Poor old AHPRA, they just can’t turn a trick. Close on the heels of last year’s Social Media Guidelines debacle comes their attempt to shoot off their remaining foot. AHPRA’s latest ‘Guidelines for advertising regulated health services” (http://www.atsihealthpracticeboard.gov.au/Codes-Guidelines/Guidelines-for-advertising-regulated-health-services.aspx) have provoked such a firestorm of criticism from social media, health professionals, patient advocacy groups and more, (see twitter @AHPRAaction for details and links) that only a complete re-think and re-write is likely to recover AHPRA’s credibility.

Once again, people have been blindsided by these guidelines, despite AHPRA’s protestations of ‘consultation’. Like many others, I don’t remember an email or letter or heaven forbid, any reaching out via social media to seek our views on such guidelines. AHPRA’s view of ‘consultation’ in 2014 is positively myopic. The Daleks consult and discuss more successfully than AHPRA.

Consultation has to mean more to AHPRA than going through a few procedural formalities like ‘putting a call up on our website’, or inviting a selection of Royal Colleges to chip in a few thoughts.

AHPRA however, inhabit a regulatory twilight zone where social media hasn’t happened, where all health professionals are equal and defined only by their qualifications and ‘office details’, where marketing and promotion is like a bad smell underfoot and where the entire patient empowerment and ‘health consumer’s voice’ movement of the last decade is a mirage.

This latter concern is perhaps the most telling. The level of condescension and the patronising tone towards patients and public is almost prehistoric. Apparently a testimonial “can distort a person’s judgement” as they ‘choose’ their health practitioner (by the way, next time you are a patient in hospital, try ‘choosing’ your nurse or doctor). The reason why it is a ‘judgement’ and not an algorithmic computing of objective statements is because patients and families will weigh up testimonials – along with word of mouth, personal impressions and numerous other ‘intangibles’ that are way beyond the scope or imagination of AHPRA’s regulatory pall.

For AHPRA, it seems that the the patient involvement and consumer voice movements have never happened. They have missed a massive opportunity and have alienated and overlooked patients and clients when they should have jumped at the chance to involve them. ‘Nothing about us without us’ should hang on every metaphorical wall in health care, AHPRA’s included. The entire tone of the latest guidelines is wearily predictable. Couched in the self-serving rhetoric that elevates AHPRA and the Health Professional to the role of lords and ladies protector, the patient is almost infantilised as some helpless, powerless blob of unsophisticated vulnerabilities.

But it is the substance and implications of these Advertising and Testimonials guidelines that gall. Rather than try to appreciate and navigate the complex ‘new world’ of social media, patient power, health marketplaces and more, AHPRA has reached for the ‘too hard basket’, rolled over at the first sight of Section 133 and dumped blanket prohibitions on health professionals that would be laughable, were they not so potentially serious.

In essence, AHPRA expects health professionals to become the paranoia police of patient or professional opinions. We are to watch over social media, lest anyone compliments us and our sense of professional ethics crumbles as a consequence. Laurie Bickhoff (@Laurie_ENL) nailed it beautifully when she tweeted that these guidelines make us truly, “the thankless professions”.

AHPRA say, in all seriousness:

“A practitioner must take reasonable steps to have any testimonials associated with their health service or business removed when they become aware of them, even if they appear on a website that is not directly associated and / or under the direct control or administration of that health practitioner and/or their business or service. This includes unsolicited testimonials.”

Fail to do this and you can be fined $5,000 if someone says something complimentary about you online. Foucault would be cheering from his grave at this pinnacle of Panopticonism where the surveillance and accrediting body manages to have the health professionals become their own scrutinisers.

What AHPRA (and Section 133) are so afraid of in relation to advertising and testimonials is hard to fathom. How hard can it be to inform health professionals that if you lie, cheat and behave unethically in this domain, AHPRA will come down on you like a ton of bricks.

Whether specific guidelines are even required in these areas is a moot point. What about using the demands and principles of health professional conduct and integrity that already exist? What about guidelines that say:

You are a registered health professional with responsibilities:
–  Be honest, don’t lie in testimonials and adverts and don’t fabricate them.
If a letter from a patient saying: “Dr Bloggs is fortunately a rare find. His incompetence is beyond belief and the best thing you can do is never visit him, now or any other time”, appears on your website as
“Dr Bloggs is … a rare find … beyond belief … visit him now”.
You should expect AHPRA in turn to visit the Wrath of Khan on you and we will all applaud.
– Be ethical, don’t try pressurise patients into providing positive feedback, don’t bribe people to praise you. If it is ever discovered that you have even ‘suggested’ that a patient’s care may be better or their waiting time for that much needed operation could be reduced or that some other sweet deal could be available, were they just to “share the positive experiences that they have had with others”, AHPRA will accord you pariah status.
– Have integrity. Never make bogus or inflated claims that you can’t substantiate. That market is already cornered by the unregulated shonks.

In a nutshell, bring the same professionalism and ethics to your advertising and testimonials that you bring to your clinical practice.

Here lies another of the grating incongruities in the current landscape. While registered health professionals have these swathes of advertising and testimonial restrictions, the shysters, charlatans and snake-oil sellers have a clear run to spruik their fake degrees, shonky cures, latest miracle diets and ‘natural health solutions’ that ‘may help’ whatever ails you. In contributing to the creation of a playing field more akin to the north face of the Eiger than anything ‘level’, AHPRA is unwittingly promulgating this embarrassing imbalance between competent and valued health professionals and cowboys.

