they harmed anyone.

“Prevention is better than cure,” the group said in its interim report, setting out the characteristics international experience showed were most common in those likely to pose a risk to patients, including:

  • being 35 years or older (with the risk increasing as age advances);
  • being male;
  • number of prior complaints; and
  • time since last complaint.

The interim report said studies had identified a number of additional individual risk factors, including:

  • doctors getting their primary medical qualification in certain countries (not specified);
  • specialty;
  • failing to respond to feedback;
  • an unrecognised cognitive impairment;
  • practising in isolation;
  • few high quality CPD activities; and
  • a change in the scope of practice.

“We propose that there is now enough evidence to trigger discussion and draw on insights available about how various risk factors might be used to proactively identify practitioners at risk of poor performance,” the export group said.

Once groups of at-risk practitioners were identified, it was important to determine which individuals actually posed a threat to public safety.

Just because someone was in an at-risk group did not mean they were underperforming, the interim report said, emphasising that early detection and remediation was preventive and should not be punitive.

Those identified as underperforming would face a “tiered approach” of assessment, scaled to match the level of potential risk.

It would start with specialty-specific “multi-source feedback” involving input from colleagues, patients and co-workers – a process the expert group judged would be effective many cases in returning doctors to safe practice.

Doctors assessed as posing a greater threat could face peer review of their medical records, and practice and outcomes data.

Those determined to be the greatest risk to patients would face “extensive performance assessment”.

The Medical Board said the proposed changes would not have “a significant impact” on doctors already undertaking effective CPD activities, though some would need to change their focus to include performance review, outcome measurement and validated educational activities.

It likened the profiling used to identify at-risk practitioners to disease screening tests.

“Most of the practitioners in the at-risk groups will be able to demonstrate that they are performing satisfactorily, just as most people who are screened in a public health intervention do not have the disease for which the screen program is testing,” the Board said.

The Board has appointed a committee to conduct consultations with the medical profession and the broader community regarding the revalidation proposals.

Those interested are invited to participate in online discussions, take a short survey and provide written submissions. The deadline for feedback is 30 November this year,

The Revalidation Expert Advisory Group will provide a final report to the Board in mid-2017.

For further details, including copies of the discussion paper and interim report, go to: http://www.medicalboard.gov.au/News/Current-Consultations.aspx

Adrian Rollins