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Substance use during pregnancy is associated with poor neonatal outcomes. Women incarcerated during pregnancy may have a history of substance use, and their babies may be at risk of neonatal abstinence syndrome (NAS). This study examines the incidence of NAS and other outcomes in infants born to currently or formerly incarcerated women. Infants born between 1985 and 2011 in Western Australia were divided into three mutually exclusive groups: born to women incarcerated during pregnancy (n = 708); born within 9–24 months of the mother's release from prison (n = 651); and born to women who were never incarcerated (n = 17,712). The impact of the timing of incarceration during pregnancy was also examined. Neonatal outcomes (NAS, preterm birth, low birthweight, infant mortality and admission to special care nursery) were compared using logistic regression. Infants born to currently or recently incarcerated women had higher odds of all adverse outcomes than infants in the nonexposed group. Infants born to women incarcerated during the second or third trimester (but not the month of birth) had poorer outcomes than infants born to women incarcerated during the month of birth. The findings show that babies born to currently or formerly incarcerated women are equally likely to experience adverse neonatal outcomes. Enhanced maternal healthcare must be provided during incarceration and after release. [ABSTRACT FROM AUTHOR]

Background: Somatic Symptom Disorder is a psychiatric diagnosis that describes the experience of physical symptoms and associated distress, that is disproportionate to recognized organic pathology. Somatic symptom severity (SSS) may be associated with some surgical diagnoses; particularly the complex pain associated with pancreatitis, or the diagnostic ambiguity of undifferentiated abdominal pain (UAP). We aimed to estimate the prevalence of SSS in different diagnostic groups in surgical inpatients with abdominal pain; and to estimate the magnitude and direction of any association of SSS, anxiety and depression. Methods: Cross sectional analysis (n = 465) of adult admissions with non‐traumatic abdominal pain, at a tertiary hospital in Australia. We estimated SSS with the Patient Health Questionnaire‐15 (PHQ‐15), depression with the Patient Health Questionnaire (PHQ‐9) and anxiety with the General Anxiety Disorder (GAD‐7), at standard cut‐points ≥ 10; comparing acute pancreatitis (n = 20), chronic pancreatitis (n = 18) and UAP (n = 64) versus other causes of abdominal pain. Results: Somatic symptoms were common, 52% having moderate and 19.6% severe SSS. There was an association between moderate SSS and pancreatitis (OR 2.11, 95% CI 1.05–4.25) and depressive symptoms and chronic pancreatitis (OR = 3.47, 95% CI 1.31–9.24). There was no significant association between the four mental health categories and UAP. Conclusions: SSS and psychological comorbidity were common in a surgical inpatients admitted for abdominal pain and equally represented across most diagnostic sub‐groups. However, the pancreatitis sub‐group had greater proportions with clinically significant SSS and depression, suggesting that they have a higher requirement for psychological assessment and intervention. [ABSTRACT FROM AUTHOR]

Objective: This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). Methods: This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self‐harm; substance‐use disorder, schizophrenia, mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. Results: A total of 121,203 patients were included, with median follow‐up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0–18.4] restrictive, 10.8 [8.4–13.9] sleeve gastrectomy, 20.4 [9.7–42.8] gastric bypass; p = 0.18). Rates of admission with self‐harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance‐use disorder increased after all surgery types. Conclusions: Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health. [ABSTRACT FROM AUTHOR]

