Orientation to Australian health system and working in

Orientation to Australian health system and working in Western Australia

Australian healthcare system (Manual section 1) § Topics covered § Australian Government and key health organisations § Medicare § Pharmaceuticals Benefit Scheme § Department of Veterans’ Affairs § private health services

Australian states and territories Australia is a Federation of 6 states and 2 territories: States New South Wales Queensland South Australia Tasmania Victoria Western Australia Territories Australian Capital Territory Northern Territory

Australian healthcare system (Manual section 1. 1) § The Australian healthcare system is complex and comprises a mix of public and private service providers supported by legislative, regulatory and funding arrangements. § Funding is provided by all levels of government, health insurers, non-government organisations and individuals. § The Australian government is responsible for the two national health subsidy programs: Medicare and Pharmaceutical Benefits Schemes. § State and territory governments are responsible for delivery of public health services including public hospitals, population health, public and community health services and mental health.

Australian healthcare system Three levels of Government Australian Government State Government Federal Government Medicare Australia Medicare Public hospital Other programs PBS Private patient – hospital treatment Private practice Other programs

Federal Government funding provides § Medicare § Pharmaceutical Benefits Scheme § aged care services (e. g. nursing homes) § primary care services (e. g. general practice) § health services for specific population groups § Defence Force personnel through Department of Veterans’ Affairs § Aboriginal communities

Department of Veterans’ Affairs – DVA (Manual section 1. 4) § Supports those who serve or have served in Australian Defence Forces. § Provides a broad range of health care and support services to eligible veterans and their dependants through DVA and various health service providers. § § Veterans’ Home Care public and private hospital care respite care community nursing

Medicare (Manual section 2. 2) What is Medicare? § Australia's universal health insurance scheme § ensures all Australians have access to free or low-cost medical, optometry and hospital care according to clinical need § individuals are free to choose private health services How is Medicare funded? § Australian taxpayers contribute through the taxation system § Medicare levy – 1. 5% of taxable income § Medicare levy surcharge – taxpayers with a certain level of taxable income who don’t have private health insurance may pay additional 1% tax.

Medicare cards Issued to all people eligible to access health services under Medicare and is used when § visiting a doctor § making a claim for benefit payment at a Medicare office § making enquiries with Medicare § seeking treatment as a public patient in a public hospital § filling a prescription at a pharmacy.

Medicare cards are also issued to eligible visitors and non-permanent residents.

Access to Medicare services § Eligible patients can access free public hospital services and after-care provided through the hospital. The hospital assigns the treating doctor. § Patients can opt to be admitted as a private patient in a public hospital § can select their own doctor § patient will be charged hospital and medical fees by the public hospital § medical insurance may cover these costs.

Medicare services § Medicare provides on-line learning modules and other information resources for health professionals www. medicareaustralia. gov. au/provider/business/education

Medicare Benefits Schedule § The online Medicare Benefits Schedule - MBS Online provides the latest MBS information § Can search the MBS by Item numbers and/or key words www. mbsonline. gov. au

Pharmaceutical Benefits Scheme (Manual section 1. 3) § Subsidy scheme for prescription medicines. Eligible people can access certain prescription medicines at reduced cost. § Approximately 80% of prescriptions dispensed are subsidised through the PBS. § Only drugs listed on the Pharmaceutical Benefits Schedule (‘the Schedule’) are subsidised. § The Schedule details clinical conditions and other criteria to be met for a patient to qualify for a PBS medicine. § Doctors must ensure that PBS medicine is prescribed in accordance with PBS requirements. www. pbs. gov. au

PBS restrictions on prescribing § Unrestricted: can be prescribed without PBS restrictions on therapeutic use § Restricted: can be prescribed if the prescriber is satisfied the patient's clinical condition matches therapeutic uses listed in the Schedule § Authority Required (two categories): § Authority Required - requires prior approval from the Department of Human Services or DVA § Authority Required (Streamlined) - does not require prior approval from Department of Human Services or DVA but must have the relevant streamlined Authority code included on the prescription

