Avant Insurance

Issue no. 4 - Protecting members every day

Issue link: http://connect.avant.org.au/i/526464

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Avant Connect 2 D espite the reduction in civil claims, the challenges our members face in their practices have not gone away. The increase in professional conduct complaints is of concern to doctors as these can potentially lead to deregistration, suspension or conditions on how a doctor practises. Doctors are also more frequently requesting assistance about complaints to AHPRA or HCCC and Medicare investigations, which appear to be driven by a combination of factors including: ▸ dissatisfied patients wanting the doctor to be 'held to account' ▸ increased patient expectations, resulting in them being more likely to make a complaint to a complaints body ▸ the rise of e-connectivity ▸ the introduction of mandatory reporting ▸ the increasingly complex statutory and regulatory framework in which doctors work ▸ coroners, regulators and other statutory bodies more aggressively investigating healthcare concerns following high profile cases where multiple patients have been harmed ▸ more sophisticated profiling and investigation of billing and prescribing patterns by Medicare. Avoiding professional conduct claims While diagnosis errors (which are a major contributor to civil claims) may also give rise to professional conduct claims, some other significant contributors to claims are: ▸ perceived and actual boundary violations and assaults ▸ prescribing issues, particularly relating to S8 and S4 drugs ▸ poor communication resulting in a failure to meet patient expectations ▸ perceived lack of knowledge or skill on the part of the treating doctor ▸ poor quality medical records ▸ privacy breaches ▸ billing practices and/or unnecessary treatment ▸ poor clinical outcomes, including delayed or missed diagnoses and procedure or treatment complications ▸ doctors impaired by illness or alcohol and other drug use. Causes of patient complaints Patient claims for compensation against doctors now account for less than a quarter of all claims by Members require our assistance for a wide range and increasing number of reasons. These reasons are changing over time. While civil claims have decreased since the early 2000s, increasingly doctors are calling on us for support on other matters including employment disputes, coronial inquests, Medicare investigations, criminal allegations and professional conduct. Lisa Clarke, General Manager – Claims Practising in a complex environment when might you need us? Multiple claims from one event Doctors often face a number of different investigations arising out of the same event. The diagram at right indicates the range of possible investigations following the death of a patient from a clinical incident. It is critical that a doctor's response to each is not provided in isolation of the others. A consistent and well considered approach is required so the doctor can be fully protected. Avant assists members to deal with each investigation in a coordinated way. workplace investigation following suspension of employment coronial inquiry professional conduct or other investigation by a complaints body credentialling issues at the hospital criminal prosecution civil claim brought by the family of the deceased internal hospital review Possible investigations Lisa Clarke

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