Appendix

Discuss the Code of Conduct and the importance of GP wellbeing on delivery of quality clinical care. As a group consider:

• The signs that someone might need help and how that might differ across those in your practice team.
• What is your responsibility to yourself and each other?
• How can you recognise that you might not be functioning at optimal capacity? How could you be more self- aware of your need for help?
• What are effective self-care strategies?

Reflect on a near miss or critical incident, or complaint that you were involved in. If you feel comfortable, discuss with a colleague or friend.

• What happened?
• How did you feel after the incident?
• What did you learn from this situation?
• How have you changed your practice as a result?

Reflect on hypothetical patient scenarios that might make you feel uncomfortable because they raise conflicts with your personal or ethical principles. Consider how the circumstances make you feel? How do you manage the tension of conflict between these issues and your ethical principles? What strategies could you see to help manage these situations.

• A patient presenting for voluntary assisted dying;
• A patient with seven children refusing contraception;
• A parent refusing vaccination for their child;
• A perpetrator of domestic violence or sexual abuse;
• A request for termination of pregnancy;
• Alternative scenarios such as someone who uses illicit substances or is homeless.

Role-play or discuss scenarios where a patient asks for a medical certificate. Consider any of the following scenarios:

• A patient who is resisting having a mandatory vaccination for their work and would like to go on sick leave while they think about this.
• A new patient who has long-standing back pain requesting three weeks’ leave because that is usually how long it takes for them to recover.
• A person who is retiring next year and has 100 days of sick leave. They want to use some of their sick leave to go on a holiday for three weeks; and their boss has said it was fine to use sick leave and to just to get a medical certificate from their doctor.
• When were your views different from your peers? Why might your peers think the way they do?
• In what situations is it appropriate to give a medical certificate? In what situations is it not appropriate?
• What if the scenarios changed slightly? For example, the patient resisting vaccination only wanted three days’ sick leave, or they had significant mental health issues.
• What are your legal obligations around giving medical certificates?
• How did you manage these consultations?

Reflect on the professional role of the GP with a friend/family member.

• What sorts of behaviours do they consider to be professional? What sorts of behaviours to be unprofessional?
• What do they think is the role of the GP in terms of advocacy for health system change?
• What is the role of the GP to advocate for their patient’s needs? Helpful to think of this in terms of role of care coordination for the patient, ensuring things don’t “fall though the gaps”, overcoming barriers to care.
• What changes could you make to your practice because of your discussion?

Consider the following scenarios and identify the issues related to professional and ethical behaviour:

1. A reception staff member books an appointment with you to obtain a pathology form for a blood test that their naturopath has requested.
2. A doctor approaches you in the corridor asking for a script for the contraceptive pill.

• What issues do these situations raise? How do you manage these situations? How do your peers manage these situations? Do these scenarios breach professional boundaries?
• What strategies might help if you are faced with these situations in the future?
• Are there ‘hard boundaries’ and ‘soft boundaries’?
• What if you were practicing in rural areas?
• How can you be self-aware of your boundaries?
• What can you do if you are concerned there is a crossing of boundaries?

The new CPD arrangements informally encourage doctors to connect and learn from each other to protect individuals from practicing in professional isolation. This type of CPD can involve giving and receiving feedback and encouraging you to seek patient feedback. 

• How do you feel giving feedback to others in your workplace?
• How do you feel when feedback is offered to you?
• What can make feedback easier or harder to listen to?
• What can make the biggest impact on your practice?
• What processes are in place in your workplace that make it easier for you to routinely do CPD with others in your practice?

Read the RACGP’s Preparing medical reports: A guide to setting fees and writing reports  and review a medical report that you or a colleague provided to a third party.

• Review the medical report in line with the themes of the RACGP’s guidance as outlined in the document above.
• How would you approach your next medical report?
• Consider your clinic’s templates and processes that are used to manage third party requests and any improvements can be made.

On your own or in a group, identify a case where you were required to exercise your duty of care for a mandatory notification. How did this make you feel? What was the process like? What did you learn? Reflect on your knowledge of and levels of adherence to the standards, and factors that impact your approach for any of the following: 

• disease notification
• child protection
• medical practitioner fitness to practice
• fitness to drive
• assessment of patients under a mental health act
• substitute decision-making.

Reflect on how you maintain your personal health and wellbeing and develop a strategy with respect to the following: 

• management of personal and professional isolation, which can be experienced by GPs in different ways throughout the different stages of your career
• management of common psychological issues that affect doctors, such as stress, depression, burnout, addiction and potentially dysfunctional interpersonal relationships
• your levels of self-awareness and prioritisation of self-care
• deal with one’s own reactions to patients and daily problems
• having your own GP and developing personal and professional support mechanisms.