The suspension of a GP has highlighted the issue of overwork in rural practices
Victorian GP Dr Andrew Griffiths was a solo practitioner in a country town where he was the only on-call after hours doctor – including for the local 60-bed nursing home.
He worked weekdays and weekends, regularly seeing more than 200 patients a week.
Such a high workload carries risks for medical practitioners, the Victorian Civil and Administrative Tribunal noted when addressing his case.
Dr Griffiths faced the Tribunal regarding his professional conduct in relation to nine patients, at various times between 1999 and 2013 – the only time he has faced such proceedings in his career.
The allegations included:
- inappropriate prescribing and/or providing inappropriate medical treatment;
- inappropriately treating persons with whom he shared a close personal or family relationship;
- inadequate notes or records in relation to the people he treated with whom he shared a close personal or family relationship;
- prescribing a drug of dependence in circumstances where he knew or ought to have known that the patient was a drug-dependent person; and
- breaching permit obligations in relation to prescribing Schedule 8 poisons, including prescribing without a permit, prescribing after the permit expiry date and prescribing in excess of maximum dosages. The drugs prescribed included opioids and benzodiazepines.
With Dr Griffiths’ agreement, the Tribunal found that he had engaged in eight instances of unprofessional conduct under the Medical Practice Act 1994 (Vic); four instances of professional misconduct and 10 of unprofessional conduct under the Health Professions Registration Act 2005 (Vic); and six instances of professional misconduct and eight of unprofessional conduct under the Health Practitioner Regulation National Law, as in force in each state and territory (the current legislation).
The Tribunal heard that a suspension of more than three months would mean that Dr Griffiths would need to close his practice.
“Unusually in such matters, we were given strong letters of support by community leaders on behalf of the whole community, which concerned not only Dr Griffiths’ commitment and dedication to the town and district for over 30 years, but also the direct impact on the community of removing him from practice,” it noted.
There was concern among panel members that a three-month suspension might not adequately reflect the seriousness of the conduct, and more discussion was entered into. This included three character witnesses appearing in person to give evidence about his importance to the town and the impact on the community if he were to close his practice.
Ultimately, the Tribunal reprimanded Dr Griffiths and suspended him for a period of three months from 1 May 2017.
Dr Griffiths also had education, audit and mentoring conditions imposed on his registration with effect from 1 June 2017.
“Although removing a clearly unsafe practitioner from practice will take priority over the impact on the community of losing a doctor, Dr Griffiths is not in that category, and it was relevant in this case to consider the impact of any period of suspension and the need to limit any period to no more than is necessary to achieve the objectives of determinations,” the Tribunal noted.
“This case highlights the hazards of high workloads for general practitioners in sole rural practices, and the pressures they can come under in the course of their practice, including to treat persons with whom they have a close personal or family connection,” it noted.
“Ultimately, practitioners themselves must ensure that they are able to maintain the standards the profession and the public expect of them.
“But rural communities that depend heavily on the commitment and dedication of their doctors will also need to do all in their power to ensure those doctors do not break under the strain.”