Volume 188 - Issue 9
A national medical register: balancing public transparency and professional privacy
Author: Peter C Arnold
Med J Aust 2008; 188 (9): 549-550. || doi: 10.5694/j.1326-5377.2008.tb01781.x
Published online: 5 May 2008
Published online: 5 May 2008
To the Editor: The timely article by Healy and colleagues1 should provoke debate within the profession. The authors’ decision to not consider “the relative merits of national versus regional registration boards” should not stifle discussion in the Journal.
In particular, Australian doctors and the public should be aware that the medical board system to which we are accustomed is not operational in most countries. In much of the English-speaking world, boards comprise mainly doctors and have considerable independence from government; medical boards in non-English-speaking countries are generally part of the health bureaucracy.2
The fundamental danger of having a Council of Australian Governments-inspired national registration “body” lies in the potential for a switch from the “English” system of self-regulation under common law to the “European” model of bureaucratic rule under administrative law.
Public and professional suspicion of self-regulation lay behind the 1987 amendments to the Medical Practitioners Act 1938 (NSW), which removed the power of deregistration from the New South Wales Medical Board, handing it instead to the Medical Tribunal chaired by a District Court Judge. This move avoided both the “Scylla” of public distrust of the profession and the “Charybdis” of criticism, such as have afflicted the boards in Victoria and elsewhere, where boards retained that power.
No less important problems with a national board lie in the assessment of local problems and surveillance of doctors whose registration is conditional. This is already difficult in the larger states, such as Queensland, NSW and Western Australia. The continued failure of the centralised Health Insurance Commission to prevent and prosecute the abuse of Medicare by doctors, despite repeated ineffectual changes to the legislation,3 does not encourage optimism that a national medical board could effectively manage impaired doctors or those performing below standard.
Having served on Commonwealth working parties on both mutual recognition of medical qualifications and Medicare “overservicing” and “inappropriate practice”, I would opt for an independent, publicly accessible national database containing a “uniform set of items that are allowable under existing privacy legislation”.1 The elements of such a database are already operational in the safe hands of the Australian Medical Council (AMC). It should not be too difficult, and certainly less cumbersome, for state and territory governments and medical boards to agree on that uniform set, on the foundations already laid by the AMC, and to continue the AMC’s ownership of the database.
Competing interests
I am a former Deputy President of the NSW Medical Board, and was organiser of a professional protest leading to the 1987 amendments to the NSW Medical Practitioners Act.
References
- Healy JM, Maffi CL, Dugdale P. A national medical register: balancing public transparency and professional privacy. Med J Aust 2008; 188: 247-249. 0_CHDJAEGH
- Arnold PC. Professional regulation. In: Lock S, Last JM, Dunea G, editors. The Oxford illustrated companion to medicine. Oxford: Oxford University Press, 2001: 669-673. 0_i1091828
- Bell R. Protecting Medicare services: trials of a peer review scheme. J Law Med 2005; 13: 29-105. 0_i1091831