Keep on caring.  We’re by your side. 

COVID-19 support for junior doctors

The healthcare workforce is under immense pressure right now as it works tirelessly to respond to COVID-19, and we know that you and your fellow junior doctors are feeling the stress. 

MDA National is committed to standing with doctors and their staff through this challenging period. To help ease some of the pressure, we are freezing premium increases for 99% of members for 2020-21 Policy Renewals. We’re also waiving most of out junior doctors premium and offering complimentary cover until 30 June 2021, when you sign up to renew your policy via direct deposit.* 

We understand that we’re living in uncertain and worrying times, but you can be assured that MDA National is here to support you. Our Medico-legal advisors are here and ready to guide you through any issue you face. 

Frequently asked questions

Refer back to this page to keep across all the latest updates and information, and get in touch with our Medico-legal Advisory Service if you have any concerns .

  Patient related FAQs  

As with all requests for 'fitness certificates' doctors have an obligation to provide factual information—but this does not mean the doctor must follow the format requested by the patient or the employer.

There is no testing currently available to demonstrate conclusively that a patient is not infected with COVID-19.

Doctors can provide a certificate or a letter dated the day the patient was seen, and this could include relevant information such as the patient presenting symptom-free, whether they have complied with public health guidelines (such as having met the requirements for a period of self-isolation, recent travel history), and the outcome of a physical examination. The history and examination should be clearly documented in the medical record.

If a certificate is provided as a result of a telemedicine consultation, this should be noted on the certificate and in the medical record.

The situation regarding COVID-19 is changing rapidly and doctors are encouraged to keep up to date with public health advice in their state. A link to relevant public health information can be found on our blog.

Updated: 16 March 2020

When providing a medical certificate, a doctor has a professional obligation under the Medical Board of Australia’s Code of Conduct (at 8.8) to be honest, accurate, and to take reasonable steps to verify the content of a certificate.  You need to be able to disclose any relevant information necessary to the submission or elect not to provide a letter at all (i.e. the patient cannot make you ‘omit’ information you consider is relevant).

If it is your clinical opinion that the patient should cancel or postpone travel to a specific destination or region, then it may be reasonable to provide a short report. An example may be an elderly patient with a pre-existing respiratory illness who is booked to travel to a destination which is currently experiencing high numbers of COVID-19 cases. This will involve a case by case assessment, and we recommend you contact us for assistance if you are unsure.

This may not be necessary if the travel provider opts to cancel flights, cruises, tours etc. However, it may still be helpful for the patient to obtain a medical certificate as they may be able to recoup other costs from their travel insurer.

A medical certificate would normally be provided to indicate that a patient is too unwell for work, or school etc. 

A letter of support can be used to assist the patient where they are not unwell, but information is needed for insurance or other purposes. 

Updated: 19 March 2020

Doctors are not obliged to treat patients unless it is an emergency, or a contractual requirement.

Doctors may consider a range of factors when deciding who they treat, and this circumstance has been contemplated by AHPRA in s.2.4 of the Code of Conduct for doctors in Australia.

One of the considerations relates to your ability to keep “…yourself and your staff safe when caring for patients. If a patient poses a risk to your health and safety or that of your staff, take action to protect against that risk. Such a patient should not be denied care, if reasonable steps can be taken to keep you and your staff safe.”

If you feel you are not in a position to keep yourself, your staff, or your other patients safe in light of COVID-19, then you can decline to treat or suggest high risk patients postpone non-urgent appointments. This will be taken into account by AHPRA in the event of a complaint.

If a patient cannot be seen at the practice, they should be directed to an appropriate alternative to access care, taking into account local resources.

The new MBS item numbers for telehealth and telephone consultations may be helpful in this situation.

Updated 16 March 2020

This is a situation where a letter of support may be more appropriate than a medical certificate.

Medical certificates

A doctor should only provide a medical certificate in a situation where they reasonably believe the patient has / had a certifiable health condition. Doctors may decide to take a patient at their word (e.g. ‘Doc I was up all night with gastro’) because there may be no objective findings on examination (perhaps the consultation is by phone or tele-link). See this Medical Council of NSW document for a detailed discussion about medical certificates.

If a doctor is not satisfied the patient was ‘sick’ with a health condition, then they should not agree to provide a medical certificate. This is because a doctor has an obligation under the Medical Board Code of Conduct (at 8.8) to ensure a signed statement is reasonably true, not misleading, accurate, and they have not omitted relevant information deliberately.

Letters of support

A doctor may be sympathetic to a patient’s plight, but can’t certify that the patient is unwell to travel, or is unfit for work. In this case the doctor can offer to provide a letter of support, rather than a medical certificate. Relevant clinical information can be provided (with the patient’s consent) without certifying the patient unwell or unfit.

