Who are the regulators?
It can be confusing! There are national health practitioner laws which apply across Australia which overseen by the Ahpra and individual professional boards (such as the Medical Board of Australia).
Uniquely, in NSW both the NSW Medical Council and the independent NSW Health Care Complaints Commission have joint responsibility for responding to complaints and concerns about individual doctors in NSW.
As a medical student currently studying in NSW Australia, your details are registered with the Australian Health Practitioner Regulation Agency. This is facilitated by the medical school you are registered with.
In a nutshell, the Health Care Complaints Commission (HCCC) and the Medical Council co-regulate and manage complaints about individual medical practitioners and medical students in NSW. The HCCC also manages complaints about other health practitioners, unregistered practitioners and institutions.
While Ahpra manages complaints in most other states, their role in NSW relates to complaints about advertisement of medical services and registering students and practitioners.
What does it mean to be regulated?
It is expected that the medical profession will ensure patients’ safety and is generally held in high esteem by the public. Part of the Medical Council’s role is to ensure that this continues to be the case. Without public trust, doctors wouldn’t be able to undertake their role effectively.
Those are the key drivers for regulating the health and conduct of medical students. You’ll be relieved to hear that no one is following you around with a clipboard grading you and that it’s not a pass/fail test. However, conduct can include issues of communication, professionalism, illicit drug taking, being drunk while working with patients, allegations of family violence and more.
Should a complaint be made about a student’s conduct, it is reasonable to expect that the Medical Council will seek further information and take this information to a committee who may decide to:
- take no further action
- send a letter to the student with advice
- direct the student to a conduct or counselling interview
- take urgent action against a student, that may temporarily prevent them from studying
- refer the complaint on.
While this can be confronting to read, the numbers of complaints about medical students are extremely small.
It is important to highlight that the Medical Council does not regulate medical students’ performance. This is entirely the remit of universities and students’ supervisors.
Is this over and above the Code of Conduct I signed at university?
Yes. In learning to be a doctor you are required to meet certain professional responsibilities and expectations. These arise from your increasing involvement with patients, families and the wider community as your learning progresses on your way to becoming a doctor. Doctors, including student doctors, should be strongly guided by the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia.
The importance of self-care
There’s plenty of research indicating that healthier doctors = healthier patients. Whilst many students recognise this and the importance of having their own doctor, there’s no doubt the demands on students and interns are intense. Acknowledging the culture of medicine and the importance of doctors’ health, the Medical Council spoke with Dr Leanne Rowe on how to maintain your health. In our podcast Dr Rowe provides realistic tips, doctor to doctor, that may help you avoid burnout and impairment. Medical indemnity insurer, Avant, also have a fact sheet that may help identify some ways to introduce self-care.
Any student or doctor that does receive a complaint relating to their health are assessed and, if required, supported around their health needs with the aim of helping them return to study and/or clinical training as soon as possible. The Medical Council is focused on helping ensure students who are impaired address and remediate any health problems so that they can continue their studies and become successful and skilled doctors in future.
What does mandatory reporting mean for me? Am I likely to be reported if I go and see a medical professional for a mental illness?
It’s no secret that medical students are typically ‘Type A’ personalities, goal focused and competitive. This also makes you more susceptible to worry (reference). So, before you listen to the rumour mill, there are a few things we would really like to clarify!
Our sources indicate that the elephant in the room continues to be mandatory reporting. Let’s tackle that head on. Yes, there are mandatory reporting laws that mean practitioners have an obligation to make a report to the Medical Council if you are a risk to yourself or the public. However, the reality is that most students with managed health conditions will never need to be subject to such a report. Remember, less than 1% of students will come to the attention of the Medical Council for health conditions.
This includes mental health conditions. We’re often approached with questions such as “I’m asking for a friend, but if my friend is studying medicine and takes antidepressants, do they need to be worried that their treating doctor will make a mandatory report?”. In most cases, the unequivocal answer is no.
Many students and medical practitioners have underlying health conditions, including mental health conditions, that are well managed and do not need to be reported to the Medical Council. Generally speaking, these students engage positively and regularly with their treating practitioners and seek additional assistance rather than trying to conceal their health issues.
There are two concerns that may trigger a mandatory notification about a student – an impairment that places the public at substantial risk of harm or concerns about sexual boundary crossing. A mandatory notification about a student must also be based upon a reasonable belief that an incident or behaviour occurred.
What am I obliged to tell you?
Students are required by law to notify the Medical Council of NSW within seven days if they have been charged with an offence that carries 12 months or more imprisonment. This may include but isn’t limited to drink driving, breach of Apprehended Domestic Violence Orders (ADVOs) or drugs charges. Ignorance is unfortunately not a defence, so if you are charged, please contact your medical indemnity insurer or medical school for advice.
Dating apps, social media and parties are all a standard part of the lives of young people. However, as future medical professionals, your actions in these areas can have long-lasting effects. While there is no hard and fast rule on dating apps and the regulators recognise that medical students are people too, there are guidelines in place to avoid putting yourself in a difficult position. The Medical Board of Australia’s Good Medical Practice: A Code of Conduct in Australia provides a good guide around many issues such as these.
A common conundrum is self-prescribing or prescribing for colleagues and family, as a junior doctor and beyond. While we are aware that this practice commonly occurs, it is strongly discouraged by the Medical Board of Australia’s Good Medical Practice: A Guide for Doctors in Australia, who note, “whenever possible avoid providing medical care to anyone with whom you have a close personal relationship”.
A student or doctor who provides care for people they know well – family, friends, work colleagues – may be acting unprofessionally because they will lack the objectivity required of a medical practitioner. It is a risk due to a potential lack of continuity of care, as well as being mired with record keeping issues. It is also important to encourage colleagues to have their own doctors. If you, a fellow student or colleague, need a doctor who may be particularly sympathetic to the demands of the profession, please visit the AMA Doctors for Colleagues page for recommendations.
Do you influence the curriculum at medical school?
Strictly, no. However, we do partner with most NSW universities to deliver guest lectures on medical regulation, impairment and self-care, primarily in the first and fourth years. However, medical students are the cornerstone of the profession, and we would encourage you to raise any questions you may have about medical regulation via your MedSoc first. If they can’t answer these, please escalate them to your NSW Medical Students’ Council (NSWMSC) Executive team. And if that doesn’t get you an answer, the NSWMSC has some key contacts here at the Medical Council who can help you.
What do I do if I get a complaint while I’m a student?
You may find that a complaint is made about you whilst you are working as a student. It’s important to note that these complaints are rare and can only be about your conduct or health. Your clinical performance is the domain of your university.
In the unlikely event a complaint is made, it is critical to contact your medical indemnity insurer straight away, to document the circumstances and seek their advice on your next steps. Should the complaint be received by the Medical Council, you will receive a letter outlining the details of the complaint and seeking more information. The Council will await your response before deciding what the best course of action may be. This is assessed on the risk to the public and may include placing conditions on your registration as a student.
The Doctors’ Health Advisory Service (DHAS) are available 24/7 and are staffed by doctors who can assist, provide counselling and support during this process, but also any time in your career.