Aims: Treatment of methamphetamine dependence requires monitoring of recent use or abstinence. Self‐report is commonly used for routine monitoring, but the accuracy of self‐report is not established. For the treating clinician, the key accuracy statistic is the negative predictive value (NPV). The study aim was to estimate the NPV of self‐reported non‐use of methamphetamine compared with an oral fluid reference standard. Design, Setting and Participants: This study was a secondary (subgroup) analysis from a randomized controlled pharmacotherapy trial. Three Australian outpatient addiction services took part. Particpants were 139 people dependent on methamphetamine. Measurements: Weekly oral fluid samples over 12 weeks to determine methamphetamine (and amphetamine) concentrations were used as the reference standard. Self‐report of any methamphetamine use in the previous 7 days by the time‐line follow‐back method was the index test. Standard diagnostic accuracy statistics were calculated for all available paired episodes (n = 1134). Three NPV values were calculated: unadjusted NPV and NPV adjusted for clustering of observations through logistic regression and generalized estimating equation (GEE). We also calculated the NPVs for a range of prevalence rates of methamphetamine use, for the calculated levels of sensitivity and specificity. Findings Sensitivity was 96.4% [95% confidence interval (CI) = 95–97.5], specificity was 63.7% (95% CI = 57.3–69.8) and positive predictive value (PPV) was 90.8% (95% CI = 88.8–92.6). The unadjusted NPV was 82.7% (95% CI = 76.5–87.9), adjusted NPV by logistic regression 82.7% (95% CI = 73.9–91.5) and GEE 76.8% (95% CI = 66.8–86.8). At a methamphetamine use prevalence of 5%, the estimated NPV would be 99.7% (95% CI = 99.6–99.9) and at 95% prevalence, 48.2% (95% CI = 39.6–57.0). Conclusions: Self‐report of no recent methamphetamine use appears to be sufficiently accurate to be clinically useful at the expected prevalence rates of methamphetamine use in clinical treatment settings. If generalizable to clinical settings, where these tests are routinely conducted, this may permit a reduction in the frequency and cost of oral fluid assays. [ABSTRACT FROM AUTHOR]

Introduction: More than half of suicide decedents have no contact with mental health services 12 months before death. It is uncertain if they have different characteristics than decedents who use mental health services. Methods: A case‐series design. Participants 45 years and older, who died by suicide (2006–2018). Comparisons were made between those who did and did not have contact with mental health services, using individually linked data from federal services in the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Results: Of 186 cases, 71% had no contact with mental health services. Physical health services were used equally by 75%. Psychiatric medication use was uncommon, except for antidepressants, 50% with mental health service contact and 20% with no contact. Older age, lower income, involuntarily unemployed, firearms as suicide method, greater physical disability, less functional impairment due to emotional problems and lesser proportions with mental illness, were associated with no contact with mental health services. Conclusions: For suicide prevention, middle‐older aged adults may have less requirement for mental health intervention, and greater requirement for the development of complementary interventions focused on physical health and social issues, which are not necessarily best delivered by clinical mental health services. [ABSTRACT FROM AUTHOR]

Introduction: People released from prison have an increased risk of morbidity, including from nonfatal violence. We examined the incidence and predictors of violence‐related morbidity after release from prison and investigated whether there are differences according to sex and Indigenous status. Methods: Baseline data were collected from 1325 people within 6 weeks of release from prisons in Queensland, Australia, between 1 August 2008 and 31 July 2010. Data were linked to state‐wide health (ambulance, emergency department and hospital) and prison records, and national death records until 31 July 2012. Predictors were identified using a multivariable Andersen‐Gill model. Differences according to sex and Indigenous status were investigated using effect modification. Results: A total of 225 (18.2%) people experienced 410 violence‐related events that were recorded in health records. The incidence was 12.8 per 100 person‐years [95% confidence interval (CI) 11.7, 14.1]. Risk factors for violence‐related morbidity included diagnosed mental illness [hazard ratio (HR) = 2.0, 95% CI 1.1, 3.8], substance use disorder (HR = 1.6, 95% CI 1.1, 2.3) or dual diagnosis (HR = 3.2, 95% CI 2.2, 4.8); high‐risk alcohol use (HR = 2.1, 95% CI 1.5, 2.8); being Indigenous (HR = 1.7, 95% CI 1.2, 2.5); and two or more prison releases (HR = 1.7, 95% CI 1.2, 2.6). Indigenous status modified the risk of violence‐related morbidity, with Indigenous men having twice the risk of non‐Indigenous men (HR = 1.9, 95% CI 1.3, 2.8). Discussion and Conclusions: Approximately one in five people released from prisons in Queensland experienced violence‐related morbidity. Coordinated and continuous mental health and substance use treatment from prison to the community may reduce the risk of violence‐related morbidity in this population. [ABSTRACT FROM AUTHOR]

