Medical Council News - May 2018

Issue 66 | May 2018

Kia ora and welcome to the latest issue of Medical Council News.

In this issue we look at recertification and why we all need to undertake it.

All doctors practising in New Zealand must recertify through a New Zealand-based recertification programme. Council is currently looking to strengthen recertification requirements for vocationally registered doctors, aligning these with its Visions and Principles for Recertification , which were published in 2016.

Council’s vision is that recertification programmes identify the individual learning needs of doctors, and are delivered by effective, efficient and reflective mechanisms that support maintenance of high standards and continuing improvement in performance. Recertification activities need to be meaningful, appropriate, and, where possible, evidence-based, and lead to improvements in practice that ultimately improve patient outcomes.

It is your responsibility to ensure you meet your recertification requirements. The consequences of not undertaking recertification are serious and we have reprinted a summary of a Health Practitioners Disciplinary Tribunal (the Tribunal) finding against a doctor.

Caring for and nurturing doctors

Caring for and nurturing doctors is an article written by Dr Pamela Hale, Chairperson of the Health Committee responding to concerns raised by Hein Stander, ASMS President, in his address to the Association of Salaried Medical Specialists Conference in November 2017.

Sadly, it is a fact of life that doctors will be referred to Council when health, competence or conduct concerns exist and we are very conscious of the stress this causes many doctors.

Council makes every attempt to support any doctor going through any Medical Council or Health Practitioners Disciplinary Tribunal process. Where we are concerned about the safety of the doctor, we contact their own treating doctor and let them know of our concerns, so that any pastoral care or treatment they need can be arranged.

We aspire to always treat doctors with sensitivity and to ensure that they are informed about support and counselling options available from independent treatment providers.  

Innovation for the deteriorating patient

Dr Jonathan Albrett’s work in developing a year-long teaching programme for first-year doctors (PGY1) at Taranaki Base Hospital was recognised by the Clinical Educator of the Year Award at the Confederation of Postgraduate Medical Education Councils (CPMEC) conference held in Brisbane.

Dr Albrett has formed a network on Facebook of clinical educators with an interest in developing similar programmes for the PGY1 doctors in their regions and I would encourage you to become part of the formed Facebook group Intern Educators New Zealand.

As always, I would welcome any feedback you may have, which you can email to me at chair@mcnz.org.nz.

Andrew Connolly
Chairman
Medical Council of New Zealand

In this issue

Medical Council of New Zealand Chief Executive Appointment

More interns gaining community experience

Caring for and nurturing doctors

Medical Council of New Zealand Chief Executive Appointment

Joan Simeon has been appointed the Chief Executive of the Medical Council of New Zealand having spent the past 14 years in various senior operational and strategic roles at Council.

Mrs Simeon was Strategic Programme Manager at the Medical Council before her appointment as Chief Executive. Prior to her role in strategy, she was Council's Registration Manager. 

In being appointed Chief Executive, Mrs Simeon will lead the organisation in further developing key strategic directions and in performing the important day-to-day functions of the Council necessary to maintain public health and safety.

In making this appointment, the Council noted that Mrs Simeon has an extensive knowledge of the role and functions of the Council and the wider health sector. She has established and maintained extensive and successful stakeholder networks that are of vital importance to the Council’s work, and she has demonstrated a vision for the challenges in the coming years that will aid the Council in being a most effective regulator.

Mrs Simeon took up her role in mid-December 2017.

More interns gaining community experience

The number of doctors gaining experience in community settings outside hospitals during their prevocational years is steadily rising and already above target, as the initiative gains traction with district health boards (DHBs) and interns.

As part of the Council’s work to continually revise and refine prevocational medical education and training in New Zealand, it has been working with DHBs to introduce community-based attachments (CBAs) for interns. The initiative began in 2015, with the intention of DHBs creating CBAs over time so that, by 2020, every intern will complete at least one CBA over the course of their two prevocational years.

The Council wanted to ensure doctors starting out in their careers were appropriately prepared for evolving models of healthcare, which includes increasingly delivering care in community settings. Community placements are recognised as an investment in the future of the medical workforce and align with the government’s health strategy to deliver more care closer to home.

Familiarising interns with settings outside of hospitals helps them better understand the interface between primary and secondary care and prepares them for future practice.  

DHBs have already surpassed the initial target of 25 percent of interns completing a CBA in 2017, managing to achieve 31 percent for that year. The Council is encouraging DHBs to further increase uptake toward 50 percent in 2018. 

Although all DHBs had at least one intern in a community placement in 2017, some areas are making faster progress than others, and the Council continues to support DHBs and facilitate the sharing of ideas. 

The definition of a CBA allows for flexibility in the type of clinical environments where interns can learn in the community, and those progressing well have developed innovative approaches to overcome potential barriers. There are a wide range of creative options available to DHBs when developing CBAs – including general practice, hospice, community mental health, urgent care and public health (amongst others) – and the Council continues to encourage innovation in this space.