I run a consulting and speaking company and in the consulting business testimonials are not unprofessional stains to be eradicated but rather the coinage of the realm. A personal testimonial or recommendation from a client is highly valued and appreciated by both consultant and prospective future client. It is not an embarrassment to apologise for.

AHPRA’s advertising and testimonials guidelines seem grounded in a basic fallacy, that all Health Professionals are equal and that any attempt to identify some as better than others, is an illegitimate threat. Perhaps this is why “objective” information seems acceptable, whereas patient opinion is deemed inherently unreliable. Post as many “approved qualifications” or “memberships and fellowships” as you like, but never an opinion about how well you practice your accredited skills.

What every Health Professional and patient knows however is that Health Professionals are NOT all the same. Some, I would trust with my life and the lives of my loved ones in a heartbeat, while there are others that I would not let take out my wheelie bins.

I would like to see our regulatory authority model some of the attributes that we so value and try to inculcate in our clinicians and students. We hope that our Health Professionals can spot and solve problems, that they can advocate for AND WITH patients and clients, that they can identify and articulate health process and policy shortcomings and propose improvements and solutions.

Instead of simply throwing their hands up and saying “the law’s the law gov”, could AHPRA not have genuinely sounded out the professions, patients and the community on this issue, partnered with them and spearheaded the campaign needed to amend and update any part of the law that is no longer fit for purpose in 2014.

There is a glint of optimism here. As I write this AHPRA has at last begun to engage with health professionals on this issue via social media. AHPRA began tweeting on 19th March! What they will find is that engaging with and opening up to Social Media is a leap of faith. AHPRA, like all organisations will discover that Social Media does not have a ‘mute’ button that they can press. They will also need to live with the idea that they no longer control their own narrative. The conversations, criticisms and dialogue will continue with or without them. Yes, Social Media can be critical but it is also a very generous and helpful community when engaged in the right spirit. If AHPRA can build on this fledgeling engagement with health professionals and service users, then perhaps we can all salvage something worthwhile from this episode.

Now wouldn’t that be something worth advertising.

One Response to “‘The Thankless Professions’ – AHPRA’s Advertised Failings”

  1. Claire McQueen

    Unfortunately, the option to send you a message is not working for me.

    Hi Philip

    I enjoyed reading your article and agree with your perspective that AHPRA operate in a somewhat old fashioned way without having any real acknowledgement of what is actually going on in today’s healthcare.

    I wondered if you’d be interested in and could help in anyway with a new AHPRA-issue. Whilst there remains a shortage of experienced nurses in various areas and hence the profession remaining on the skills shortage list – and immigration granting international nurses erm ament residency visas – AHPRA have decided on an apparent whim that they don’t want many of these nurses.

    Prior to the new framework for assessing internationally qualified nurses and midwives (IQNM) that was published in February, UK nurses with a Diploma of Higher Education in Nursing (3 year university course) were accepted for registration, no problem. For some unknown reason yet to be answered by AHPRA, UK DipHE has been downgraded from Australian Qualiications Framework (AQF) level 7 to AQF5/6. AQF7 is required for registration as this is where an Australian Bachelor Degree sits.

    Now, the new framework and registration criteria were published on AHPRA’s website in February, though AHPRA decided that any incomplete applications at October 2013 should be placed on hold in the meantime, and assessed under this new framework when up and running in February. Obviously they failed to communicate any of this applicants. But not only applicants – Immigration, Education, Health, Recruitment Agencies, the rest of the Government.

    So what happened was a load of UK nurses who had been granted permanent visa (because ANMAC still assess UK DipHE at AQF7), moved over to Australia whilst awaiting registration having sold their houses and quit jobs, put their children into Aussie schools, to then be told they had been refused registration. Healthcare providers had been extending deadlines for job offers all this time. Some of these nurses spent all their savings just trying to survive and eventually had to claim benefits (which they were now entitled to as permanent residents). They were “too qualified” for support worker roles and had only worked in nursing for their whole lives.

    But.. AHPRA are offering a lifeline for some of these nurses – a Bridging Course! Oh, it costs around $15,000 though.. And wait, I live in QLD and they don’t run in this state.. So, it requires me to move to another state, work full time in a hospital setting for eight weeks, with four weeks theory on top of that, to be given a letter making me eligible to apply to AHPRA from scratch again. Hmm. And the course outcomes are ‘to enable nurses to practice safely’. Seems legit..?!

    Interestingly, AHPRA’s Chief Exec, Martin Fletcher, agreed to a radio interview with ABC Perth following word getting out about this scandal, and stated (I quote) “there is nothing wrong with their (UK DipHE nurse’s) standards”, after explaining that they needed to complete the Bridging Course to bring them up to standard and teach them how to be safe practitioners. Condescending?

    Freshly graduated UK Degree nurses with no experience whatsoever are able to register though. Because a 10,000 word dissertation makes them safer than having a DipHE and 30 years experience (so AHPRA believe).

    Oh, and when these nurses contacted the providers of the Bridging Course with their referral letters in hand, they were told that it is not offered to UK nurses, and that they don’t know anything about this situation.

    Another day, another scandal.

    Thanks for reading, and if you’re interested, there is a group of 150+ of us, growing by the day as more applicants are made aware of what’s going on, that would love to tell you more.

    Kind Regards
    Claire McQueen

    Reply

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