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For doctors with mental health or substance use disorders, publication of their name and sensitive medical history in disciplinary decisions may adversely impact their health and may reinforce barriers to accessing early support and treatment. This article challenges the view that naming impaired doctors or disclosing the intimate details of their medical condition in disciplinary decisions always serves the public interest in open justice. We analysed and compared the approach of Australian and New Zealand health tribunals to granting orders that suppress the name and/or medical history of impaired doctors. This revealed that Australian tribunals are less likely to grant non-publication orders compared to New Zealand, despite shared common law history and similar medical regulatory frameworks. We argue that Australian tribunals could be more circumspect when dealing with sensitive information in published decisions, especially where such information does not directly form a basis for the decision reached. This could occur without compromising public protection or the underlying goals of open justice. Finally, we argue that a greater distinction should be made between those aspects of decisions that deal with conduct allegations, where full details should be published, and those that deal with impairment allegations, where only limited information should be disclosed. [ABSTRACT FROM AUTHOR]

Objective: Immediate action is an emergency power available to Australian health practitioner regulatory boards to protect the public. The aim of this study was to better understand the frequency, determinants and characteristics of immediate action use in Australia. Methods: This was a retrospective cohort study of 11 200 health practitioners named in notifications to the Australian Health Practitioner Regulation Agency (AHPRA) between January 2011 and December 2013. All cases were followed until December 2016 to determine their final outcome. Results: Of 13 939 finalised notifications, 3.7% involved immediate action and 9.7% resulted in restrictive final action. Among notifications where restrictive final action was taken, 79% did not involve prior immediate action. Among notifications where immediate action was taken, 48% did not result in restrictive final action. Compared with notifications from the public, the odds of immediate action were higher for notifications lodged by employers (mandatory notifications OR = 21.3, 95% CI 13.7–33.2; non-mandatory notifications OR = 10.9, 95% CI 6.7–17.8) and by other health practitioners (mandatory notifications OR = 11.6, 95% CI 7.6–17.8). Odds of immediate action were also higher if the notification was regulator-initiated (OR = 11.6, 95% CI 7.6–17.8), lodged by an external agency such as the police (OR = 11.8, 95% CI 7.7–18.1) or was a self-notification by the health practitioner themselves (OR = 9.4, 95% CI 5.5–16.0). The odds of immediate action were higher for notifications about substance abuse (OR = 9.9, 95% CI 6.9–14.2) and sexual misconduct (OR = 5.3, 95% CI 3.5–8.3) than for notifications about communication and clinical care. Conclusions: Health practitioner regulatory boards in Australia rarely used immediate action as a regulatory tool, but were more likely to do so in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What is known about this topic: Health practitioner regulatory boards protect the public from harm and maintain quality and standards of health care. Where the perceived risk to public safety is high, boards may suspend or restrict the practice of health practitioners before an investigation has concluded. What does this paper add?: This paper is the first study in Australia, and the largest internationally, to examine the frequency, characteristics and predictors of the use of immediate action by health regulatory boards. Although immediate action is rarely used, it is most commonly employed in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What are the implications for practitioners?: Immediate action is a vital regulatory tool. Failing to immediately sanction a health practitioner may expose the public to preventable harm, whereas imposing immediate action where allegations are unfounded can irreparably damage a health practitioner's career. We hope that this study will assist boards to balance the interests of the public with those of health practitioners. [ABSTRACT FROM AUTHOR]

Background: The distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care.Methods: Using data from the National Practitioner Data Bank, we analyzed 66,426 claims paid against 54,099 physicians from 2005 through 2014. We calculated concentrations of claims among physicians. We used multivariable recurrent-event survival analysis to identify characteristics of physicians at high risk for recurrent claims and to quantify risk levels over time.Results: Approximately 1% of all physicians accounted for 32% of paid claims. Among physicians with paid claims, 84% incurred only one during the study period (accounting for 68% of all paid claims), 16% had at least two paid claims (accounting for 32% of the claims), and 4% had at least three paid claims (accounting for 12% of the claims). In adjusted analyses, the risk of recurrence increased with the number of previous paid claims. For example, as compared with physicians who had one previous paid claim, the 2160 physicians who had three paid claims had three times the risk of incurring another (hazard ratio, 3.11; 95% confidence interval [CI], 2.84 to 3.41); this corresponded in absolute terms to a 24% chance (95% CI, 22 to 26) of another paid claim within 2 years. Risks of recurrence also varied widely according to specialty--for example, the risk among neurosurgeons was four times as great as the risk among psychiatrists.Conclusions: Over a recent 10-year period, a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims. [ABSTRACT FROM AUTHOR]

