Interview with Dr Veronica Payne and Annette Ruhotas Morgan AM

MCNSW: Annette, you’re one of 7 community members on the Medical Council. Tell us a bit about your background and how you became a Council member?

Annette I’ve always been interested in science and medicine, but my involvement as a community and consumer representative in health, stemmed from when I had my second child. At the hospital I was invited to be participate in medical research and sit as a community member on the research project’s steering committee.

I applied for a community position with the Medical Council because it’s really important that community members are part of decision-making when it comes to concerns about patient safety. The Medical Council plays a vital, impactful role as a regulator, in working with individual doctors, and the profession more broadly, so the public is protected. It’s great to be able contribute to this. I am also a community member of NSW Board of the Medical Board of Australia, so I’m very supportive of collaboration and communication between regulators to ensure the system is working for practitioners and the public.

MCNSW: Veronica, can you tell us a little about your background and how you became a Council member.

Veronica: After starting my career at St George Hospital, I did my provisional fellowship in 2004 at RPA, where I’d been a medical student. I've stayed there ever since and I'm really happy working there.  My clinical interests are predominantly anaesthesia for vascular surgery and for liver transplantation. I also do a lot of anaesthesia for melanoma and urological surgeries as well. I've always been interested in teaching which has led me to becoming an Australian and New Zealand College of Anaesthetists (ANZCA) final examiner and a supervisor of training.

I care greatly about our profession and ensuring we maintain high standards of anaesthesia care in Australia and New Zealand. I applied to be a hearing member for the Medical Council and was later nominated by ANZCA as a member of the Medical Council. My membership of the Council brings together both my interest in high standards of care and the larger issue of patient safety. 

MCNSW: What do you think the biggest misconceptions are about the Medical Council?

Annette: Outsiders might think that the Council is made up of bureaucrats. It is actually made up of experienced medical practitioners, from a variety of specialities and backgrounds and knowledgeable community representatives appointed by the Health Minister. The day-to-day work of the Council is supported by a small number of diligent staff employed by the Health Professional Council Authority (HPCA), but the regulatory decisions are always made by the Council members.

Veronica: I think there’s a perception the Council is harsh. This may be because we can require doctors to make positive changes to their clinical practice, conduct or take steps to better manage their health impairment. This may include placing conditions on a doctor’s registration for a period of time to ensure the public is protected. Suspension of a doctor always attracts news and attention but last year there were only 5 doctors suspended by the Council.

MCNSW: What kinds of complaints and notifications does the Council deal with?

Veronica: The biggest category of complaint relates to clinical care which includes inadequate or inappropriate treatment, missed or delayed diagnosis.  We also see complaints relating to lack of informed consent and documentation. Without proper records it is very hard if you are the subject of a complaint to provide evidence of your version of events.  Many of these types of complaints, along with poor patient communication, are avoidable. The good news is there are great resources and CPD training to support doctors to avoid these types of complaints in the first place. 

Annette:  I agree failure to communicate properly so there is a genuine shared understanding between patient and doctor about their care, can lead to a complaint. Practitioners need to always be cognisant that there is a power imbalance between them and their patients, which can be more pronounced with vulnerable patients such as children, the elderly, First Nations people and those whose first language is not English. Doctors should always communicate with each patient at their level and make sure to check understanding.

The Council also engages with a small number of practitioners who have a health condition that causes impairment that could impact patient safety. The Council’s aim is always to support a doctor to continue to practise safely while ensuring guardrails are in place for their recovery and patient safety.

MCNSW:  What’s your message to a doctor who has a complaint made about them?

Veronica:  The Council’s members understand the process can be stressful for complainants and medical practitioners. At the same time the Council needs to properly look at a complaint to make a fair and informed decision about whether regulatory action is required. It’s important to know the Council does not have punitive powers – we don’t prosecute doctors. Our remit is to protect the public.

If you do receive a complaint, it can be easy to feel it is a personal attack because medicine takes a lot of yourself. But it’s important to get over the initial hurt, step back and reflect and look to any ways which you can improve your practice. It’s also essential you engage with your medical indemnity insurer, who are highly experienced in these areas. Focus on your self-care. Lean on your personal supports and reach out to bodies such DRS4DRS or the Medical Benevolent Association of NSW-ACT or your employee assistance program for further help.

Annette: There are over 42,000 doctors in NSW, and there are around 3,000 complaints each year. Less than 500 of these are referred to the Medical Council for assessment following joint consultation with the HCCC. So having a complaint made about you does not necessarily mean it will meet the threshold for consideration by the Council.