Medical Council News - October 2020

Tēnā koutou e ngā rata, e ngā iwi o te motu. Ngā mihi ō te Kaunihera ki a koutou mā.

In this edition our Chief Executive discusses our new Statement on Unprofessional Behaviour, released today, and we acknowledge the commitment, hard work and dedication of medical professionals throughout the COVID-19 pandemic.

Message from our Chair

Tēnā tatou!

Nau mai ki tēnei pūrongo ō te Kaunihera Rata ō Aotearoa – welcome to this edition of the Medical Council News.

We are now in the final quarter of what has been an extremely challenging and unpredictable year for the medical workforce as part of the health and nationwide efforts to contain COVID-19. While the pandemic is far from over, I would like to first and foremost acknowledge the medical profession’s ongoing commitment and dedication to patient care during these uncertain and difficult times.

Health Equity & Cultural Safety

Towards the end of September, Council, together with our partners Te ORA, released an independent report outlining findings on the current state of cultural safety and health equity in Aotearoa New Zealand.

Based on the experiences of Māori patients, the report highlighted some of the major barriers throughout our health system to achieving equitable healthcare for Māori. These issues are sector-wide and span many areas of healthcare, from clinical practice through to health sector governance and leadership. Some of the key findings include:

  • a poor understanding of the importance of patient culture, beliefs and values in clinical practice
  • a low representation of Māori in health sector governance and decision-making
  • persistently low numbers of Māori doctors compared to population size
  • a lack of recognition of the additional demands Māori doctors experience on top of their work – known as cultural loading.

On a positive note, the Report notes:

  • that many doctors are increasingly aware of the wider socio-economic determinants on health outcomes of individuals and populations.
  • the excellent work medical schools are doing in selecting, training and supporting the next generation of doctors to be culturally safe.
  • the progress that specialist Colleges are making in recognising health equity and cultural safety as key issues (but also the ongoing challenges of embedding these into training and recertification activities).

As Council and Te ORA consider the important recommendations in the report, we need to emphasise that it will take collective action – across the whole health sector – to achieve cultural safety and health equity. We will continue to work with the profession and other key stakeholders, and the systems we work within, to achieve this most important of goals.

Our guidance for doctors – including our Statement on Cultural Safety and He Ara Hauora Māori: A Pathway to Māori Health Equity – are the next steps in this journey for the medical profession.

Noho ora mai,

Curtis Walker
Medical Council of New Zealand

Message from our Chief Executive

I would like to recognise the outstanding levels of dedication and commitment to patient care provided by all of our health professions. With the recent re-emergence of COVID-19 in Auckland communities, I want to particularly acknowledge doctors and all those who work in healthcare in the Auckland region, for their resilience, agility and adaptability throughout the recent changing of alert levels. It truly has been an inter-professional team effort!

A special thank you to our Chair, Dr Curtis Walker, and Te ORA Chair, Professor David Tipene-Leach, for their work on the recently released independent Health Equity and Cultural Safety Baseline Data Report. Considerable time was spent analysing the results and developing Te Ora and Council’s recommendations for the health sector. Dr Walker and Professor Tipene-Leach have also both engaged in numerous interviews, including on Maori TV, live radio and several other mainstream outlets. Thank you to all our health sector colleagues who have also welcomed the Report.

We have been pleased to collaborate and share this work with our fellow health practitioner regulators and will shortly commence some work with the Nursing Council, taking a collaborative approach to address health equity and promote cultural safety for our nursing and medical professions.   

Reflecting on the past nine months, our response to COVID-19 has given rise to a number of developments, which have supported changes to clinical practice and the way doctors provide health care for their patients. Perhaps the most significant change to how doctor’s practise was the rapid change to Telehealth consultations, which enabled doctors to carry out consultations remotely with the use of digital technology. Into the future, it is clear that virtual consultations will become an increasingly commonplace, acceptable, and safe form of patient care.

Statement on Unprofessional Behaviour 

Council has today released a new updated Statement on Unprofessional Behaviour.  The new statement covers the behaviours expected of medical professionals, not just with colleagues and patients, but also in non-work settings.

We appreciate the feedback you provided during our consultation. Your input is of great value to us and has informed the statement.

Thank you for your ongoing support, collegiality and commitment as we work together to deliver an excellent standard of medical care for all New Zealanders.