Objective: In the United States, there was an increase in calls to helplines following media reporting of Robin Williams' suicide. We aimed to determine whether this was the case in Australia. Method: The helpline services Lifeline and Beyond Blue provided us with weekly data on calls received for 2013–2015. We conducted interrupted time series regression analyses to determine whether there was an increase in the average weekly number of calls received by each helpline in two periods after the story about Williams' suicide broke (1 week and 4 weeks). Results: We found strong evidence of an increase in calls to Lifeline (incidence rate ratio [IRR] =1.13; 95% confidence interval [CI] =1.02–1.25; p = 0.016) and Beyond Blue (IRR = 1.32; 95% CI = 1.09–1.59; p = 0.004) in the week after Williams' suicide was first reported. We found no evidence of higher than normal call volumes for Lifeline (IRR = 1.04; 95% CI = 0.99–1.10; p = 0.104) or Beyond Blue (IRR = 1.10; 95% CI = 1.00–1.22; p = 0.058) over the four weeks following Williams' death, however, suggesting that calls leveled out over this period. Conclusion: Suicide prevention experts and media professionals must work together to minimize the negative impacts of reports on suicide and maximize their positive ones. In cases where the story is likely to receive extensive international coverage, it may be important for local media to encourage help‐seeking. [ABSTRACT FROM AUTHOR]

Objective: To determine the care pathway and rate and predictors of mental health care contact within seven days of discharge from acute care following self-harm.Method: In a representative cohort of adults released from prisons in Queensland, Australia, we probabilistically linked person-level, statewide ambulance, emergency department, and hospital records, both prospectively and retrospectively, and community mental health service and Medicare records prospectively, to baseline survey data. We fit multivariate modified log-linked Poisson regression models to examine the association between sociodemographic, health, and criminal justice factors and mental health care contact after self-harm.Results: Of 217 discharges from acute care following self-harm, 55% (n = 119) received mental health care within seven days of discharge. Mental health care contact was associated with substance use disorder (adjusted relative risk (ARR) = 0.48; 95% CI: 0.27-0.85), dual diagnosis (ARR = 0.58; 95% CI: 0.41-0.82), physical health-related functioning (ARR = 0.98; 95% CI: 0.97-0.99), being female (ARR = 1.39; 95% CI: 1.02-1.90), being identified as at risk of self-harm by correctional authorities (ARR = 1.50; 95% CI: 1.07-2.09), and prior engagement with state-funded mental health care (ARR = 1.55; 95% CI: 1.08-2.22).Conclusion: Our findings highlight the need to improve the integration of community mental health care for people who present to acute care following self-harm with a recent history of incarceration, particularly for men and those with substance use disorder or dual diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: To assess the numbers of notifications to health regulators alleging sexual misconduct by registered health practitioners in Australia, by health care profession.Design, Setting: Retrospective cohort study; analysis of Australian Health Practitioner Regulation Agency and NSW Health Professional Councils Authority data on notifications of sexual misconduct during 2011-2016.Participants: All registered practitioners in 15 health professions.Main Outcome Measures: Notification rates (per 10 000 practitioner-years) and adjusted rate ratios (aRRs) by age, sex, profession, medical specialty, and practice location.Results: Regulators received 1507 sexual misconduct notifications for 1167 of 724 649 registered health practitioners (0.2%), including 208 practitioners (18%) who were the subjects of more than one report during 2011-2016; 381 notifications (25%) alleged sexual relationships, 1126 (75%) sexual harassment or assault. Notifications regarding sexual relationships were more frequent for psychiatrists (15.2 notifications per 10 000 practitioner-years), psychologists (5.0 per 10 000 practitioner-years), and general practitioners (6.4 per 10 000 practitioner-years); the rate was higher for regional/rural than metropolitan practitioners (aRR, 1.73; 95% CI, 1.31-2.30). Notifications of sexual harassment or assault more frequently named male than female practitioners (aRR, 37.1; 95% CI, 26.7-51.5). A larger proportion of notifications of sexual misconduct than of other forms of misconduct led to regulatory sanctions (242 of 709 closed cases [34%] v 5727 of 23 855 [24%]).Conclusions: While notifications alleging sexual misconduct by health practitioners are rare, such misconduct has serious consequences for patients, practitioners, and the community. Further efforts are needed to prevent sexual misconduct in health care and to ensure thorough investigation of alleged misconduct. [ABSTRACT FROM AUTHOR]