Background: Doctors with a history of mental health or substance use challenges face barriers accessing treatment and are difficult to recruit for research. This makes understanding their experiences challenging, yet essential. Overcoming barriers to research participation among unwell doctors is critical to advancing their overall health and wellbeing. Methods: A qualitative interview study of 21 allegedly impaired doctors in Australia and Aotearoa New Zealand who were subject to regulatory processes relating to their health. Based in an interpretative phenomenological paradigm, this paper examines participants' motivations for participation in this study and their reactions to participating. It highlights wider implications for sensitive research involving doctors and marginalised groups. Results: Participants were strongly motivated to participate in our research for their own benefit (desire to be heard, catharsis, and empowerment) and to benefit others (to change the system, and to avoid other doctors experiencing what they experienced). Careful planning and communication of unique legal risks fostered a trusting researcher-participant relationship. To assist other researchers undertaking sensitive qualitative research with vulnerable participants, we describe our research protocol, challenges, and successes in detail. Conclusions: Despite ethical concerns about research risk, researchers can and should pursue qualitative research into the experiences of under-represented groups, including allegedly impaired doctors. Without involving them in research that examines issues directly impacting on them, we may be inadvertently perpetuating the barriers and stigma that also hinder them from accessing treatment and support. This also deprives us of knowledge that can be used to improve doctors' health. This paper has broader relevance for anyone doing research with doctors, people in vulnerable positions, people disempowered by institutional or social systems, people who are stigmatised or shamed, and people who have experienced trauma. [ABSTRACT FROM AUTHOR]

Objectives. To determine the nature and extent of governance activities by health service boards in relation to quality and safety of care and to gauge the expertise and perspectives of board members in this area. Methods. This study used an online and postal survey of the Board Chair, Quality Committee Chair and two randomly selected members from the boards of all 85 health services in Victoria. Seventy percent (233/332) of members surveyed responded and 96% (82/85) of boards had at least one member respond. Results. Most boards had quality performance as a standing item on meeting agendas (79%) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). Fewer boards benchmarked their service's quality performance against external comparators (50%) or offered board members formal training on quality (53%). Eighty-two percent of board members identified quality as a top priority for board oversight, yet members generally considered their boards to be a relatively minor force in shaping the quality of care. There was a positive correlation between the size of health services (total budget, inpatient separations) and their board's level of engagement in quality-related activities. Ninety percent of board members indicated that additional training in quality and safety would be 'moderately useful' or 'very useful'. Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service. Conclusions. Collectively, health service boards are engaged in an impressive range of clinical governance activities. However, the extent of engagement is uneven across boards, certain knowledge deficits are evident and there was wide agreement among board members that further training in quality-related issues would be useful. [ABSTRACT FROM AUTHOR]

The article discusses negligence claims and complaints in Australia relative to legal disputes over obligations in disclosing treatment risks to patients. It mentions the 1972 Canterbury v. Spence case which involve the failure of a surgeon in outlining clinical risks. It also notes that physicians particularly surgeons are frequently unsure which risk they should discuss with patients before treatment.

Background: Doctors with a history of mental health or substance use challenges face barriers accessing treatment and are difficult to recruit for research. This makes understanding their experiences challenging, yet essential. Overcoming barriers to research participation among unwell doctors is critical to advancing their overall health and wellbeing. Methods: A qualitative interview study of 21 allegedly impaired doctors in Australia and Aotearoa New Zealand who were subject to regulatory processes relating to their health. Based in an interpretative phenomenological paradigm, this paper examines participants' motivations for participation in this study and their reactions to participating. It highlights wider implications for sensitive research involving doctors and marginalised groups. Results: Participants were strongly motivated to participate in our research for their own benefit (desire to be heard, catharsis, and empowerment) and to benefit others (to change the system, and to avoid other doctors experiencing what they experienced). Careful planning and communication of unique legal risks fostered a trusting researcher-participant relationship. To assist other researchers undertaking sensitive qualitative research with vulnerable participants, we describe our research protocol, challenges, and successes in detail. Conclusions: Despite ethical concerns about research risk, researchers can and should pursue qualitative research into the experiences of underrepresented groups, including allegedly impaired doctors. Without involving them in research that examines issues directly impacting on them, we may be inadvertently perpetuating the barriers and stigma that also hinder them from accessing treatment and support. This also deprives us of knowledge that can be used to improve doctors' health. This paper has broader relevance for anyone doing research with doctors, people in vulnerable positions, people disempowered by institutional or social systems, people who are stigmatised or shamed, and people who have experienced trauma. [ABSTRACT FROM AUTHOR]