Patient categories under the PBS § General category: pay the cost of dispensed medicines up to a maximum amount per item, PBS pays cost of the drug over that level. § Concessional category: pay significantly less than general category for PBS prescribed drugs. Must be eligible for Medicare and meet specific criteria that qualify them to be declared disadvantaged. PBS online learning § Medicare provides on-line tutorials with information on prescribing and using the PBS correctly http: //www. medicareaustralia. gov. au/provider/pbs/education/index. jsp

Provider and prescriber numbers To provide services funded by Medicare, doctors must apply for provider and prescriber numbers. Medicare provider number § Used for referral and diagnostic test requests. § Identifies the medical practitioner and the location where they work. Doctors can have multiple provider numbers. www. medicareaustralia. gov. au/provider/pubs/medicare-forms/provider-number. jsp PBS prescriber number § Must be included on prescription when prescribing under PBS. § Is automatically issued with the initial provider number. Doctors have one prescriber number throughout their career.

Private health system (Manual section 1. 5) § Works in tandem with Medicare to reduce the demand on public hospital services. § Includes privately operated hospitals and health care centres which provide services to fee-paying patients. § Some private hospitals are contracted by the State Government to provide services to public patients. § Private hospitals currently providing public patient services in WA are: § Joondalup Health Campus (northern metropolitan) § Peel Health Campus (southern metropolitan)

Western Australian health system (Manual section 2) § Topics covered § WA Government and structure of public health system § metropolitan health services § country health services § other health service providers in WA § Emergency service providers

WA public health system (Manual section 2. 1) In 2012 the WA population was 2. 4 million. § Most people (75%) live in the Perth metropolitan area with the rest of the population spread across country areas. The public health system, known as WA Health, comprises: § Public hospital and community health services § Public health services (health protection and disaster preparation) § Mental health services § Dental health services § Aboriginal health policy development and service coordination

WA public health services Public health services are provided through the following health services: § Metropolitan Health Service § Child and Adolescent Health Service § North Metropolitan Health Service § South Metropolitan Health Service § WA Country Health Service (WACHS) § Northern and Remote Country Health Service § Southern Country Health Service

Metropolitan Health Service (Manual section 2. 2) § Child and Adolescent Health Service § § Princess Margaret Hospital for Children (PMH) Child and Adolescent Community Health (CACH) Child and Adolescent Mental Health Service (CAMHS) New Children’s Hospital project § North Metropolitan Health Service § 3 tertiary hospitals (SCGH, KEMH, Graylands) § 3 secondary hospitals § South Metropolitan Health Service § 2 tertiary hospitals (RPH, FH) § 3 secondary hospitals (new tertiary hospital Fiona Stanley opens 2014)

WA Country Health Service (Manual section 2. 3) § Services a region of 2. 5 million km 2; manages 70 hospitals, 38 nursing posts, provides community and mental health services. § Northern and Remote Country Health Service § Goldfields § Kimberley § Midwest § Pilbara § Southern Country Health Service § Great Southern § South West § Wheatbelt

WA Health – other services (Manual section 2. 4 - 2. 7) § Community Health supports patients in their home to retain independence and minimise hospital admissions. § Dental Health provides emergency and general dental care for eligible persons. § Public Health Division develops and coordinates delivery of statewide public health policy and programs. § Mental Health services are provided through public hospitals and health services. § Aboriginal Health provides policy leadership to deliver health services equitably for the WA Aboriginal population.

Community-based health services (Manual section 2. 9) § Aged Care Assessment Team (ACAT): teams of health professionals who assist older people and their carers determine the level of care needed to enable the older person to remain at home or find alternate care. § Home and Community Care (HACC): provides basic support services to some older people, people with a disability and their carers to assist them to continue living independently at home. § Hospital in the Home (HITH): provides hospital care in the patient's own home, under the care of the hospital doctor, receiving the same treatment that they would have received had they been in a hospital bed.

