Medical student newsletter, Issue 4, September 2022

Contents

• Message from the Chair
• Cosmetic surgery practice in the spotlight
• Link between culture and patient care driving positive change
• Caring for people close to you means not being their doctor
• Graduating soon? Be ready to start work – apply for registration now
• AMACDT and AMSA – Traffic light guide to mental health support for medical students and doctors in training
• Professional pitfalls
• Want to know more?

Message from the Chair

As a medical student in Australia, you are registered with the Medical Board of Australia. We will be a feature of your professional life because you need to be registered to practise medicine.

Hot topics this edition include cosmetic surgery, lessons from practice and – if you’re in final year – getting registered before you start work!

Good luck for the last chapter of 2022 – we’ll be in touch again next year.
 

Dr Anne Tonkin Chair, Medical Board of Australia

↑ Back to top

Cosmetic surgery in the spotlight

Poor practice in the cosmetic surgery industry has made headlines across Australia. Ahpra and the Medical Board have announced a series of reforms aimed at improving practice, lifting standards and promoting informed consumer choice. Australia’s Health Ministers are also taking action.

We have mapped out the reform agenda in response to the findings of the Independent review of the regulation of medical practitioners who perform cosmetic surgery that we commissioned. Ahpra and the Medical Board have accepted all 16 recommendations to improve patient safety in the cosmetic surgery industry.

There are some worrying features of the broader cosmetic industry that set it apart from conventional medical practice. The independent review noted that the cosmetic surgery industry challenges the traditional surgical specialist model, with the industry largely sitting outside existing health systems and frameworks that offer safeguards to the public. Social media marketing emphasises benefits and downplays risks to consumers. There is also a poor reporting culture that allows poor practice to go unchecked, which harms patients.

We commissioned the independent review after media reports about alleged serious hygiene breaches, patient safety issues, poor patient care, unsatisfactory surgical outcomes, and aggressive and inappropriate advertising.

While we investigate, we’ve banned all the doctors identified in media reports from practising cosmetic surgery or suspended their registration so they can’t practise medicine in Australia.

You can read more about what we’re doing and what’s in the independent review report.
 

↑ Back to top

Link between culture and patient care driving positive change

The culture of medicine affects patient care and the wellbeing of individual doctors. Culture is an issue that organisations across the health sector are focused on improving – after recurring and consistent feedback identified cultural fault lines in medicine, and research identified the link between culture and patient care.

Across three years, results from the Medical Board’s Medical Training Survey have shown that while medical training in Australia is generally in good shape, there are serious cultural problems in medicine, including bullying, harassment, racism and discrimination. Unacceptably, things are even worse for Aboriginal and Torres Strait Islander trainees.

The Board has brought leaders across Australia’s medical community together to build support and commitment to improving the culture of medicine. Our Culture of Medicine Symposium shared evidence of poor culture but focused primarily on fostering a commitment to positive change. It aimed to build a common understanding of current problems and a shared commitment to enabling a different future.

Improved awareness and understanding of cultural safety, meaningful action on racism and collaborations to help effect change are a focus for future effort.

Cultural change is complicated. No single agency or individual – acting alone – has all the levers needed to achieve positive change. But what we can’t do individually, we can do collectively. Everyone involved can make a contribution and help improve the culture of medicine.

When you are doctors, you’ll need to be open to caring about and respecting each other, as you care for and respect your patients. We need to be open to not knowing all the answers, but trust that together we can build a culture we can be proud of.

↑ Back to top

Caring for people close to you means not being their doctor

Caring for the people close to you means not being their doctor. Emergencies of course are different – when you do what you can until independent care arrives. Most of the time, there can be unintended consequences of providing medical care to people close to you. It’s better for everyone if the people who mean the most to you get medical care from other doctors.

We’re sharing some examples now, so you know what might go wrong before you are put on the spot. Forewarned is forearmed, and it’s easier to handle difficult situations if you already know the right thing to do.

The sort of cases that have come before the Board relate to medical practitioners:

• prescribing medication for family members and friends. Examples have included prescribing Schedule 8 medications and a medical practitioner prescribing the contraceptive pill for their daughter
• treating family members and friends with mental health conditions
• treating family members and friends with complex health needs
• performing elective surgery on family members
• providing treatments to family and friends for conditions outside the doctor’s usual scope of practice, experience and competence.

In one case, the doctor’s adult child took a fatal overdose of a medication the doctor had prescribed. In another, a doctor decided to not call an ambulance for their unconscious friend and monitored them instead. Tragically, that friend died from a medication overdose – because the doctor’s judgement was clouded by their concern for the family’s potential embarrassment.

We have heard that sometimes practitioners are hesitant but provide a prescription or other treatments because they feel obliged to or find it difficult to refuse persistent requests. Some practitioners try to justify their actions by convincing themselves that they aren’t really ‘providing treatment’, ‘it’s just a script’ or because they aren’t billing through Medicare. Others are trying to protect their family member from possible stigma associated with the condition, especially in the area of mental health.

Providing treatments to those with whom you have a close personal relationship can be fraught. The standard of care provided to family and friends can be compromised, because the close relationship can cloud professional objectivity and affect professional judgement.

For example, prescriptions written informally are sometimes done without the doctor taking a comprehensive history. Thorough assessments, including physical examinations can be embarrassing and therefore may not be done, and diagnoses are not made and/or not documented.

