Milestone

Consolidation

Last updated 13 September 2022
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Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

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10. Maintain legal and duty of care responsibilities

Know

• Understand when duty of care responsibilities override confidentiality agreements.

Do

  • Manage situations in which duty of care responsibilities override confidentiality agreements in consultations, including:
    • mandatory reporting of communicable diseases (full details of the individual may not be required)
    • recommendation for involuntary admission under the mental health laws for the relevant jurisdiction
    • mandatory reporting of suspected child abuse
    • mandatory reporting of suspected impairment of professional colleagues
    • individuals who have guardians who hold medical power of attorney
    • individuals with occupational injuries being managed under workers compensation.
  • Identify clinical symptoms and signs, including when physical symptoms or signs are not consistent with the history provided, that may raise concerns about:
    • abuse, including neglect
    • family violence
    • risk of suicide (consideration of involuntary admission)
    • risk to others (eg communicable diseases).

Know and do

  • Understand and carry out medico-legal responsibilities, including:
    • fitness to drive
    • requirements for involuntary admission under the mental health laws for the relevant jurisdiction for individuals identified to be at high imminent risk of suicide
    • criteria for mandatory reporting of suspected child abuse relevant in own state or territory
    • criteria for mandatory reporting of family violence (in specific states and territories)
    • understanding occupational health and safety legislative requirements
    • communicable disease notifications and contact tracing.

Know

  • Understand and interpret false positive and false negative rates of diagnostic investigations and the ‘number needed to treat’ statistics.

Do

  • Consider multiple factors (competencies 5.3.1, 5.3.2, 5.3.3, 6.3.4, 8.3.3) when identifying appropriate diagnostic and management options.
  • Communicate the benefits and risks of each diagnostic investigation, procedure and management option to the individual, in clear language appropriate to their level of health literacy and preferred language to support informed consent and shared decision-making.
  • Assess capacity for consent, where relevant, to ensure the individual is able to participate in shared decision-making. Capacity is dependent on the decision being made and is specific to each decision in healthcare settings (incapacity in one area may not mean incapacity for all decisions).
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

11. Demonstrate professional and ethical conduct

Do

  • Use an ‘ethical lens’ in every consultation.
  • Consider a range of ethical issues that may arise in practice; for example:
    • in the care of people with disability (eg conflict between competent medical care, patient autonomy, and inherent concepts of ‘social worth’ and universal human dignity)
    • during antenatal screening and/or in making decisions to continue or terminate pregnancies when there are genetic abnormalities or bodily impairments
    • the need to report a colleague with suspected impairment to the Medical Board of Australia
    • providing care to individuals who decline potentially lifesaving treatment due to religious and/or cultural beliefs
    • being offered gifts by patients.
    • during discussions about sexual wellbeing
    • how individual doctors define ‘troublesome behaviours’
    • decisions about carer/family involvement for patients with limited capacity to provide consent
    • inequity arising from disparity between wait times and services available through the public system compared to private specialist services funded through private health insurance
    • when a patient refuses to inform family members who are at risk when a diagnosis is made (eg communicable disease).

Do

  • Regularly reflect on whether personal values, beliefs, personal biases (including cultural or social bias) or conflicts of interest are impacting delivery of care, either broadly or with specific patients or colleagues.
  • Identify consultations where own values, beliefs, biases or conflicts of interest have impacted the quality of care delivered; for example:
    • experience with heartsink response, where negative perception or experiences of frustration with patients may have impacted ability to identify the contributors to complex presentations and reduced ability to identify a diagnosis, investigate appropriately or initiate management, including referrals
    • being unable to or feeling uncomfortable about providing a specific aspect of care due to a personally held belief
    • awareness of cultural bias in cross-cultural consultations
    • requests for Schedule 8 medications from a relative or colleague.
  • Identify strategies to manage these while maintaining quality and continuity of care.

Do

  • Be aware of the power imbalance between doctor and patient.
  • Set and maintain clear personal and professional boundaries, especially in small communities.
  • Manage transference and countertransference, especially with vulnerable patients.
  • Recognise and manage red flags for the risk of inappropriate interactions where there is a blurring of therapeutic boundaries.
  • Identify situations where it may be appropriate to terminate a therapeutic relationship and to fulfil duty of care responsibilities by communicating this to the individual patient and handing over care to another health professional.

Be

  • Be self-reflective.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

12. Use self-reflection to deliver quality care and to enhance and maintain self-care practices

Know

  • Know the relevant codes and standards of ethical and professional behaviour, including resources that can help health professionals define acceptable conduct and practice in relation to their peers, professional values and ethics, and practising medicine safely (competency 11.3.1).

Do

  • Identify disparities and access support to manage these.

Be

  • Be self-aware.

Do

  • Develop strategies for reflection and self-appraisal (eg seeking advice and support from peers, colleagues or supervisors).
  • Reflect on own values and beliefs, motivations, style of communication, cultural bias and impact of gender on provision of care (eg considering need for gender-concordant clinician for intimate examinations).
  • Develop strategies to recognise and manage personal factors; for example:
    • regular self-reflection on any personal factors that are impacting on the quality of care being delivered (and consider whether a referral to another provider is warranted)
    • addressing potential conflict that may occur if a variety of professional roles are held; for example, when:
      • patients are family members, professional colleagues or close friends
      • patients have another type of professional relationship with the GP (eg accountant, lawyer)
      • a rural GP carries out multiple roles within their community (eg involvement in local sporting clubs, council).
  • Recognise the importance of maintaining therapeutic boundaries to avoid power imbalances (either the GP or the patient being the holder of most power), which may impact how either party behaves (eg GPs feeling pressured to prescribe medications outside of guidelines or to write inappropriate sickness or disability certificates).
  • Demonstrate intellectual humility.

Be

  • Be insightful and committed to continuous improvement.

Know

  • Understand that the health of GPs can be adversely impacted in many ways as a consequence of the type of work they do.
  • Know the importance of having insight into own health needs and ability to prioritise them when required.
  • Recognise potentially risky situations or therapeutic relationships early to minimise risk by engaging support from colleagues, other health professionals or organisations, and implement protective strategies.

Do

  • Optimise physical safety at work to minimise risk of patient-initiated violence by:
    • ensuring awareness of safety systems in the workplace, including location of duress alarms and safe exit routes and action plan, should a situation arise that puts staff or patients at risk
    • developing and maintaining skills in de-escalation techniques
    • being aware of safety issues; for example, ensuring safety during visits outside the practice, avoiding working alone in the clinic, identifying patients who have a history of physical and/or verbal aggression.
  • Manage occupational health risks, including:
    • impacts of stress and fatigue from working with priority population communities (eg Aboriginal and Torres Strait Islander peoples, homeless people, or people who have experienced trauma, are substance dependent or experiencing complex mental health issues)
    • working in remote and regional areas
    • emotionally challenging clinical situations (eg palliative care).
  • Develop strategies to maintain health and wellbeing; for example:
    • accessing professional support
    • seeking support following difficult or confronting situations
    • managing occupational health risks such as stress and fatigue and work-related safety risks (inside and outside the practice).
  • Have own GP to assist in implementing preventive strategies (including access to screening and healthy lifestyle modifications) to ensure physical and psychological wellness and ability to deliver quality care.
  • Manage fatigue. Fatigue management is an important aspect of self-care, particularly for doctors who work in rural and remote areas with onerous on-call responsibilities.
  • Identify any blurring of boundaries in therapeutic relationships. In the event of a physical or psychological impairment that may impact the GP’s wellbeing or ability to manage their professional responsibilities, a robust management plan may need to be developed in collaboration with other health professionals, as appropriate.
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