Other health service providers § Aboriginal Medical Services (AMS): deliver holistic primary health care services based on Aboriginal needs and cultural values. Governed by representatives of the local Aboriginal community, also known as Aboriginal Community Controlled Health Service (ACCHS). § Links to these can be found at the Aboriginal Health Council of WA website: www. ahcwa. org § Disability Services Commission (DSC): provide support to people with disability, their family and carers. www. disability. wa. gov. au

Emergency service providers § Newborn Emergency Transport Service (NETS): coordinates the transfer of newly born babies from their hospital of birth to tertiary care in Perth. Can also be contacted for clinical advice. 1300 638 792 § Poisons Information Centre: provide toxicological advice to doctors and general public. 13 11 26 § Royal Flying Doctor Service (RFDS): provide aero-medical evacuation, emergency and primary health care services. 1800 625 800 See Orientation Manual for additional listings

Communication and cultural awareness Manual section 3 § Topics covered § Australian society § Aboriginal Australians § Australian patients § cultural awareness § communication § professional conduct

Australian society (Manual section 3. 1) § Australia has a democratic, culturally diverse society which elects a government every 3 to 4 years. § Australian principles and values are based on a premise of equal opportunity, mutual respect and tolerance. § As a multicultural society there are few social customs which are specific to Australia. § People are generally informal with friends and work colleagues, referring to each other by their first name. § Detailed information about Australian culture is available on the Department of Immigration website http: //australia. gov. au/topics/immigration/settling-in-australia

Aboriginal Australians (Manual section 3. 2) § Aboriginal and Torres Strait Islander people are the original (indigenous) inhabitants of Australia. § Aboriginal people, as a whole, experience disproportionate levels of disadvantage and poorer health compared with other Australians. § Life expectancy at birth may be 12 years lower and infant mortality is around 3 times higher. § In remote WA, Aboriginal populations may have higher rates of cardiovascular and respiratory disease, as well as diabetes and infectious diseases. Children are prone to ear infections, resulting in hearing loss. § Aboriginal Health Workers can assist doctors communicate with patients if there are language and/or cultural barriers.

Australian patients (Manual section 3. 3) § Patients are becoming better informed and expect medical staff to inform them of treatment options, risks and benefits, and tests required. § Consumer organisations exist which challenge health providers and policy makers. § No “typical” patient in multicultural Australia. § Free interpreter services are available to assist patients who have difficulty understanding English. § Using an interpreter, rather than family or friends, helps to maintain patient privacy. http: //www. immi. gov. au/living-in-australia/help-with-english/help_with_translating/

Cultural awareness (Manual section 3. 4) § Australians come from many cultural backgrounds so medical staff should be mindful of the range of values and beliefs that may be held by patients. § Medical practitioners should be mindful of their own beliefs and values and be aware that these may potentially conflict with those of their patient. § Be aware of potentially sensitive areas such as § termination of pregnancy § process of dying § substance abuse § Codes of Conduct exist which guide medical practitioners to manage patient care appropriately. This may include referring the patient to a colleague.

Communication (Manual section 3. 5) § Cultural differences can impact significantly on the relationship between the patient and the doctor. § Be polite, honest and direct, and confirm with the patient that they fully understand your proposed actions. § Good communication is essential to good medical practice § § assume difference until similarity is proven check your assumptions delay judgement until you have had time to observe remain sensitive to the other person’s viewpoint § The Adelaide to Outback GP training program offers an online communication and language module. http: //olle. aogp. com. au/course/view. php? id=62

Cultural awareness training (Manual Section 3. 6) § Cultural training helps participants to understand Aboriginal culture and history and develop awareness of the key issues facing Aboriginal people. § All WA Health staff must undertake online training modules in cultural awareness. § Some WACHS regions conduct Aboriginal cultural training specific to local population groups. Sessions may be presented by representatives from the local Aboriginal community. § External agencies also provide training modules § Combined Universities Centre Rural Health (CUCRH) § Reconciliation Australia website “Share our Pride” http: //lms. cucrh. uwa. edu. au/login/index. php

Professional conduct of doctors (Manual section 3. 7) § Doctors in Australia are expected to protect and promote the health of communities and individuals. § The Medical Board of Australia has documents to guide medical practitioners working in Australia § Good Medical Practice § Medical - Guidelines for Mandatory Notifications § Sexual Boundaries: Guidelines for doctors § The AMA Code of Ethics outlines core principles to guide doctors in their professional conduct § respect for patients § standards of care § professional conduct § clinical research and teaching § doctor’s role in society § the dying patient

