12 commandments to mitigate Ahpra notifications

Despite the instant anxiety brought on by the word ‘notification’, practitioners can take positive steps to ensure they’re well placed to deal with one that (inevitably) comes their way.

While the receipt of a notification is not within your control, what you do in caring for your patients – from an initial consult through to discharge – certainly is. And while it’s the quality of care that is critically important, the documentation of such care is equally so.

We believe there are a number of ‘controllables’ for practitioners in seeking to mitigate any adverse finding by the Medical Board. While these may seem onerous at the time, your future self may just praise you for going the extra distance.

The 12 commandments

Keep full, accurate and contemporaneous clinical records.

This is a challenge with the busyness of everyday practice. It’s critical to record the process of taking informed consent and the actual risks discussed (rather than simply stating they were discussed) and making a note of any documentation you’ve provided to the patient. Templates can assist in this regard, provided they are thorough and up to date.

Communicate clearly with patients and colleagues.

This cannot be overstated. Try to document all conversations, or follow up important conversations with an email, where there’s potential for dispute (pretty much always!).

Be open and honest, and apologise if something goes wrong.

Importantly, do not actively dissuade aggrieved patients (or anyone) from making a notification. That said, be careful about apologising where it could be construed as an admission of liability (see commandment 12).

Seek advice from colleagues or mentors when unsure.

This may help you defend your decision-making and assists in developing a collegiate profession.

Respect professional boundaries.

Be aware of boundaries with patients and colleagues. Seek to terminate a therapeutic relationship at the first sign of a relationship evolving into something personal.

Use a chaperone where appropriate.

Chaperones are there to protect you (as well as the patient). Their presence can be critical when defending allegations of sexual misconduct – which can mean being out of practice for 12 months or more.

Be informed and cognisant of Medicare requirements.

Be aware of requirements regarding the billing of items. Regularly review Medicare updates and engage in open discussion with colleagues. Don’t assume your billing is fine “because everyone else is doing it”. This defence won’t fly with Medicare.

Don’t self-prescribe, and don’t prescribe for your friends and family.

The various codes of conduct stipulate this should be avoided wherever possible. If you have to do so, be prepared to justify your decision, make a clear record of what you have done, and advise the patient’s GP in writing, including your clinical reasoning (unless the patient objects).

Use social media with caution.

Be very careful when using social media (even on your personal pages), when authoring papers, or when appearing in interviews. Health practitioners are obliged to ensure their views are consistent with public health messaging. This is particularly relevant in current times.

Engage regularly with a GP and/or psychiatrist or psychologist.

As well as maintaining good mental health, this can assist you if concerns are ever raised that you may have a health impairment affecting your practice. It can mean the difference between sitting on the sidelines and continuing to practise.

Be a good colleague and allow your colleagues to support you.

Asking for help can prevent a situation escalating out of control.

Your MDO is your lifeline.

Seek advice from your medical defence organisation (MDO) before responding to any complaint. They have generally been there and done it. Put your faith in them and trust their advice.

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