Issue Addressed: A website was designed to form the core of a multimedia strategy surrounding the Man Up documentary - a three-part documentary that aimed to address the problem of male suicide in Australia. Together these formed a media-based, public health intervention that explored the link between masculinity and suicide and promoted help-seeking. This is of great importance given the demonstrated link between masculine norms, men's reduced help-seeking and suicidal thinking. This study assesses the website's effectiveness in facilitating help-seeking and fostering conversations about suicide, mental health and help-seeking. Help-seeking indicators included website clicks to helping organisations, downloads of health information from the website and request for help received via emails.Methods: Google Analytics data, emails to the Man Up team received through the website and open-ended responses to an online survey were analysed.Results: The website reached 43 140 users. Indictors of help-seeking activity on the website included 307 outbound clicks to helping organisations and 802 downloads of health information. Qualitative analysis of emails received and responses to the survey demonstrated that Man Up's messages resonated with viewers and provided further evidence of help-seeking.Conclusion: The findings demonstrate that the website provided an important opportunity for people to engage with Man Up and seek help. SO WHAT?: Media-based public health interventions offer enormous potential to provide suicide prevention interventions and promote help-seeking. The website evaluation findings provide insight into the ways in which websites can be used as part of a multimedia strategy to address the problem of male suicide. [ABSTRACT FROM AUTHOR]

Background: Adults released from prison often have complex health needs. They are at high risk of poor health outcomes and reincarceration, with health service use unlikely to be planned.Aims/hypotheses: To determine the incidence of emergency health service (EHS) use, ambulance attendance and/or emergency department presentation, among 1,181 adults released from Australian prisons. We hypothesised that EHS contact would be associated with increased reincarceration risk.Methods: Baseline surveys were conducted within 6 weeks before release. Postrelease EHS contacts and reincarceration were identified through prospective data linkage. For each participant, EHS contacts within a 24-hour period were combined to make an episode. We used Cox proportional hazards regression to examine the relationship between EHS episodes and reincarceration, controlling for covariates.Results: More than half (53.3%) of participants had at least one EHS contact over a median of 25.6-month follow-up. In adjusted analyses, compared to those with no EHS contacts, the hazard of reincarceration was greater for participants who had one to three EHS episodes (hazard ratio [HR] = 1.84; 95% confidence interval [CI] [1.48, 2.29]) or four or more (HR = 2.35; 95% CI [1.67, 3.29]).Conclusions/implications For Practice: Emergency department attendance by people with a history of imprisonment may be indicative of wider decompensation. Improved management of such patients may improve health outcomes and have collateral benefits for reducing reincarceration. [ABSTRACT FROM AUTHOR]

