Avant talk: professionalism, privacy & the traps that end careers

Speaker

Patrick — senior claims manager at Avant (≈10 years), professional conduct / medicolegal. Acknowledgement of Country delivered at open.

Session context

Otter id EQI0sZGBwKf7iFWrT1IyEfPDUHo · title Avant talk · ~44.5 min (2670 s). Real cases (not all GP/cardiology-specific). Sponsored meeting close noted separately by host.

Key messages for GPs

• Never share patient images on social media, WhatsApp, or “closed” chats without specific consent — assume anything shared becomes public.
• Take clinical photos only when needed for care (or research/education with clear consent); prefer practice devices; save to the file; document.
• In conflict: do not match anger. De-escalate, listen, set boundaries; boards care about how you managed the escalation.
• Access notes only for a valid clinical (or limited lawful) purpose — curiosity, “checking if someone is trustworthy,” or gossip = professional misconduct risk.
• Avoid self-prescribing; get your own GP before you need one. Never forge scripts. Do not prescribe S8 / psychotropics / drugs of dependence to people close to you.
• Doctor wellbeing is not optional — many of these cases started with unmanaged stress, burnout, or untreated mental illness.

Case 1 — Sharing clinical images

Orthopaedic registrar at a major public hospital shared graphic photos, video and X-rays of patients via text/WhatsApp with friends, often with unprofessional comments (e.g. a traumatised foot likened to a pizza; an abdominal CT of a foreign body with emojis). One image included a partial patient name. Images were obtained in the course of work.

Outcome path: suspended; lost a training position; ~6 months unemployed; retrained as a GP; nearly five years to tribunal. Found guilty of unprofessional conduct (accepted). Mitigating: no record access beyond the images; patients not identifiable; shared to individuals not social media; no sexual intent; extreme personal/professional stress; insight. Tribunal did not reprimand (time elapsed; no protective purpose now) and agreed non-publication of name — but imposed a $5,000 fine as a deterrent; each party paid own costs.

Case 2 — Escalating patient conflict

Doctor removed small skin cancers from scalp and back. At follow-up the patient was unhappy with the cosmetic result; discussion became a shouting match. Patient notified the Medical Board. Board gathered statements (patient, partner, doctor, staff) — accounts differed, but the Board found the doctor failed to adequately manage an escalating situation. Three prior notifications about communication (no further action then) were noted. Board proposed eight conditions including 1:1 education on de-escalation and a reflective report.

Doctor admitted some fault in hindsight but preferred self-directed learning over conditions; appealed. By tribunal, a fuller education plan appeared — “too little too late.” Tribunal criticised early lack of insight and blame on the patient; brief/muted reflection; voluntary education looked like avoidance of conditions rather than genuine need.

What boards expect

• Do not match the patient’s anger.
• Listen; try to understand the behaviour; set acceptable boundaries; protect staff/colleagues.
• If steps fail, consider ending the therapeutic relationship appropriately.
• Insight early beats a polished plan after appeal.

Avant’s website has guidance on difficult interactions (speaker pointed attendees there).

Case 3 — Unauthorised record access

NZ trainee suspended after admitting unauthorised access to 35 patients’ records on 97 occasions, including disclosing information. None were patients under their care; many were psychiatric / mental-health notes. One disclosure to a friend who knew the patient led to police, then regulator. Audit showed months of access. Reasons included assessing whether people “posed a risk” or were “trustworthy.” Doctor later diagnosed with PTSD and major depression — relevant to penalty, not to the finding of professional misconduct.

Penalty flavour: censure; education; 3 years supervision with quarterly access audits; ~$30,000 costs. Tribunal thought ≥4 months suspension appropriate but did not add suspension because the doctor had already been out of practice ~3 years.

Australian parallel cited: SA Health — multiple staff accessed records after a high-profile hit-and-run death; resignations mid-investigation; others reprimanded/warned on permanent records; SA Health said termination would have been pursued had they not resigned.

Case 4 — Self-prescribing & dependence

Doctor involved in two car accidents while under the influence of sleeping tablets; dependent on medication started for insomnia/depression around exams. Admitted self-administering S4 and S8 medicines and forging prescriptions over ~6 years; pleaded guilty to 40 poisons-legislation breaches. Gave undertaking not to practise until approved — then two further notifications of continued self-prescribing. Referred to tribunal; accepted unprofessional conduct and professional misconduct.

Later cooperation: monthly drug tests, clinical training, shame/remorse. Tribunal: reprimand; screening; supervision; medical treatment; prohibited from prescribing/administering S4/S8 except within clinical role scope; non-publication order re name.

Case 5 — Treating / prescribing for family

Orthopaedic surgeon (originally US) forged a colleague’s name/prescriber details on codeine scripts — some for himself, some for his wife — filled at multiple pharmacies over ~6 months (>20 forged scripts). Claimed drugs were for wife’s dependence; wife was not a patient, no clinical records, and she did not even have her own GP. Criminal fraud charge — discharged without conviction. Disciplinary: professional misconduct; censure; registration cancelled; reported to US authorities; ~$19,000 costs. Doctor had returned to the US by then.

Code of conduct / practice rules (as framed in talk)

• Avoid self-prescribing; seek independent care; get a GP before you need one.
• Forging / altering / presenting forged scripts is an offence; also endangers colleagues who may be reported.
• Unprofessional to prescribe for those close to you; never for S8 or high-risk medicines.
• Prefer not to start a doctor–patient relationship with family/friends except true emergency; refer for ongoing care.
• If you must treat someone close: clinical setting, proper records, document carefully, hand over ASAP.
• Prepare a short script for declining corridor consults / staff requests — treat staff at another practice when possible.

Q&A practical answers

Clinic checklist

1. Audit phone/WhatsApp habits — no patient images off practice systems.
2. Consent script for clinical photography ready; practice camera preferred.
3. De-escalation plan: listen → boundaries → exit/end relationship → document contemporaneously.
4. Never open a file for curiosity, gossip, or “is this person safe/trustworthy.”
5. Have your own GP; no self-scripts; no S8 for anyone close to you.
6. Staff policy: no corridor medicine; another practice for ongoing care.
7. Wellbeing: burnout and untreated mental illness are risk factors for the cases above — seek help early (Avant resources linked via QR at the talk).

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