Caring for and nurturing doctors

by Dr Pamela Hale, Chairperson of the Health Committee

Chairperson of Council’s Health Committee, Dr Pamela Hale, clarifies Council’s role in providing support to doctors referred for a health concern. This follows comments made by Dr Hein Stander, ASMS President, in his address to the Association of Salaried Medical Specialists Conference in November 2017.

Dr Stander said: 

A referral to the Medical Council or Health and Disability Commissioner is one of the most stressful events in any doctor’s life. We know this. The Medical Council does have a Health Committee but its primary objective is to protect the public’s health and safety and then address the doctor’s health afterwards. The MCNZ seems not to have any obligation to ensure the safety of the doctor or take into consideration whether the doctor is “fit to stand trial”. It will, however, decide whether the doctor is fit to practise or not …

I want to challenge the Medical Council of New Zealand to review its current processes in dealing with doctors and practitioners that have been referred, for whatever reason, to firstly establish that the doctor is “fit to stand trial” and ascertain that support has been put into place to keep the doctor safe during the process. Is it acceptable to hide behind the “we are responsible for protecting the health and safety of the public”? My colleagues and friends are also members of the public and also have mental health needs and a right to professional help to protect against self-harm and destruction while the Council’s processes run its course.

As Chair of the Council’s Health Committee, I would like to respond to Dr Stander’s comments.

Referrals about health are managed by the Health Committee. Our role is to assess and support the treatment of doctors with health problems affecting their practice, whilst ensuring that their health issue does not adversely affect their patients. Doctors who are referred to us are helped to continue working or to return to work in some capacity, if at all possible, by being helped to manage their illness in a way that allows them to practise safely. This ensures safety for the public whilst also assisting the doctor. 

We make every attempt to support any doctor going through any Medical Council or Health Practitioners Disciplinary Tribunal process. Their “fitness” to undergo the required process is considered carefully by all staff. Where we are concerned about the safety of the doctor, we contact their own treating doctor and let them know of our concerns, so that any pastoral care or treatment they need can be arranged. If a doctor is not well enough to be involved at the time of referral, we are able to defer any direct interaction with the doctor until they are well enough.

Despite their initial reaction to involvement with the committee, which may be fearful or angry, many doctors end up expressing gratitude for the help they have received and the safeguards allowing them to continue or return to work.

The Medical Council is very conscious that any review or investigation may cause considerable stress and anxiety for the doctor. We aspire to always treat doctors with sensitivity and to ensure that they are informed about support and counselling options available from independent treatment providers.

Medical Council supports Choosing Wisely

The Medical Council statements and the document Good Medical Practice outline the standards expected of doctors. They aim to assist doctors to provide good medical practice. Many aspects of Choosing Wisely align closely with the standards the Medical Council expects of a doctor. 

Good Medical Practice states, “In providing care you are expected to provide effective treatments based on the best available evidence."²   Choosing Wisely recommendations, compiled by professionals, are aimed at improving the quality of care (rather than save costs) and are evidence based. The recommendations give guidance so doctors are able to start a conversation about what is appropriate and necessary. As each situation is unique, healthcare professionals and patients should use the recommendations to collaboratively formulate their own appropriate healthcare plan together.

Good Medical Practice notes that doctors operate in an environment of resource limitation and they must strive “to use resources efficiently.³   Thus, doctors have a responsibility to ensure the allocation of health resources is based on need and evidence. In a system where resources are constrained, it is unethical as well as inefficient to provide interventions that have no clinical value. Choosing Wisely programmes are clinician-led and give doctors a way to challenge themselves and their colleagues on the way they think about healthcare, questioning the notion that more is always better. It helps start a conversation about what care is truly needed – identifying which practices are helpful and which are not.

Good Medical Practice also requires doctors to consider and respond to the needs of all patients:

You should make reasonable adjustments to your practice to enable them to receive care that meets their needs.⁴

[Doctors should] work in partnership with patients by: listening to them and responding to their concerns and preferences, giving them the information they want or need in a way they can understand and ensuring they understand it, respecting their right to reach decisions with you about their treatment and care and supporting them in caring for themselves to improve and maintain their health.⁵   

Communication and joint decision-making between health professionals and patients and informed consent is central to Choosing Wisely.

Choosing Wisely urges doctors to take a leadership role on reducing unnecessary care by being involved in a local Choosing Wisely campaign or implementation project – refer http://choosingwisely.org.nz/health-professionals/ . For more information, contact enquiries@cmc.org.nz.

The principles of the Choosing Wisely campaign are that the campaign must be

• health professional-led
• patient and consumer-focused
• multiprofessional
• evidence-based
• transparent

Notes

<sup>1. Ray Moynihan, Jenny Doust and David Henry, Preventing over diagnosis: How to stop harming the healthy. BMJ 2012;344:e3502 ↩
2. Good Medical Practice . MCNZ (December 2016), page 9. ↩
3. Safe practice in an environment of resource limitation . MCNZ (August 2008) ↩
4. Good Medical Practice . MCNZ (December 2016), page 13. ↩
5. Good Medical Practice . MCNZ (December 2016), page 6. ↩</sup>