Medical regulation: Scapegoats and blame shifting

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Scrutiny in the medical profession and the introduction of a national database should be transparent and subject to safeguards, says Dr Don Kane.

The Australian recently published an exclusive article by Katherine Towers, ‘Negligence shouldn’t be hidden'. Two “leading medical negligence lawyers” are quoted as the source for the content of the article.

It was certainly exclusive but in a democracy – that presumably still exists in Australia – why not be inclusive? Why not include all professions?

The medical profession is regulated, frequently members are identified in the media before the true facts of cases are known and its fees for services are constantly under review. The Medicare rebate schedule is incorrectly identified in the press as a fee, whereas it is a rebate from Medicare and not a fee. No other profession is exposed to such “independent” scrutiny.

It begs the question,

“Why not include all professions?”

The aim to expose practitioner malpractice in any profession is laudable provided the system is fair, transparent and provides due process, natural justice and presumption of innocence until rigorous investigation discloses all the facts and the truth.

In order to achieve these goals, protective caveats should be considered:

  • The system must be faultless.
  • Authorities vested with the responsibility to assess performance need to investigate complaints to identify the veracity of the claims before taking action.
  • The investigation should be done by a completely independent panel of peers, approved by both parties — individuals who perform the same tasks as those of the "defendant". 
  • Representation for “defendants” of complaints should be by experienced agents familiar with the workings of the field involved.
  • An appeal process is essential to ensure that any adverse findings can be challenged and are verified.
  • The decision to take action should be conveyed to the subject of the investigation before put in place and applied only after any appeal proceedings.

No single profession should be exempt from this scrutiny. Exposure on a national database may be justified, but only if the database is created so that all contributors to the process of reaching the decision are held accountable for their part if adverse findings are the outcome. There should be no exemptions for any individuals or organisations involved in the whole process.

Unethical, unprofessional, anti-collegiate behaviour has entered almost all workplaces in the community. The change from collaborative, cooperative, collegiate competition to hostile, malicious, destructive competition in workplaces has possibly been the driver for the change.

The focus for many has changed from job satisfaction to financial reward. This generates unhealthy attitudes that too often lead to bullying, harassment and vexatious, malicious and spurious accusations against a colleague. A large number of these are based on personal and commercial grounds and not on work performance or quality.

There is hardly a profession in Australia that is without these problems. Conversations with contacts in a variety of professions reinforce the view that this is so. Hence, the need for an inclusive approach. Include all rather than a single profession if a national database is to be introduced.

It is important that any national registration system that is created deliver fairness, transparency, provide due process, natural justice and presumption of innocence until rigorous investigation discloses all the facts and the truth. There should be no exemptions or protection for individuals or organisations involved in the whole process — all should be accountable.

Any medical registration system in Australia should not take the National Patient Data Base (NPDB) in the U.S. as a desired template. A reading of that document illustrates problems that already exist in the regulation and administration of health professionals in Australia. No fair person would wish to foist such a database on any individual in Australia.

If you would like to learn more about the Health Professionals Australia Reform Association (HPARA) please email or call 0499 399 081.

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