Example 1

Dear travel insurer

I am writing a letter in support of my patients, Mr and Mrs Smith who have made the difficult decision to cancel their travel plans to Europe on 1 April 2020 in light of the escalating COVID-19 risk. 

I support their decision to cancel their overseas travel, based on the risks of being exposed to COVID-19 (both in transit and during the holiday) and also the increasing risk that COVID-19 poses to older patients if they do develop infection. The Commonwealth Department of Health notes “Based on what we know about coronaviruses, those most at risk of serious infection are: ...elderly people”.

I also note the current Victorian Health guidance to “the public to be mindful and take steps to minimise the risk of COVID-19” [16 March accessed 18 March 2020] and the advice on SmartTraveller [accessed 18 March 2020] “Coronavirus (COVID-19) 8 March 2020: We now advise all Australians not to travel at this time”. 

I ask that you take this information into account when considering their application for reimbursement. 

Example 2

Dear Mr Jones

I confirm I have been treating you for [list conditions] since [enter date]. You are currently on [list medications] to manage your chronic health conditions.

You have indicated that you are concerned you will be at higher risk of serious infection if you contract COVID-19, due to your underlying health issues and/or age.

I understand you are keen to discuss your options with your employer to limit your potential exposure to the virus. According to the Health Department website “those most at risk of serious infection are…people with chronic medical conditions” so any modifications you can agree with your employer in order to reduce your risk would be sensible.

Updated:  20 March 2020

Clearly document your assessment and advice to the patient including your concern of the risk to themselves and others.

COVID-19 is now a reportable disease. If you have public safety concerns, you can notify your local public health unit who can assess the need to follow up with the patient.

Updated: 16 March 2020

 

  New telehealth related FAQs  

Telehealth (healthcare services provided over the internet, video conference or phone) is covered under your indemnity policy, provided both you and the patient are located in Australia and the service is provided in accordance with the guidelines of the Medical Board, the relevant College and Medicare.


Updated: 30 March 2020

The MBS online guide provides information on this.

Changes to the original wording of the MBS now include that the 'usual GP' has been expanded to include where there has been a face to face attendance in the previous 12 months with the practitioner or at the practice. The 'need for a limited examination' has been removed from the GP and Other Medical Practitioner items.

If a patient requests a COVID-19 telehealth consultation, but is new to the practice, then you cannot use the new telehealth item number. You may wish to offer a privately billed consultation. Prior to this the patient should register at the practice and provide the usual information required for registration, which can be done electronically.

Updated: 19 March 2020

Electronic prescribing (‘e-prescribing’) was legislated in Australia in late 2019 however most clinical software does not yet support it.


The federal health department has announced an interim process allowing electronic prescribing during telehealth consultations. The steps for the doctor are:

 

1.  Create a paper prescription, as usual, on a standard PBS script pad, or an electronically generated script on PBS provided paper.

2.  Create a digital image of the prescription, such as a photo or pdf. The image must be clear enough to allow any barcode to be scanned. 

3.  Send the image by email, text or fax to either the patient or the patient’s pharmacist

4.  Send the pharmacy the paper copy of the prescription within 15 days of the drug being supplied

 

Schedule 8 and 4(D) medicines such as opioids and Fentanyl are not part of this interim arrangement. 

If the script is not urgent, a hard copy script can be posted to the patient.

 

Updated: 6 April 2020

Our understanding is that to claim the new MBS telehealth item numbers, the service has to be rendered from within Australia. However, detailed information is currently not available.

MBS Advice: (note: this advice relates to pre-COVID-19 telehealth consultations)

Telehealth patient-end support services can only be claimed where:

(a)  a Medicare eligible specialist service is claimed;

(b)  the service is rendered in Australia; and

(c)  where this is necessary for the provision of the specialist service.

 

You need a valid provider number for the location from which you are providing your telehealth service, bearing in mind your provider number is location specific.

Telehealth (healthcare services provided over the internet, video conference or phone) is covered under your indemnity policy, provided both you and the patient are located in Australia and the service is provided in accordance with the guidelines of the Medical Board, the relevant College and Medicare.

If you are undertaking any other form of telehealth services, please contact us on 1800 011 255 and speak to Member Services.

