Ahpra notifications – one doctor’s journey

Ahpra released some helpful resources¹ in 2018 to explain the notification process and link practitioners to the support services available to them. While this information helps to normalise the process, each individual doctor will deal with the situation differently.

Below is a first-hand account written by one of our longstanding Members.

I am an obstetrician and gynaecologist working in both private and public practice at a large tertiary teaching hospital.

Last year, I received notification from Ahpra that I was being investigated following a patient complaint. I was accused of making inappropriate sexual comments and failing to ensure a patient’s privacy.

The complaint related to a brief consultation 12 months prior in a public gynaecological outpatient clinic.

The patient had made an informal complaint to the hospital about two months after I had seen her. My head of department made me aware that the patient had complained about my manner, and my failure to properly cover her during an examination. The patient was seeking an apology and financial compensation.

I examined the patient’s chart and noted that a nurse chaperone had assisted me throughout the minor procedure.

At the time, I suggested that the head of department contact the nurse chaperone for further clarification as I had no personal recollection of the consultation. I did not accept the allegations due to my invariable practice of preserving a patient’s modesty. However, I offered the patient a conditional apology for any unintentional distress as a gesture of goodwill. I also suggested that her care be transferred to one of my colleagues. The head of department subsequently advised me that the complaint had been investigated by the hospital and they considered the matter closed.

I was therefore shocked to receive a notification from Ahpra many months later. I immediately contacted MDA National for advice. In compliance with Ahpra regulations I advised my employer, and any hospital that I had admitting rights to, that I was being investigated.

I felt humiliated.

I responded to the complaint with MDA’s assistance, explaining that I had no recollection of the consultation. I outlined my usual practice during a consultation and examination, and I explained the role of nurse chaperones during this process.

I reassured Ahpra that following the complaint, I had reviewed my usual practice to ensure that I was complying with AMA, MDA and hospital guidelines regarding patient–doctor boundaries and conducting intimate examinations, and I was conforming to the Medical Board’s Code of Conduct. I was confident that I was compliant and up to date.

About six months after my response, I received notification from Ahpra that they proposed to issue me with a caution.

I was devastated.

I started to question my competence, and I could barely sleep for more than two hours without waking and worrying about the case. I became very wary of each patient encounter. COVID-19 and telehealth came as a welcome relief at the time, as I no longer needed to see patients face to face.

With assistance from MDA, I responded to Ahpra’s proposal to caution, strongly denying any wrongdoing. I provided testimonials from medical and nursing colleagues, and I asked for the opportunity to present in person to the Medical Board.

Permission was granted, and I subsequently had a Zoom hearing with the Medical Board and my MDA representative.

Several weeks later, I received notification from Ahpra of its decision ‘to take no action in relation to the matter’. A few months on, I remain somewhat distrustful of patients and their motives.

I appreciate that Ahpra has a role in protecting patients and upholding the ethics of the profession, but it felt like my guilt was assumed and everything that the complainant alleged was true – however implausible or unlikely.

We are really grateful to our Member for his candour. Doctors often feel alone and avoid talking to family members or trusted colleagues for fear of having their reputation diminished by virtue of a notification.

Dr Deacon’s article on page 18 discusses Ahpra statistics in more detail. It’s important to note that the majority of notifications are resolved with no further action against the medical practitioner – but this is cold comfort when you’re the one being investigated.

You should never ignore a notification, but nor should you let it cloud your judgement to the point that you’re no longer effective as a doctor. Trust, communication and mutual respect are vital in any good therapeutic relationship, and we find many notifications arise due to a misunderstanding or miscommunication.

If you receive a notification from Ahpra, don’t panic. Contact MDA National immediately so we can help you respond and support you throughout the process.

Reference:

1. Ahpra & National Boards. Further information: https://www.ahpra.gov.au/Notifications/Further-information.aspx