The Medical Council of NSW has recently reminded medical practitioners of the importance of engaging and ensuring regular visits to a General Practitioner following a recent disciplinary decision¹.
The Council frequently receives complaints from patients and others where it is suspected that a practitioner is suffering from cognitive impairment. An undiagnosed impairment at its extreme has the potential to result in a catastrophic outcome for a patient and could be career ending, as it was in this case².
A missed diagnosis
The complaint against the doctor followed the tragic death of an eight year old child on 28 March 2009. The doctor, a 71 year old general practitioner at the time, was the first to assess the young boy and failed to diagnose appendicitis. Although another general practitioner made the correct diagnosis when he re-presented a few days later, a series of avoidable failures in two hospitals resulted in his death³.
The HCCC prosecuted the general practitioner before a Professional Standards Committee (the PSC). During questioning, the PSC had concerns about the doctor’s presentation and the manner in which he was answering the questions put to him. The inquiry was adjourned so the doctor could be assessed for possible impairment and consideration of his capacity to practise medicine4. As there were concerns about the risk to the public, the doctor’s registration was suspended in the meantime.
The doctor was assessed by a psychiatrist who concluded that he had a “significant cognitive impairment”. Before the New South Wales Civil and Administrative Tribunal, the HCCC alleged that the doctor was impaired, that he lacked the physical or mental capacity to practise as a medical practitioner and further alleged that the doctor was guilty of unsatisfactory professional conduct as he was self-prescribing and failed to keep appropriate medical records.
On the first day of the hearing, the doctor conceded that the complaints were proven and consented to his name being removed from the register5. Those orders were made by the Tribunal and the doctor’s registration was cancelled.
In its decision, the Tribunal noted that the doctor admitted unsatisfactory professional conduct as he self-prescribed medication contrary to the Medical Council Policy guidelines on self-treatment and treating family members 6.
The Tribunal highlighted that the first principle in the guideline is:
‘All medical practitioners should have their own, Independent Medical Practitioner’7
The Medical Council of NSW explains that medical practitioners are not immune to the reality that one’s health and cognitive ability declines with age. Objective independent assessment ensures early detection and management of health concerns whether they be physical or cognitive. This allows the practitioner to manage his or her exit from, or modification of practice before it becomes unsafe for patients or the practitioner. This can prevent harm and avoid extremely stressful complaints and/or disciplinary action as demonstrated in this case.
Risk management tips
At MIGA, we regularly assist practitioners who are pro-actively disengaging from practice or when complaints have been made questioning a practitioner’s ability to practise safely.
To avoid mandatory notifications by colleagues or complaints to the regulator we encourage the following:
- Consult an independent General Practitioner at least annually
- Maintain regular specialist appointments if required
- Have frank and open discussions about your ability to practise with your treating practitioners
- Do not self-prescribe or prescribe to friends and family
- Have a plan in place for winding down your practice
MIGA Doctors’ Health e-book
MIGA has recently launched a Doctors’ Health e-book which covers some of the key issues impacting doctors and their management of their own health. Incorporating videos and audio files, we hope the content is engaging and encourages you to consider your circumstances and take steps to make your own health a priority. Access the e-book below.
 Health Care Complaints Commission v Khan  NSWCATOD 32. A copy of the decision can be found here: Website link
 Medical Council of NSW April 2016 Newsletter. A copy of the newsletter can be found here: Website link
 Findings of New South Wales Deputy State Coroner Mitchell in Jacob Belim of 15 August 2011 (0839/09)
 HCCC v Khan above N1 at 
 HCCC v Khan above N1 at  and 
Medical Council of NSW Guideline for self-treatment and treating family members 02 December 2014 97/008. Similar provisions exist in the Medical Board of Australia, Good Medical Practice: A Code of Conduct for Doctors in Australia, March 2014 Website link
 HCCC v Khan above N1 at 
MIGA’s Doctors’ Health e-book
Understand the issues impacting doctors’ management of their health