Background: Some health practitioners pose substantial threats to patient safety, yet early identification of them is notoriously difficult. We aimed to develop an algorithm for use by regulators in prospectively identifying practitioners at high risk of attracting formal complaints about health, conduct or performance issues.Methods: Using 2011-2016 data from the national regulator of health practitioners in Australia, we conducted a retrospective cohort study of 14 registered health professions. We used recurrent-event survival analysis to estimate the risk of a complaint and used the results of this analysis to develop an algorithm for identifying practitioners at high risk of complaints. We evaluated the algorithm's discrimination, calibration and predictive properties.Results: Participants were 715,415 registered health practitioners (55% nurses, 15% doctors, 6% midwives, 5% psychologists, 4% pharmacists, 15% other). The algorithm, PRONE-HP (Predicted Risk of New Event for Health Practitioners), incorporated predictors for sex, age, profession and specialty, number of prior complaints and complaint issue. Discrimination was good (C-index = 0·77, 95% CI 0·76-0·77). PRONE-HP's score values were closely calibrated with risk of a future complaint: practitioners with a score ≤ 4 had a 1% chance of a complaint within 24 months and those with a score ≥ 35 had a higher than 85% chance. Using the 90th percentile of scores within each profession to define "high risk", the predictive accuracy of PRONE-HP was good for doctors and dentists (PPV = 93·1% and 91·6%, respectively); moderate for chiropractors (PPV = 71·1%), psychologists (PPV = 54·9%), pharmacists (PPV = 39·9%) and podiatrists (PPV = 34·0%); and poor for other professions.Conclusions: The performance of PRONE-HP in predicting complaint risks varied substantially across professions. It showed particular promise for flagging doctors and dentists at high risk of accruing further complaints. Close review of available information on flagged practitioners may help to identify troubling patterns and imminent risks to patients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Patents' complaints are 'tip of an iceberg' in New Zealand," by H. Marcovitch.

Objectives To determine whether ‘older doctors’ (aged over 65) are at higher risk of notifications to the medical regulator than ‘younger doctors’ (aged 36–60 years) regarding their health, performance and/or conduct. Design Retrospective cohort study. Setting National dataset of 12,878 notifications lodged with medical regulators in Australia between 1 January 2011 and 31 December 2014. Participants All registered doctors in Australia aged 36–60 and >65 years during the study period. Main outcome measures Incidence rates of notifications and incidence rate ratios of notifications (older versus younger doctors). Results Older doctors had higher notification rates (90.9 compared with 66.6 per 1000 practitioner years, p < 0.001). Sex-adjusted incidence rate ratios showed that older doctors had a higher risk of notifications relating to physical illness or cognitive decline (incidence rate ratio = 15.54), inadequate record keeping (incidence rate ratio = 1.98), unlawful use or supply of medications (incidence rate ratio = 2.26), substandard certificates/reports (incidence rate ratio = 2.02), inappropriate prescribing (incidence rate ratio = 1.99), disruptive behaviours (incidence rate ratio = 1.37) and substandard treatment (incidence rate ratio = 1.24). Older doctors had lower notification rates relating to mental illness and substance misuse (incidence rate ratio = 0.58) and for performance issues relating to problems with procedures (incidence rate ratio = 0.61). Conclusions Older doctors were at higher risk for notifications relating to physical or cognitive impairment, records and reports, prescribing or supply of medicines, disruptive behaviour and treatment. They were at lower risk for notifications about mental illness or substance misuse. Incorporating knowledge of these patterns into regulatory practices, workplace adjustments and continuing education/assessment could enhance patient care. [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]

Background: Medical boards and other practitioner boards aim to protect the public from unsafe practice. Previous research has examined disciplinary actions against doctors, but other professions (e.g., nurses and midwives, dentists, psychologists, pharmacists) remain understudied. We sought to describe the outcomes of notifications of concern regarding the health, performance, and conduct of health practitioners from ten professions in Australia and to identify factors associated with the imposition of restrictive actions. Methods: We conducted a retrospective cohort study of all notifications lodged with the Australian Health Practitioner Regulation Agency over 24 months. Notifications were followed for 30-54 months. Our main outcome was restrictive actions, defined as decisions that imposed undertakings, conditions, or suspension or cancellation of registration. Results: There were 8307 notifications. The notification rate was highest among doctors (IR = 14.5 per 1000 practitioners per year) and dentists (IR = 20.7) and lowest among nurses and midwives (IR = 2.0). One in ten notifications resulted in restrictive action; fewer than one in 300 notifications resulted in suspension or cancellation of registration. Compared with notifications about clinical care, the odds of restrictive action were higher for notifications relating to health impairments (drug misuse, OR = 7.0; alcohol misuse, OR = 4.6; mental illness, OR = 4.1, physical or cognitive illness, OR = 3.7), unlawful prescribing or use of medications (OR = 2.1) and violation of sexual boundaries (OR = 1.7). The odds were higher where the report was made by another health practitioner (OR = 2.9) or employer (OR = 6.9) rather than a patient or relative. Nurses and midwives (OR = 1.8), psychologists (OR = 4.5), dentists (OR = 4.7), and other health practitioners (OR = 5.3) all had greater odds of being subject to restrictive actions than doctors. Conclusions: Restrictive actions are the strongest measures health practitioner boards can take to protect the public from harm and these actions can have profound effects on the livelihood, reputations and well-being of practitioners. In Australia, restrictive actions are rarely imposed and there is variation in their use depending on the source of the notification, the type of issue involved, and the profession of the practitioner. [ABSTRACT FROM AUTHOR]

The original article [1] contains a major error whereby all rates in Table 2 are mistakenly presented as 50% of their true values; this error was caused by a miscalculation in annualising the original values that represented the rates. [ABSTRACT FROM AUTHOR]