Ngā mihi 

Joan Simeon
Chief Executive
Medical Council of New Zealand

Congratulations to Dr Rhys Jones

The Medical Council would like to congratulate Dr Rhys Jones for recently receiving the Prime Minister’s Supreme Award for Teaching Excellence. Dr Jones is one of our lead cultural safety advisors and it is great to see his ongoing work to make Māori health a key focus in medical training.

Ngā mihi tino mahana nā tōu taounga whaknui, e te Rangatira!

Recollections from Dr John Hillock

The Council is sad to announce the retirement of longstanding Performance Assessment Committee member and convener, Dr John Hillock. We would like to thank Dr Hillock for his 20 years of service with Council.

Here, Dr Hillock reflects on his time with the Council and how things have changed:

“I started working on performance assessments for MCNZ in the late 90s, when they were called Competency Reviews, but I prefer the new title, as one rarely finds that any doctor is 'incompetent'. I was put forward for this role as a result of my work on the GPEP1 committee of the College.

My first review was very much a learning experience, but the format of 3 people and the tools provided by Council for us to use made it very straightforward.

As time passed, I became more familiar with the process and I was invited to be a convenor, a role that I have enjoyed, enjoying the logistics and progress of it all, from initial contact with the doctor, where I hopefully have been able to reduce anxieties and explain the process as well as possible, right through to providing a completed report for Council.

Obviously, there have been many changes in the environment of general practice during the last 20 years and technology has made some of the process much easier, especially now that all notes are computerised.

Being a reviewer has led me to visit a broad spectrum of practices from the Deep South to the Far North and it has underlined for me what is good practice and what is not. It is useful to note that PACs are looking for doctors who practise acceptable standards, not necessarily 'gold standards'. Even so, the process has been very much a two-way process and PACs will nearly always learn of new and useful approaches to medicine when they visit practices, even if some aspects of the doctors performance are below par.

The support of the staff at MCNZ has always been excellent and doctors in NZ should feel that they have a good team looking after the standards of the profession!

This, along with working with some excellent, well-informed and interesting other doctors and lay persons has made this a most enjoyable role over the years, despite interesting challenges on occasions!"

Medical Council of New Zealand updates behavioural expectations for doctors

We have released an updated Statement on Unprofessional Behaviour, which clarifies standards of behaviour expected of doctors in non-work settings. Developed in consultation with doctors, colleges other medical organisations, the statement covers the behavioural expectations of doctors, not just when at work interacting with patients and colleagues, but also on social media and other public spaces. Other changes include:

  • improved readability
  • clarifying the definitions of some forms of unprofessional behaviour
  • guidance on reporting concerns about a doctor’s conduct, competence or health.

The statement, Unprofessional behaviour, is now available online and will be followed with more specific guidance later.

Council’s annual workforce survey results now available

Diagnostic radiology, urgent care and emergency medicine are the fastest growing specialities in the medical workforce, according to the Council’s Workforce Survey 2019 results. Based on individual surveys completed by doctors applying for their practising certificates, the results help Council to understand changes in the profession over time as we work to promote a medical workforce that reflects the needs of New Zealand communities. Other key findings include:

  • A 3.8% increase in the number of practising doctors i.e. those applying for an annual practising certificate. In total, there are 16,908 registered medical practitioners
  • Māori doctors continue to be under-represented at 3.8% of the medical workforce. With 15.3% of students beginning medical school between 2015 and 2019 identifying as Māori, it will still take many years at the current rate for the number of Maori doctors to be proportional to the population
  • Pasifika doctors are similarly under-represented, making up just 1.8% of doctors, despite being 8.1% of New Zealand’s population
  • A small increase in the proportion of female doctors, and predictions that women will outnumber men in the medical workforce by 2025.

Thank you everyone who completed surveys – your help is greatly appreciated. The results are available now on our website here.

Choosing Wisely presentation on COVID-19 learnings

Take a look a look at a recent presentation by Dr Berwick, President Emeritus and Senior Fellow for Healthcare Improvement, at the latest Choosing Wisely international meeting.

His talk, Addressing Overuse in the ‘New Normal’, highlighted how health care systems and providers are rapidly learning and changing in response to COVID-19.  It outlined how considerations of sustainability, reducing waste, and improving value are vital to meeting the complex health needs posed, not just by the COVID-19 pandemic, but also our rapidly changing society.

Dr Berwick’s presentation has been made available to all Choosing Wisely stakeholders, and is on the Canadian Choosing Wisely website for 30 days under events. You can watch the presentation here .