We sought to compare clusters of suicidal events between two different time periods and examine the extent to which earlier clusters predict later clusters. We included data on suicides and suicide attempts from New South Wales between July 2001 and June 2012 and Western Australia between January 2000 and December 2011. Suicide attempts included admissions to hospital for deliberate self-harm and suicides were deaths due to deliberate self-harm. We combined data on suicides and suicide attempts and grouped them into two equal time periods. We detected clusters in each period using Poisson discrete scan statistics adjusted for socio-economic status. We estimated the predictive values of earlier clusters on later clusters. The results showed that clusters from earlier time period had a moderate power (36%) in predicting later clusters. During the later time period, some additional cluster areas (14%) were found and some earlier cluster areas subsided (64%). Historical clusters predict 36% of the subsequent clusters, which is probably not sufficient for targeting interventions. Our study highlights the need for other strategies to detect emerging clusters, for example, up-to-date data. [ABSTRACT FROM AUTHOR]

Assessment of a patient after hospital-treated self-harm or psychiatric hospitalization often includes a risk assessment, resulting in a classification of high risk versus low risk for a future episode of self-harm. Through systematic review and a series of meta-analyses looking at unassisted clinician risk classification (eight studies; N = 22,499), we found pooled estimates for sensitivity 0.31 (95% CI: 0.18-0.50), specificity 0.85 (0.75-0.92), positive predictive value 0.22 (0.21-0.23), and negative predictive value 0.89 (0.86-0.92). Clinician classification was too inaccurate to be clinically useful. After-care should therefore be allocated on the basis of a needs rather than risk assessment. [ABSTRACT FROM AUTHOR]

Failure to provide follow-up care after a suicide attempt is associated with increased risk of reattempt. This online survey examined the experiences of patients of the Australian health system after a suicide attempt. Just over half of the participants had a psychiatric assessment within 1 week of their attempt. Fewer than half believed they had been offered enough help. Low service satisfaction was associated with lower help-seeking intentions. Support for individuals who have made a suicide attempt needs to be enhanced, and an integrated approach to care is required, including improved referral pathways and staff attitudinal change. [ABSTRACT FROM AUTHOR]

Background: Compared with other doctors, surgeons are at an increased risk of medicolegal events, including patient complaints and negligence claims. This retrospective study aimed to describe the frequency and nature of complaints involving surgeons compared with physicians. Methods: We assembled a national data set of complaints about surgeons and physicians lodged with medical regulators in Australia from 2011 to 2016. We classified the complaints into 19 issues across four domains: treatment and procedures, other performance, professional conduct and health. We assessed differences in complaint risk using incidence rate ratios (IRRs). Finally, we used a multivariate model to identify predictors of complaints among surgeons. Results: The rate of complaints was 2.3 times higher for surgeons than physicians (112 compared with 48 complaints per 1000 practice years, P < 0.001). Two‐fifths (41%) of the higher rate of complaints among surgeons was attributable to issues other than treatments and procedures, including fees (IRR = 2.68), substance use (IRR = 2.10), communication (IRR = 1.98) and interpersonal behaviour (IRR = 1.92). Male surgeons were at a higher risk of complaints, as were specialists in orthopaedics, plastic surgery and neurosurgery. Discussion: Surgeons are more than twice as likely to attract complaints as their physician peers. This elevated risk arises partly from involvement in surgical procedures and treatments, but also reflects wider concerns about interpersonal skills, professional ethics and substance use. Improved understanding of these patterns may assist efforts to reduce harm and support safe practise. [ABSTRACT FROM AUTHOR]

