Why GPs aren’t protected under new assault laws, what makes AHPRA complaints so tough and how to be a doctor to doctors.
Last week, The Medical Republic published a story about Adelaide GP Dr Alvin Chua’s account of being physically and verbally assaulted by a patient in early 2020.
He sustained injuries which eventually led him to require several rounds of neurosurgery.
Police declined to press charges.
On the day he went in for surgery number one, Dr Chua was notified that AHPRA had received a complaint from the abusive patient, who claimed the incident had exacerbated his mental health issues.
While the complaint was eventually dismissed, the entire situation sent Dr Chua into what he describes as a deep depression.
The Adelaide GP’s mental health has improved, but it was a long, lonely process.
Here’s a deeper look at some of the systemic issues that Dr Chua encountered.
GPs aren’t included in frontline health worker protection bills
If the assault on Dr Chua had happened, say, in a hospital setting and police had found enough evidence to substantiate a charge, his former patient would be facing a maximum of 15 years’ jail.
Over the last few years, states across the country have made moves to increase the maximum penalties for assaulting health or frontline emergency workers. GPs are not included.
The best illustration of just why this is the case is currently unfolding in NSW, where Attorney General Mark Speakman has introduced one such bill.
A curious aspect of the NSW bill is that community pharmacy staff are included under the definition of healthcare workers, even though GPs aren’t.
This appears to be a direct result of pharmacy lobbying.
“The inclusion of pharmacy staff reflects the government’s concerns about assaults occurring within pharmacies, which have been raised by the NSW branch of the Pharmacy Guild of Australia,” Mr Speakman’s spokesman told TMR.
In a NSW Sentencing Council report on emergency worker assaults last year, which formed the basis for the bill, there’s just one reference to GPs.
“In consultations for this review, we heard evidence about high rates of violence in hospitals generally,” the council said.
“However, we have not received evidence that assaults against healthcare workers in other healthcare settings, such as general practitioner clinics or community health clinics, are a particular problem.”
While some submissions did argue that these settings should be covered, the council said it did not have the evidence to justify the inclusion.
Mr Speakman’s spokesman said that the NSW government acknowledges the important role of GPs within the health system, and that the protections may apply to GPs working in certain capacities.
“Although the Sentencing Council report concluded that there was not sufficient evidence to justify the inclusion of general practitioners within the reform at this time, some general practitioners may fall within the definition of those employed to provide treatment to patients in a health institution under the control of a Local Health District or those providing community health services on behalf of a public health organisation,” they said.
Receiving an AHPRA notification is equal parts stressful and cold
Dr Chua’s situation would have been far less stressful had he not received that AHPRA notification.
University of Melbourne public health clinician Professor Marie Bismark, who has been working with researchers who are investigating the effect of AHPRA notifications on doctors, said many physicians described the process as the most stressful experience of their life.
“They spoke about the death of family members or divorce or really catastrophic life events and said that the AHPRA complaint process was just as stressful,” she told TMR.
The distress which comes with a complaint, Professor Bismark said, is often amplified by the cold and bureaucratic nature of the notification.
“I’ve spoken with a number of health practitioners who had an AHPRA complaint and who have actually been so unwell that they’re in hospital,” she said.
“Then they receive correspondence from AHPRA telling them that they only have a small number of days to respond … which really doesn’t seem fair or appropriate.”
But reform is possible – and people like AHPRA’s own national engagement advisor Susan Biggar are actively trying to make it happen, according to Professor Bismark.
“She’s led a lot of work to try and understand the impact of regulatory processes on clinicians and on patients, and she’s published some of her work on trying to make regulatory processes kinder,” Professor Bismark said.
“So I think it’s something that AHPRA is really trying to address.”
Accessing support as a doctor is challenging
Help was not necessarily easy for Dr Chua to access, even as his mental health worsened following the assault.
This is not a unique situation.
“Fewer doctors have a GP than non-doctors, which is just crap,” AMA board member Dr Antonio Di Dio told TMR.
Dr Di Dio, who is also deputy chair of mental health initiative DRS4DRS, encouraged all doctors to take the organisation’s free online course, which counts for CPD points with most colleges.
“There are so many barriers for doctors to go and see a doctor – they’re busy, they’re very time poor, they often get embarrassed,” he said.
Working with doctors as patients, according to Dr Di Dio, is “enormously rewarding” but does require a certain attitude.
“They’re never going to tell you everything they need to tell you if they think you’re rushed, if they think they’re taking advantage of you, if they feel shame and embarrassment, or if they feel fear that you’re going to report them to AHPRA,” he said.
The approach that Dr Di Dio takes is trying to make it as professional and “normal” as possible.
“I don’t charge doctors, but I often make it very clear to them that they’ve got the same length of appointment time as any other person,” he said.
The DRS4DRS education course is available online for free.
