Protecting patients and their doctors

Wednesday, Mar 6, 2019, 05:07 AM | Source: Pursuit

Marie Bismark

When people go to see a doctor or lawyer, they’re often vulnerable and at an important moment in life. When I started at the University of Otago in New Zealand I was torn between Law and Medicine, so I enrolled in Law School and Medical School. I did medical school during the day and the law subjects at lunchtime and at night.

I thought it would quickly become apparent which was the career for me but twenty-five years later I’m still doing both. Soon after I started both degrees, I saw an interface between the two professions. People place trust in both professions to do the right thing and can be badly harmed if things go wrong.

Society places high demands on doctors and lawyers, and the consequences of mistakes can be severe. Picture: Jose Luis Pelaez/Getty Images

I have witnessed and worked on some terrible events. When I began working as a junior doctor in a New Zealand hospital, one surgeon was known for the number of patients who had preventable complications or who died after surgery. That had a profound impact. Decades later I vividly remember the pain and distress of the families who lost loved ones.

There is a huge demand placed on doctors and lawyers and I’m interested in their wellbeing. In the media recently we have seen shocking reports of bullying and sexual harassment of young female lawyers and doctors. There are concerns in both professions about burnout and suicide risk. A stronger, healthier workplace culture has positive outcomes for people working in the professions and for the way they treat clients and patients.

Most doctors make dozens of potentially life-and-death decisions every day. If something goes wrong, a single decision made under immense time pressure, can be scrutinised by the legal system for months. Having worked as both a doctor and a health lawyer, I’m very mindful that it’s easy to be critical of decisions when you have the benefit of time and hindsight – two privileges that are rarely available to those working at the bedside.

When I applied for the Harkness Fellowship in Healthcare Policy at Harvard University, I had a two year old, a three year old, and I was 40 weeks pregnant with our third child. Looking back, I’m not sure what I was thinking. But it turned out to be the best year of my life.

My year at Harvard eventually led to my move to the University of Melbourne in 2010, when my Harkness mentor Professor David Studdert took up an appointment here.

At Harvard, I learned that my work mattered. Having come from an ordinary public school in a small town in New Zealand I worried that I wouldn’t be able to hold my own in the US. The year I spent at Harvard doing research taught me that the work I was doing was important, not just in New Zealand and Australia, but internationally.

In medicine, a single decision made under time pressure can be scrutinised by the legal system for months. Picture: Piron Guillaume/Unsplash

The class I teach is a mix of lawyers, doctors, nurses and dentists. So, there’s a lot of inter-disciplinary learning. I currently work two days a week as a psychiatry registrar at the Northern Hospital and the rest of the week I am at the University of Melbourne.

I lead a research team within the Centre for Health Policy and I teach patient rights and patient protection at Melbourne Law School. Much of my teaching simply facilitates conversations that bring out the immense knowledge and wisdom of the students.

Australia probably has the best health practitioner regulatory data in the world. We have data on more than 640,000 health practitioners from 15 health professions. My research team at the University works with large datasets of complaints about health practitioners and lawyers. We analyse this data to identify hot spots of risk to help make patients safer and to support practitioners in providing good care

We do a lot of myth busting. A current myth is that doctors can’t seek help for their own mental health conditions because of a fear of mandatory reporting. Our research shows mandatory reports about doctors by their treating practitioner are very rare. They usually only happen when a doctor lacks insight – perhaps they have a dementia or psychosis and don’t understand the risks they pose to patient safety.

But the average doctor with depression or anxiety should know that they can see their GP, and receive confidential treatment, without any need to worry about a mandatory report to the medical board as long as they’re taking sensible steps to keep their patients safe.

Medical doctors need to know they can seek psychological support and help without fear of it being reported. Picture: Getty Images

Less than five per cent of doctors account for about 50 per cent of patient complaints. We’ve done some research that showed by the time a doctor has had three complaints made to the medical board, they’re highly likely to have more complaints made against them unless something is done. Knowing that helps regulators focus their resources and intervene with that five per cent group of doctors.

Sometimes there are small pieces of a puzzle that make up a bigger picture. My research team would like to do more data linkage studies. The inquiry into the deaths of babies at Djerriwarrh Health Services’ Bacchus Marsh Hospital highlighted that when a health service is in trouble many agencies can see a small piece of the puzzle.

The Hospital knew about some concerns, the medical board knew about some concerns and the Department of Health knew about some concerns. But nobody could see the full picture which contributed to the preventable deaths of babies. We need to get better at data linkage to put those pieces of the puzzle together.

Our hospitals are out of step with ensuring people are supported to work safely. The medical profession needs to learn more from other occupations about how to ensure healthy working conditions. There are strict requirements for truck drivers, taxi drivers and pilots around the number of hours they can work because we know how dangerous fatigue is. I’d love to spend more time identifying solutions and helping to bring about change.

I don’t really think about work/life balance. For me, it’s all life. I love the work I do – my children say I’d come to work even if I wasn’t paid and that’s probably true. My work is a source of connection, meaning and purpose in my life.

I don’t really have working hours. Once my children go to bed, I open my computer again. But many other people make this possible for me – I receive so much support from my husband, my parents, my bookclub and my friends.

- As told to Sarah Marinos

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