When treatment is provided outside a formal doctor-patient relationship, the usual monitoring is less likely to occur, records may not be kept, and continuity of care can be adversely affected.

Doctors can play an important role in advocating for and supporting family members and friends with their medical care. However, they should encourage any friends or family to have a general practitioner who can be objective and provide continuity and coordination of care. Medical practitioners should not be taking on the role of primary medical practitioner for family members and should avoid providing prescriptions and treatment except in an emergency or where other medical care is not available.

↑ Back to top

Graduating soon? Be ready to start work – apply for registration now

If you're set to complete medical school in the next three months – apply for registration now. We'll start assessing your application while we wait for your graduation results.

Need help applying?
Check out our graduate video to help you get your application right.

You’ll find helpful advice, tips for avoiding common causes of delay and downloadable information flyers on the graduate applications page of the Australian Health Practitioner Regulation Agency (Ahpra) website.

Easy steps to apply online

1. Create your account using the online services portal and complete your application.
2. Upload your documents and pay the required fees. Check that you have provided all required documentation to prove you’ve met the registration standards, including certified copies of your photo ID.
3. Wait for your education provider to provide your graduate results to Ahpra.

Make sure you provide correct photo ID

It's important that you provide correctly certified photo ID documents with your application as the wording is very specific.

‘I certify that this is a true copy of the original and the photograph is a true likeness of the person presenting the document as sighted by me.’

To get it right the first time download the Certifying documents guide and take it with you to the authorised officer.

Who can certify documents?

In addition to JPs, most registered health practitioners, public servants, teachers, lecturers and members of the legal profession can certify photographic ID documents. For the full list of authorised officers see the guide.

Meeting the registration standards

You may need to provide supporting documents with your application to prove that you meet the Medical Board’s registration standards including meeting the English language skills requirements. Make sure you provide all the documents we need with your application so we can assess it quicker.

Do I need to sit an English language test?

Before you can register as a medical practitioner in Australia, you need to show that you are proficient in English. You might need to sit an English language test – even if you’ve studied medicine in Australia.

To be sure you are eligible for registration, check out the Board’s English language skills registration standard. One way you can prove proficiency in English is to show you have completed at least two years of secondary school taught and assessed solely in English, in a recognised country.

The registration standard sets the minimum requirements for a doctor to communicate effectively and provide safe care to the Australian community.

Clear, effective communication is critical in the doctor-patient relationship. As a doctor, you will need to be able to listen to patients and respond to their concerns and preferences. You also need to be able to discuss all aspects of their clinical management with them so that they can make informed decisions.

For more information about English language skills requirements for medical practitioners, please read the FAQs.

How long does it take to assess my application?

We can’t finalise your application until we receive your graduation results from your education provider.

If you’ve submitted everything you need to prove you’ve met the requirements for registration, we aim to finalise your application within two weeks of receiving your graduation results.

If you’re about to finish medical school, you can apply for provisional registration online now and get the paperwork sorted before you finish your course.

Don’t leave sorting out your paperwork until the last minute. Incomplete applications can delay your registration and ability to start work.

Look out for an email from Ahpra in the next few weeks inviting you to apply for registration.

↑ Back to top

AMACDT and AMSA – Traffic light guide to mental health support for medical students and doctors in training

It has been a difficult few years for medical students and doctors in training. The impacts of the pandemic, disruptions to training, and increased workloads on the health and wellbeing of our future workforce have been immense, with many of the repercussions yet to be seen.

Navigating the many support services available for medical students and junior doctors can be difficult, with many reporting although they know services exist, when they are feeling stressed and overwhelmed it is difficult to know where exactly to go, and what level of support each service provides.

The Australian Medical Students’ Association (AMSA) and the Australian Medical Association Council of Doctors in Training (AMACDT) have partnered to create a Traffic lights flyer which lists all the support services available for students and junior doctors, and provides recommendation as to which services to access depending on the level of stress, mental illness or acute need the individual is facing.

AMACDT and AMSA vision is for every doctor and medical student to have this flyer saved on their phone, should they or any of their colleagues ever need support. The flyer is available on the Australian Medical Association website.

↑ Back to top

Professional pitfalls

Most doctors do a great job but in some rare cases, the Board will refer a doctor to a tribunal because they are seriously concerned about the risk to patients from the doctor’s practice. In the last financial year, tribunals considered 48 cases involving doctors. There were almost 130,000 doctors registered during that same period.

Tribunals operate like courts. Doctors and the Board and Ahpra are usually legally represented and after hearing the evidence, the tribunal has to decide whether or not a doctor has engaged in unsatisfactory performance, unprofessional conduct, professional misconduct, has an impairment or whether their registration was improperly obtained. 

Tribunals have significant powers, including to stop a doctor’s practice by cancelling their registration.

Tribunal hearings are public and decisions are published. 

You can read about professional pitfalls and how to avoid them by reading these tribunal decisions. 

Court and tribunal summaries are accessible on the Ahpra website. You can also view recent hearing summaries in the news section. 

↑ Back to top

Want to know more?

For more information, see the Medical Board of Australia website and the Ahpra website.

Comments on the newsletter are welcome, send your feedback and suggestions to newsletters@ahpra.gov.au

↑ Back to top