Objectives: To determine the rates at which people recently released from prison attend general practitioners, and to describe service users and their encounters.Design, Participants and Setting: Prospective cohort study of 1190 prisoners in Queensland, interviewed up to 6 weeks before expected release from custody (August 2008 - July 2010); their responses were linked prospectively with Medicare and Pharmaceutical Benefits Scheme data for the 2 years after their release. General practice attendance was compared with that of members of the general Queensland population of the same sex and in the same age groups.Main Outcome Measures: Rates of general practice attendance by former prisoners during the 2 years following their release from prison.Results: In the 2 years following release from custody, former prisoners attended general practice services twice as frequently (standardised rate ratio, 2.04; 95% CI, 2.00-2.07) as other Queenslanders; 87% of participants visited a GP at least once during this time. 42% of encounters resulted in a filled prescription, and 12% in diagnostic testing. Factors associated with higher rates of general practice attendance included history of risky opiate use (incidence rate ratio [IRR], 2.09; 95% CI, 1.65-2.65), having ever been diagnosed with a mental disorder (IRR, 1.32; 95% CI, 1.14-1.53), and receiving medication while in prison (IRR, 1.82; 95% CI, 1.58-2.10).Conclusions: Former prisoners visited general practice services with greater frequency than the general Queensland population. This is consistent with their complex health needs, and suggests that increasing access to primary care to improve the health of former prisoners may be insufficient, and should be accompanied by improving the quality, continuity, and cultural appropriateness of care. [ABSTRACT FROM AUTHOR]

Objectives: To report age-standardised rates and methods of suicide by health professionals, and to compare these with suicide rates for other occupations.Study Design: Retrospective mortality study.Setting, Participants: All intentional self-harm cases recorded by the National Coronial Information System during the period 2001-2012 were initially included. Cases were excluded if the person was unemployed at the time of death, if their employment status was unknown or occupational information was missing, or if they were under 20 years of age at the time of death. Suicide rates were calculated using Australian Bureau of Statistics population-level data from the 2006 census.Main Outcome Measures: Suicide rates and method of suicide by occupational group.Results: Suicide rates for female health professionals were higher than for women in other occupations (medical practitioners: incidence rate ratio [IRR], 2.52; 95% CI, 1.55-4.09; P < 0.001; nurses and midwives: IRR, 2.65; 95% CI, 2.22-3.15; P < 0.001). Suicide rates for male medical practitioners were not significantly higher than for other occupations, but the suicide rate for male nurses and midwives was significantly higher than for men working outside the health professions (IRR, 1.50; 95% CI 1.12-2.01; P = 0.006). The suicide rate for health professionals with ready access to prescription medications was higher than for those in health professions without such access or in non-health professional occupations. The most frequent method of suicide used by health professionals was self-poisoning.Conclusion: Our results indicate the need for targeted prevention of suicide by health professionals. [ABSTRACT FROM AUTHOR]

Objective To determine the accuracy and reliability of triage of children in public hospital EDs using the Australasian Triage Scale ( ATS). This is the first study to examine these issues in paediatric triage following the 2007 development of the Emergency Triage Education Kit ( ETEK) to foster accurate and consistent application of the ATS. Methods A convenience sample of 167 triage nurses working at three general hospitals and one speciality paediatric hospital in greater metropolitan Melbourne assigned triage ratings for nine paediatric clinical scenarios using the ATS. Scenarios were derived from the ETEK or from other published sources. Kappa was used to assess interrater reliability within and between hospitals. Results Triage nurses correctly assigned triage scores to an average of 5.3 of nine paediatric clinical scenarios. Accuracy in specific hospitals ranged from a low of 15% on one scenario, to 100% accuracy on a different scenario at a different hospital. Interrater reliability within and across the EDs studied was found to be kappa = 0.27. Both accuracy and interrater reliability were marginally higher at the speciality paediatric hospital. Conclusions Our findings demonstrate inconsistencies in the accuracy and reliability in which sick children presenting to EDs receive triage scores both within and across hospitals. These results suggest the need for improvements either in current triage nurse training or training resources. Use of the ETEK alone has not resulted in high levels of paediatric triage accuracy or reliability. [ABSTRACT FROM AUTHOR]

The article discusses the research which shows the frequency and characteristics of mandatory reports on the health, performance, and conduct of registered health practitioners in Australia. It states that nurses and doctors dominated notifications. It notes that health professionals other than respondents made 46 percent of notifications. It mentions that incidence of notifications against men was more than two-and-a-half times compared to women.