Working with children § Children are among the most vulnerable members of society and WA Health has a duty of care to provide a safe environment. § WA Health employees who’s duties potentially involve contact with children, must undertake a Working with Children Check. Mandatory reporting of child abuse § Under the Children and Community Services Act 2004, doctors are listed as mandatory reporters of child sexual abuse. § Medical practitioners must make a report if they form a reasonable belief that child abuse has or is occurring. See Orientation Manual for information on reporting child neglect

Registration of doctors in Australia (Manual section 4. 0) § Topics covered § AHPRA and Medical Board of Australia § Australian Medical Council § medical registration pathways § Competent Authority § Specialist pathway § Standard pathway § professional development

AHPRA and Medical Board of Australia (Manual section 4. 1) § The Australian Health Practitioner Regulation Agency (AHPRA) is responsible for registration and accreditation of 14 health professions across Australia. § AHPRA's operations are governed by the Health Practitioner Regulation National Law Act 2009, (National Law). § The Medical Board of Australia (MBA) is one of the Boards supported by AHPRA. § Every doctor practicing medicine in Australia must be registered with the MBA. § Registration categories include: general, provisional, limited, specialist and non‐practicing.

Registration with the MBA § IMGs applying for initial registration must show evidence that they are eligible under one of the pathways: § Competent Authority pathway § Specialist pathway § Standard pathway § Must prove proficiency in the English language through satisfactory completion of English assessment process. § Primary qualifications must be verified through the International Credentials Services (EICS). http: //www. medicalboard. gov. au/Registration-Standards. aspx

Australian Medical Council (Manual section 4. 2) § The AMC is an independent national standards body for medical education and training. § The AMC conducts the assessment process for IMGs in the Standard Pathway only § AMC administers exams for IMGs to ensure they meet the standard of knowledge, skills and attitudes expected of Australian medical graduates following internship. § AMC oversees the workplace-based assessment program (WBA) in WA and other states. http: //www. amc. org. au

Competent Authority pathway (Manual section 5. 3) § CA Pathway is intended for non-specialist IMGs, but is available to specialists, including general practitioners. § The current AMC-designated competent authorities are § United Kingdom - General Medical Council § Canada - Medical Council of Canada § United States - Educational Commission for Foreign Medical Graduates § New Zealand - Medical Council of New Zealand § Ireland - Medical Council of Ireland § As of 1 July 2014, IMGs who are eligible may apply for provisional registration via the Competent Authority Pathway. http: //www. medicalboard. gov. au/Registration/International-Medical. Graduates/Competent-Authority-Pathway. aspx

Specialist pathway (Manual section 4. 4) § This pathway is open to specialists who § have overseas qualifications which are partially recognised by an Australian medical specialist college § seek to work as an Area of Need specialist § wish to train in Australia for a limited period § Primary qualifications must be internationally recognised and verified through the AMC. § As of 1 July 2014, IMGs apply directly to the specialist medical college for the Specialist Pathway. § Transitional arrangements are in place for competent authority pathway IMGs with limited registration. http: //www. medicalboard. gov. au/Registration/International-Medical. Graduates/Specialist-Pathway. aspx

Standard pathway (Manual section 4. 5) § Generally for non-specialist IMGs seeking general registration in Australia and who do not qualify for the Competent Authority Pathway. § These IMGs can progress to AMC Certificate and general registration via AMC exams § Part 1: Computer Adaptive Test Multiple Choice Questionnaire (CAT MCQ) § Part 2: Clinical Examination through an integrated, multistation multidisciplinary structured clinical assessment OR Workplace-based assessment (limited availability) http: //www. medicalboard. gov. au/Registration/International. Medical-Graduates/Standard-Pathway. aspx

Workplace-based assessment (Standard Pathway) § Program of clinical assessment in everyday clinical practice setting to assess § integration of clinical knowledge and skills § safe and effective clinical judgement § managing patients and working in multidisciplinary teams § WBA is being implemented in several states, overseen by members of the AMC Board of Examiners to ensure consistency in format and standards. § Duration of the WA program is 12 months. IMGs enrolled in the program complete the supervised practice requirement during the assessment program.

