From 1 October 2020 a new version of the Medical Board’s Good medical practice – a code of conduct for doctors in Australia was introduced.
The new code – MIGA advocating for key changes
Reassuringly the new code is only an evolution, not a revolution. Many of the new or refined obligations are unsurprising, reflecting what you already do in your practice.
MIGA engaged closely with the Medical Board on the code revision, which began more than two years ago. Pleasingly most of the issues we raised have been addressed in the new code.
You might have seen controversies around development of the new code. Issues about doctors’ public comments and cultural safety caused considerable debate. Some changes received less attention, but are no less important and are outlined below.
Why the code is important
Doctors have a professional responsibility to be familiar with the code and apply it to their practice. It is a common feature of Medical Board/Ahpra processes involving doctors. The code is the primary authority for professional obligations on a wide range of issues.
The changes that got more attention
Issues around public comment and cultural safety were debated during the new code’s development. The potential for unintended consequences was the main challenge.
For public comment, initial proposals requiring public acknowledgement of the profession’s generally accepted views seemed directed to practices outside the clinical mainstream. Concerns were raised about stifling comment on issues of conscience. New section 2 of the code tries to strike a balance by emphasising the right of doctors to have and express personal beliefs, but to consider how public comment and actions outside work relating to clinical issues impact on your role as a doctor and the broader profession. The scope for conscientious objection (sections 3.4.6 and 3.4.7) remains unchanged.
In relation to cultural safety, concerns were that earlier proposals would enable patients to push for doctors to do things they felt clinically inappropriate. This has been dealt with in new section 4.8, which indicates that “culturally safe practice, like all good medical practice, does not require doctors to provide care that is medically unsafe or inappropriate”.
The changes that got less attention (but are no less important!)
Some of the key changes that received less attention are:
- Treatment recommendations (section 3.2.7 and 3.2.8)
— Only recommend treatments where there is an identified therapeutic need and/or a clinically recognised treatment, and a reasonable expectation of clinical efficacy and benefit
— Informing patients when your clinical opinions do not align with the profession’s generally held views
- Clinical records (sections 4.4.3 and 4.4.6)
— Only accessing an individual’s clinical records when there is a legitimate need
— Clarifying that confidentiality and privacy obligations extend in electronic realms beyond social media to digital communications, e.g. email and text message
- Patients with capacity issues (section 4.9.1 to 4.9.2)
— Reassessing a patient’s decision-making capacity when indicated
— Encouraging supported decision-making by patients with impaired capacity so they can participate in decision-making where possible
- Treating self and others close to you (sections 3.14, 11.2.3 and 11.2.5)
— Seek help when suffering stress, burnout, anxiety or depression
— Do not self-prescribe
— Do not prescribe Schedule 8, psychotropic medication and/or drugs of dependence or perform elective surgery on anyone you have a close personal relationship with
- Bullying, harassment and discrimination (sections 4.4.6 and 5.4) – a zero tolerance approach and seek to eliminate it
- Continuity of care (section 6.3.1) – ensuring arrangements for continuing care of patients when you are not available, made in advance when possible, and communicated to the patient and others involved in their care
- Clinical records (sections 10.5.6 and 10.5.9) – dating any changes and additions, and ensuring records are destroyed securely when no longer required to be kept.
A new year’s resolution – be familiar with the code?
While it’s probably a bit too much to say reading the code should be a new year’s resolution for those who aren’t familiar with it, its importance for your practice as a doctor cannot be understated. Know where to access it, be familiar with its requirements and refer to it when uncertain about key issues. MIGA’s team can help you understand what the code means for your practice.
The new code is available at www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx
MIGA’s submission to the Board’s public consultation on a draft version of the new code is available at https://www.medicalboard.gov.au/documents/default.aspx?record=WD18%2f27183&dbid=AP&chksum=5TSi4eLzCLV%2fnmksOroY5Q%3d%3d
See for example www.ama.com.au/articles/updated-medical-board-code-conduct