The article discusses a study on the risks of medical board complaints and adverse disciplinary findings against international medical graduates (IMG) in Victoria and Western Australia. The researchers gathered data on all complaints made against doctors to medical boards and assessed them for associations between IMG status and the incidence of complains. They found that complaints against IMG were higher than Australia-trained medical graduates.

BSTRACT [ABSTRACT FROM AUTHOR]

Objective: To identify characteristics of doctors who are repeated subjects of complaints by patients.Design and Setting: Case-control study of doctors about whom patients had complained to the Victorian Health Services Commissioner between 1 January 2000 and 31 December 2009.Participants: 384 doctors in private practice; cases comprised 96 doctors who were the subject of four or more separate complaints; and the control group comprised 288 doctors who were the subject of a single complaint over the study period.Results: Among doctors in private practice in Victoria, 20.5% (95% CI, 19.7%-21.3%) experienced at least one complaint over the decade. Among doctors who were the subject of a complaint, 4.5% (95% CI, 3.6%-5.4%) had four or more complaints, and this group accounted for 17.6% (95% CI, 16.3%-19.0%) of all complaints to the Victorian Health Services Commissioner. Multivariate analyses showed that surgeons (odds ratio [OR], 8.90; 95% CI, 3.69-21.50) and psychiatrists (OR, 4.59; 95% CI, 1.46-14.43) had higher odds of being in the complaint-prone group than general practitioners. Doctors trained overseas had lower odds of being complaint-prone than those trained in Australia (OR, 0.31; 95% CI, 0.13-0.72).Conclusions: A small group of doctors in private practice in Victoria account for nearly 18% of complaints. Interventions to improve patient satisfaction and public confidence in health services should target complaint-prone subgroups of practitioners. [ABSTRACT FROM AUTHOR]

The article analyzes the disciplinary cases for doctors charged with professional misconduct in Australia and New Zealand from 2000 to 2009. More male doctors were disciplined for misconduct than their female colleagues at 91 versus 22 cases per 100,000 doctor-years. Highest rates of disciplinary cases were noted in the specialties of psychiatry, obstetrics and gynaecology. About 24% of the cases involved sexual misconduct followed by unethical prescribing at 21%.

Several letters to the editor are presented in response to articles in previous issues including "Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia," by Elkin, M. J. Spittalm and D. M. Studdert in the 2012 issue.

Objective: To describe the frequency, nature and outcomes of reports about health practitioners made by their treating practitioners under Australia's new mandatory reporting system.Design and Setting: Retrospective case file review and analysis of treating practitioner reports received by the Australian Health Practitioner Regulation Agency between 1 November 2011 and 31 January 2013, and of the outcomes of the completed investigations of these reports to November 2014.Main Outcome Measures: Characteristics of treating practitioners and reported practitioners; nature of the care relationship; grounds for report; regulatory action taken in response to report.Results: Of 846 mandatory reports about medical practitioners, 64 (8%) were by treating practitioners. A minority of reports (14 of 64) were made by a practitioner-patient's regular care provider; most (50 of 64) arose from an encounter during an acute admission, first assessment or informal corridor consultation. The reported practitioner-patients were typically being treated for mental illness (28 of 64) or substance misuse (25 of 64). In 80% of reports (50 of 64), reporters described practitioner-patients who exhibited diminished insight, dishonesty, disregard for patient safety, or an intention to self-harm.Conclusions: The nature and circumstances of the typical treating practitioner report challenge assumptions expressed in policy debates about the merits of the new mandatory reporting law. Mandatory reports by treating practitioners are rare. The typical report is about substance misuse or mental illness, is made by a doctor who is not the patient's regular care provider, and identifies an impediment to safely managing the risk posed by the practitioner-patient within the confines of the treating relationship. [ABSTRACT FROM AUTHOR]