Updated: 19 March 2020

Documentation of telehealth consultations should contain the same level of detail as a face to face consultation, as well as the type of consultation and the patient’s location. The RACGP also recommends documenting information such as:

(a) the rationale for a video consultation instead of a physical consultation

(b) responsibility for any follow-up actions

(c) the presence of other parties and the patient’s consent for those parties to be present

(d) any technical malfunctions which may have compromised the consultation

 

Consent to conduct a telehealth consultation can be verbal or written, and the patient should be informed that telehealth has some limitations, for instance:

 

(a)  no physical examination

(b)  possible technical issues, e.g. poor image resolution impeding diagnosis, Wi-Fi dropout etc

(c)  security of the transmission may not be guaranteed (if using an app, is it encrypted?) and there is an extremely small risk it could be seen by a third party

 

The default position is that telehealth consultations are not recorded (by audio or video), just as face to face consultations are not recorded. If any part of a video consultation is recorded, written consent is recommended. An example of a written consent form is available at ehealth.acrrm.org.au

If patients send in photos, they should be told how secure the process is (e.g. unencrypted email) and whether the photos will be stored in the medical records or deleted.

Updated: 19 March 2020


 Membership and Insurance FAQs 

We anticipate that government indemnity will be extended to all medical students who are engaged /employed in public hospitals. We advise Members to ensure their engagement and contract terms clearly set out the terms of such indemnity prior to commencing any duties. Medical students also need to ensure that their Ahpra registration is appropriate to their circumstances.

MDA National is pleased to advise that we will extend cover for student members under the Professional Indemnity Insurance Policy to provide an additional layer of support and protection.  
Specifically for those MDA National student Members who are engaged to assist during the COVID-19 pandemic, we will extend indemnity  under the Policy to cover the costs of defending student Members against  hospital or professional body investigations or inquiries as well as employment issues in  accordance with the Policy terms and conditions.  

This means that any student Member of MDA National who has a Professional Indemnity Insurance Policy issued by us should contact us for advice if they are required to respond to any inquiry or investigation. 
This cover is provided at no cost to student Members.

Not a MDA National student member? Join for free here 

 

Updated: 3 April 2020

We are happy to confirm Members will be covered in the event of a claim or investigation arising as the result of (alleged) transmission of COVID-19.

It is expected that Members will comply with all relevant Government, Hospital and Health Department directives in relation to COVID-19.

Updated: 1 April 2020

As a doctor owned membership organisation, MDA National is very aware of the emotional and financial impacts that COVID-19 is having on our Members. 

We are currently considering how best to support our Members and will provide an update ahead of the 2020/21 Membership and Insurance renewal period. 

 

Professional indemnity insurance for training doctors

As a doctor in training, you may be indemnified by the state for medical negligence claims that could arise during your provision of medical care to patients in the public health system. However, there are several situations that may not be covered by the state:

  • disciplinary and administrative proceedings undertaken by a range of professional bodies
  • Medical Board and AHPRA proceedings
  • Coronial investigations
  • hospital inquiries
  • employment disputes

 

Having your own cover protects your best interests and gives you security in knowing you have a team of medico-legal experts behind you.

To find out more about your career stage policy cover Click Here

 

Health & Well-being

Along with the everyday pressures of life, this stress can affect your health and wellbeing. We are here to provide you with confidential advice and practical support so that you can keep on thriving.


Videos:

Strategies for dealing with stress

Mental Health in the Workplace

Health and Wellbeing for Rural Doctors

Work-life Balance for Medical Practitioners

Mindfulness for Medical Practitioners

Stretching in the Workplace


Blog:

Impact of working hours on junior doctors' mental health


Podcasts:

Doctor Health and Wellbeing – Dr Ben Veness

Doctors’ Health and Wellbeing – Dr Eric Richman

 

Did you know that each year, there is a 1 in 20 chance of you receiving a complaint from AHPRA? 

No matter how experienced a doctor is or how successful they are in their career, this doesn’t prevent a complaint from being made. 

Manager of Professional Services at MDA National, Julie Brooke-Cowden, says that it’s normal to feel concerned and upset when a complaint is made against you – particularly when you are just starting out in medicine.   Over the years, Julie has helped many young doctors through some of most challenging times in their career. She remembers one junior doctor whom she supported through the process of giving evidence at a Coronial inquest, following the death of a patient. 

“Giving evidence in any sort of hearing, particularly when you're under pressure, is really difficult.”

Julie recalls that at the end of the investigation, the doctor told her that if he didn’t have his own indemnity insurance with MDA National, he felt he could have lost his registration. 

“You worry – especially if you haven’t been through the process, or don’t know anyone who has been through the process”.

“Then you feel like you must be a bad doctor, or there must be something wrong with you. But most of the time, it’s just something that happens.”

Here is a case study showing just how important it is to have your own medical defence organisation that you can depend on for advice.