The ‘unprofessional conduct’ implications of poor administration

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PracticeLaw partner Raizel Davidow, writing for Medicalbrief, asks whether the poor handling of the administrative side of the practice lead a medical practitioner to a Health Professions Council of SA finding of unprofessional conduct?

Davidow, of  Clyde & Co in South Africa, writes:

The Health Professions Act 56 of 1974 defines unprofessional conduct as “improper or disgraceful or dishonourable or unworthy conduct or conduct which, when regard is had to the profession of a person who is registered in terms of this Act, is improper or disgraceful or dishonourable or unworthy”.

In Groenewald v South African Medical Council 1934 TPD 404, the Court sought guidance from the English case law to determine what is meant by improper or disgraceful conduct and referred to the case of Allinson v General Council of Medical Education and Registrations [1894] 1 QB Div 750. The following definition was adopted:

“If it is shown that a medical man, in pursuit of his profession, has done something with regard to it which would be reasonably regarded as disgraceful or dishonourable by his professional brethren of good repute and competency, then it is open to the General Medical Council to say that he has been guilty of ‘infamous’ conduct in a professional respect. The question is not merely whether what a medical man has done would be an infamous thing for anyone else to do, but whether it is infamous for a medical man to do…”

To many practitioners the failure or delay in attending to administrative tasks are hardly “dishonourable” or “disgraceful”- in fact many practitioners delegate the delivery of reports and invoicing to their administrative staff, believing that these tasks are not worthy of their attention, time or effort. Few practitioners supervise these tasks – after all practitioners don’t spend almost a dedicate slogging it out at medical school or doing a fellowship to be embroiled in drafting reports, checking invoices or following up with patients for payments.

However, the following Ethical Rules demand that practitioners: 27 A (d) provide adequate information about the patient’s diagnosis, treatment options and alternatives; the practitioner must provide adequate information about the costs associated with each such alternative and any other pertinent information to enable the patient to exercise a choice in terms of treatment and informed decision-making pertaining to his or her health and that of others – 27 A (c) must maintain the highest standard of personal conduct and integrity; 27A (f) – must maintain proper and effective communication with his or patients and other professionals; and 16A (4) – shall issue a brief factual report to a patient where such patient
requires information concerning himself or herself.

Accordingly, the Health Professions Council of SA (HPCSA) expects that practitioners employ professionalism to their practice and should embody, integrity, appropriate and accurate communication in addition to appropriate skill. A delay in reporting to patients or inaccurate reports/ certificates or invoices could all be regarded as a breach of the above principles or Rules and as such be regarded as unprofessional.

It is clear that the HPCSA demands an element of professionalism from practitioners which relates to the customer service side of the practice, (responding to communication, doing so timeously and ensuring that information despatched whether on an invoice or a report is accurate). Whilst breach of these duties is largely regarded as minor offences by the HPCSA, these offences are still considered at the preliminary committee where a practitioner can be found guilty and his certificate affected.

Practitioners should take note that whilst these tasks are at times painful and time consuming, 7.5% of the matters referred to the preliminary committee, relate to billing, overcharging, failure to complete reports, or inaccurate reports. Many of these administrative type cases are referred to mediation. However, 3% of these cases are referred back to the preliminary committee and the remainder are regarded as too serious to refer to the Ombudsman for mediation. 36% of the matters referred to mediation related to accounting issues, 28% related to medical reports and 21.8 % related to issues relating to communication difficulties with patients.

Irrespective of whether a matter is referred to a preliminary committee or mediation, a practitioner still has to prepare an explanation, which is both emotionally taxing and time consuming. Practitioners should be aware matters can take more than a year (in some cases more than 5 years) to resolve and until such time as the matter is finalised are reflected on a practitioner’s certificate of good standing. In addition, practitioners’ pockets are also affected as the fines are not usually covered by indemnity providers.

If the matter is not referred to mediation, or where a matter is referred back to the preliminary committee due to failed mediation, the preliminary committee is empowered to impose a fine. These fines range from R5,000 to R70,000, depending on the number of charges.

It is no wonder that some studies conducted in the US and the UK, found that practitioners reported that 25-27% of their time is spent completing administrative tasks. This may well be excessive, but South African practitioners may need to take a page from the US and the UK and limit dissatisfaction and complaints, by taking professionalism more seriously and play a more active role in the administrative side of their practices.

This may well require that their staff obtain adequate training and/or that appropriate systems are implemented to ensure that the administrative tasks are attended to timeously and accurately.

Whilst administrative tasks are a pain, management of these duties is critical to ensuring a healthy certificate of good standing and limiting patient complaints.


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