Professional development and education (Manual section 4. 6) § Diversity of clinical practice in Australia means medical practitioners must undertake life-long learning to ensure they maintain their clinical knowledge. § Continuing Professional Development (CPD) is mandatory to maintain medical registration. § Specialist medical colleges provide CPD activities to members and many professional organisations offer training workshops and education sessions. § Seeking advice is part of the learning process. Most colleagues will have faced similar situations in their work experience and be happy to advise you. § These interactions with colleagues will help you to build a strong collegiate network.

Professional organisations § Specialist medical colleges http: //www. cpmc. edu. au § Australian Doctors Trained Overseas Association provides information on Australian medical registration, exams and study, courses, colleges and work, as well as political and legal issues. http: //www. adtoa. org § Australian Medical Association (AMA) a political and industrial association representing doctors in public and private practice, aims to maintain professional and economic wellbeing of its members. www. amawa. com. au

Professional organisations § Rural Health West: the rural workforce agency in WA, works collaboratively with other organisations to develop a high-quality, sustainable health workforce in rural WA. www. ruralhealthwest. com. au Support organisations § Colleague of First Contact: confidential 24 -hour telephone support service in times of personal crisis. (08) 9321 3098 § Doctor. Connect: website for IMGs providing information about Australian society and the health system. www. doctorconnect. gov. au

Working in Western Australia (Manual section 5) § Topics covered § working in hospitals § medical credentialing and scope of practice § working in general practice § infection control § notifiable conditions § taxation and insurance § medico-legal issues § deaths in hospital

Working in hospitals (Manual section 5. 1) § WA hospitals operate with multidisciplinary teams comprising doctors, nurses and allied health staff. § Hospital employment provides valuable clinical experience to enhance knowledge and technical skills. § Interns and Resident Medical Officers (RMOs) undertake supervised rotations across a range of clinical settings. § Many hospitals have regular education sessions which support career development of IMGs and Australiantrained graduates.

Hospital doctors: role, training, supervision § RMOs play a key role in day-to-day management of patients whilst enhancing knowledge and clinical skills. § Liaise with other medical staff, nurses and allied health staff and play a central role in patient management. § Ensure patient records are maintained, tests are ordered, results reviewed and discharge plans created. § Participate in education sessions and are regularly assessed by their supervising clinician during the clinical placement. § The Australian Curriculum Framework can guide you to set learning goals with your supervisor to the standard of clinical competence expected of Australian graduates. http: //curriculum. cpmec. org. au

Hospital support for doctors § Junior doctors who experience professional or personal difficulties can access a number of support options § § § Clinical supervisor Director of Clinical Training (DCT) Medical administration staff Director of Medical Services (DMS) Director Postgraduate Medical Education Medical Officer representative § All new medical staff must be provided with an orientation to the hospital which includes § hospital layout, services and how to access these § emergency procedures and escalation protocols § online mandatory training modules via hospital intranet site

Rosters and salary § Junior doctors work a mix of day, night and weekends. § Interns and RMOs at RPH, SCGH, FH rotate through five terms of approximately 10 weeks duration. § Rotations may be in outer metropolitan and rural sites. § RMOs at PMH and KEMH undertake six-month terms comprising three rotations. § Employment conditions for junior doctors in WA public hospitals are set out in industrial agreements signed between the AMA (WA) and Minister for Health. § Copies can be obtained from the AMA (WA) or your employing hospital.

Taxation and insurance (Manual section 5. 5) § A tax file number is issued by the Australian Taxation Office (ATO) and is provided to your employer to withhold the minimum required tax. Apply directly to the ATO for a tax file number: www. ato. gov. au § Salary packaging uses pre-tax income to purchase benefits thereby reducing the amount of tax paid. Access to salary packaging depends on employment arrangements. § Superannuation is money set aside to provide for your retirement. Employers must contribute 9% of salary payments and employees can make pre-tax contributions. § To maintain registration, medical practitioners must have professional indemnity insurance for all areas of practise.

Imaging and pathology services (Manual section 5. 1) § Imaging and pathology investigations should be ordered in terms of how they influence medical decision making. § Request forms should be written clearly specifying the range of investigations to be performed. Additional reports can be ordered (e. g. copy to the GP). § Specimens must be fully labelled including time and date of collection, type of specimen and site. § Indicate clearly if investigations are urgent and notify the service in advance to facilitate processing. Contacts in this hospital are § Pathology: § Radiology:

Prescribing medications (Manual section 5. 1) § National Medicines Policy encourages the use of generic medicines to reduce pressure on the PBS. § Medications are generally referred to by their brand/generic name rather than active ingredients. These may be very different to the names IMGs are used to. § Resources to assist you identify Australian brand generic names are provided in the Orientation Manual. § Specific protocols and forms exist for prescribing drugs of dependence (Schedule 8 drugs). § When preparing to discharge a patient ensure they know to consult their GP for community-dispensed prescriptions for any ongoing medications.

Occupational safety and health § WA Health has comprehensive OSH programs in place at all sites. § Success of the OSH program relies on hospital staff reporting potential dangers and adverse incidents using the correct reporting mechanisms. § The OSH Officer for this hospital is: § § Report forms are available from: §

Communication and handover (Manual section 5. 1) § Communication among members of the multidisciplinary team is essential for good patient management. § Includes discussions with nursing and allied health staff and doctors who may be covering your patients. § WA Health uses the ISOBAR handover protocol I - introduce self (name, role, contact number) and patient (name, birth date, gender) S - explain situation: presentation, diagnosis, principle problems, reason for making contact O - most recent observations, drips and drains B - background to the patient: medications, allergies, test results, social A - agree a plan: what is the urgency, who does what, when R - read-back the situation: clarify shared understanding, clear on roles/tasks

Discharge planning (Manual section 5. 1) § Clear and appropriate communication with communitybased health practitioners is essential to support the patient following discharge. GPs, allied health etc. § Commence discharge planning early to ensure timely discharge, particularly for patients living in rural WA. § Consider the patient’s personal status and support network and their access to rehabilitation and long-term care. § Discharge planning should include § § communication with GPs transport arrangements follow-up appointments pharmacy requirements

Discharge planning § Discharge summaries must be completed for all patients. § Prior to discharge, if the patient consents, written communication should be prepared for the patient’s GP to advise of follow-up treatment and medications required. § Arranging follow-up by the following services should be considered when preparing to discharge the patient: § § ACAT geriatric assessment HACC assessment Silver Chain services (nursing and home help) Allied health services (physio and occupational therapy, social work, speech and hearing etc. ) § Outpatient appointments at hospital clinics

Medical credentialing and scope of practice (Manual section 5. 2) § Medical practitioners providing hospital services are credentialed to ensure they hold suitable qualifications. § Scope of practice is set based on these credentials. § Doctors must show evidence that they are maintaining their skills to retain their credentialed scope of practice. § In setting scope of practice, the hospital Credentialing and Clinical Privileges Committee consider: § qualifications, professional training, clinical experience, training and experience in leadership, research, education, communication and teamwork § professional registration, disciplinary actions, indemnity insurance and criminal record.

Restrictions to medical practice (Manual section 5. 3) § IMGs who first gained general registration after July 1997 have restricted access to a Medicare provider number for 10 years (known as the 10 year moratorium). § To gain a provider number exemption must be sought under section 19 AB of the Medical Insurance Act 1973. § IMGs can access provider and prescriber numbers if they work in a District of Workforce Shortage. § To gain limited registration with MBA, IMGs must work in an Area of Need, where there is a recognised shortage of medical practitioners and medical positions remain unfilled. http: //www. overseasdoctors. health. wa. gov. au/

Rural general practice in WA § Working as a GP in rural WA can be immensely challenging and rewarding. Many GPs work in group practice and enjoy the support of their colleagues. § Some GPs work as solo practitioners and rely on the support of locum doctors to take time away from work. § If granted admitting rights as a Visiting Medical Practitioner, GPs can treat patients at the local hospital. § Depending on their scope of practice and the hospital’s facilities, GPs may provide emergency services, as well as surgical, anaesthetic and obstetric services. § Services provided by the VMP are contracted by WACHS and the conditions and rates of pay are set out in the Medical Service Agreement.

Support for country doctors § WACHS salaried doctors and rural GPs can access clinical advice from doctors in metropolitan hospitals. § Perth-based medical specialists may provide services to country hospitals through the visiting specialists program. § Country doctors should be familiar with the schedule of visiting specialists and know how to access clinical support from Perth-based colleagues. § Many country hospitals have well-established referral patterns which new doctors should become familiar with. § WACHS has established a telecommunications network and a Telehealth program to provide specialist clinical support to remote locations.

Infection control (Manual section 5. 4) § Infection prevention and control is covered in a mandatory training module for all WA Health staff. § Be aware of hand washing; wearing gloves; handling sharp implements and exposure to blood and body fluids. § All WA hospitals have protocols to be followed in the case of exposure to risk of infectious diseases. Medical practitioners should § adhere to infection control guidelines and protocols § be immunised against Hepatitis-B early in their career § be aware of and follow post-exposure protocols § Doctors treating a health care worker for exposure to an infectious disease should consider whether that person’s practise should be reviewed. Seek advice if unsure.

Medico-legal issues (Manual section 5. 6) § In both public and private practice, all medical treatment must be documented in the patient’s medical record. Information should include: § patient identification, presenting problem and medical history § physical exam, diagnostic and treatment orders § observations, findings, diagnosis and discharge summary. § Except under specific legal requirements, medical practitioners must keep all patient information confidential. § While working for WA Health, requests from lawyers for legal reports or patients wishing to make a complaint should be referred to Medical Administration. § Minimise potential risks through good communication and accurate patient records.

Patient consent § You must obtain consent from the patient before any surgical or invasive procedure. § Doctors must adequately explain all proposed treatment, highlighting benefits, risks and consequence of no treatment. § In many instances children will require parental consent. § In some circumstances a child may be considered a “mature minor” and can grant their own consent. § The scope of consent for medical treatment varies based on the level of responsibility held by appointed guardians. § Use a professional interpreter to gain consent from patients with limited English, particularly of medical terminology. § To protect patient confidentiality avoid using family or friends.

Freedom of information § Patients can obtain access to their medical records by submitting a written request to the hospital. Sexual harassment § WA law makes it unlawful to discriminate against a person on the basis of such things as § gender, marital status, race, pregnancy, sexual orientation, family responsibility and status, impairment and age, religious or political conviction. § WA Health has policies in place to uphold this law and to prevent bullying, violence and aggression in the workplace.

Notifiable conditions § Medical Practitioners practising in WA are legally required to report a number of diseases and medical conditions. § This information is vital to assist the Department of Health to monitor medical events and develop appropriate health responses and policies. § The Public Health Unit deals with reporting of a number of notifiable conditions which are listed on their website: http: //www. public. health. wa. gov. au/3/287/2/statutory_notifications_and_a uthorisations. pm

Deaths in hospital (Manual section 5. 7) § All Health Services have protocols for certifying deaths. § Medical practitioners should know how to access the necessary forms and information for this process. § Numerous circumstances have been identified which, if they occur, result in a death being considered “reportable”. § Those aware of a “reportable death” are legally obliged to report this to the Coroner or the Police. § If there is any doubt, the Coroner’s advice must be sought. § An inquest is a formal hearing into a “reportable death” in WA. § The State Coroner, the Deputy Coroner and all magistrates can conduct coronial investigations.

Living in Western Australia (Manual section 6. 0) § The Orientation Manual provides general information on the following topics: § § § § § visa requirements banking learning English housing and utilities personal health insurance education system employment for partners accessing emergency services public and private transport

Other useful information (Manual Appendix 1 and 2) § The Appendices in the orientation manual provide the following information § Medication terminology used in WA § Dose frequency and timing § Route of administration § Unit of measure § Dose forms (including latin terms) § Dangerous abbreviations § Health industry acronyms

Questions?