Medical Board of Australia V. Dr. Topchain

The case is between the applicant, The Medical Board of Australia and the respondent Dr. David of Topchain practice. Dr. Topchain is a cosmetic surgeon working in Melbourne Australia.  He is a doctor licensed and registered by the medical board of Australia. However, he got himself linked with a sexual affiliation with a patient which caused a violation of the Health Professions Registration Act of 2005 and also the Health Practitioner Regulation National Law Act of 2009. Based on the findings of the case, it was found that Dr. Topchain involved himself with a sexual relationship with the patient for a period between August 2009 and October 2009. It is against the law for registered health care professionals to engage in any form of relationship with patients. Another finding was that Dr. Topchain involved himself with a behavior that can be considered as unprofessional because of trying to pay the patient to refrain from speaking about the relationship to anyone and using a lawyer to silence her.

Allegations of the Case

Between July 2010 and September 2010, the doctor engaged himself in negotiations with the patient over the signing of formal documents that would force her against exposing any information about the sexual relationship between the two. It would also refrain her from taking any actions against the doctor that would disclose any dealings with the doctor. The negotiations also involved the payment of a certain amount of money to the patient for her silence. This was a clear violation of the Health Practitioner Regulation National Law Act of 2009 that is specific on professional misconduct for which Dr. Topchain was involved in with the patient.

Dr. Topchain himself admitted to the sexual relationship with the female cosmetic patient.  The patient was twenty-one years of age at the time. She received cosmetic surgery, and other services from the doctor during and after they had ended their relationship. When Dr. Topchain tried to end the relationship, the patient asked for money and used threats until she got what she wanted from the doctor. The negotiation with the patient and use of a lawyer came about when the patient began to ask for money. Dr. Topchain used the help of a lawyer to establish legal mechanisms that would refrain the patient from exposing the relationship. However, using the lawyer to silence the patient only worsened the situation because she continued with her threats of disclosing the details of the relationship to the doctor’s wife as well as the Australian Health Practitioner Regulation Agency. It was at that point that Dr. Topchain decided to report himself to the same authority and save himself from all the trouble that the patient was causing him as a result of blackmail and threats. The patient never notified the authorities and never disclosed any of the information to anyone. Dr. Topchain presented the case with the relevant evidence about the situation, and the Medical Board of Australia came to agreements with evidence from documents and statements of facts from the doctor and other relevant people. The board decided that the best cause of action was to cancel Dr. Topchain’s license for two years where the doctor would receive medical and psychiatric help. However, Dr. Topchain suggested a three-month suspension as the appropriate action for the case. However, the Board reserved its decision.

Orders of the Tribunal

Based on the suspension by the board, it was viewed that Dr. Topchain made significant errors of judgment when he involved himself in a sexual association with a patient and also vexing to avert the conduct from being uncovered. It is, therefore, clear that he was charged for two wrongdoings that all violated different laws. Cosmetic surgery is a field that is very sensitive. Surgeons in this field are professionals that carry out alterations to people’s appearances, which is very influential of their self-worth, esteem and other critical personal factors. The order by the board was for a suspension for which the board viewed as useful for the violations and offenses conducted by the doctor.  The actual determinations were a one-year suspension and a two-year reprimand, and the board found it appropriate. However, the board also considered cancellation but determined that there be no risks of involvement in sexual relations again by the doctor after the case. The determination was sufficient to teach the doctor a lesson and gave him an adequate understanding of the consequences of such actions. The determination was also based on some benefits associated with the action of self-reporting by the doctor. The information did not come from the patient but Dr. Topchain Himself. However, the board held that there should not be any credit given to the doctor from self-reporting.  From the statements of facts and other investigations, he only reported the matter when he found that it was getting out of hand. The determinations were, therefore, useful in ensuring that the doctor received adequate punishment for his actions with the patient.

The Victorian Civil and Administrative tribunal conducted the hearing where it determined whether or not the doctor was a person of good character, a doctor who has had unsatisfactory performance as a healthcare practitioner, a doctor whose ability to practice had been affected, and or the doctor engaged in unprofessional misconduct. The case involved the instituting of whether the actions of the doctor were professional misconduct or unprofessional conduct. These are two are legal facets that are very different from one another and therefore, have different consequences. The application for case alleged that it was professional misconduct which involves more severe consequences because it is connected with departure from medical standards of ethics and professionalism. Professional misconduct is well defined in the Health professions registration Act in section 3 and can be described as any action that does not meet, to a particular degree the standard of professionalism. It can also be defined as conduct by health professionals that is different to the exercise of the health profession and would then validate that the professional is not of good personality. According to the board as well as the statements by Dr. Topchain, the actions of the doctor with the patients were clear examples of professional misconduct. This is because his sexual relationship with the patient was contrary to his health care profession. In simple terms, it can be said that his behavior fell short of what was required of him as a cosmetic surgeon and also what was expected of him by the society. Medical practitioners are people placed in positions of high trust because they deal with personal issues of patients. Sexual relationships between doctors and patients are, therefore, highly inappropriate.

Requirements For Healthcare Professionals

From the above, it is clear that relationships between patients and doctors are highly inappropriate. This is because doctors have a very sensitive position of knowledge of personal information about their patients. Doctors and other practitioners, therefore, can easily exploit the trust of patients because of the knowledge of their physical and psychological well-being. Engagements between doctors and patients, therefore have high expectations especially when it comes to matters of sexuality. Patients expect that their engagement with doctors needs to be kept professional and not be sexualized in any way.  Doctors and other healthcare professionals also have high expectations that patients will refrain from using their engagement with doctors as opportunities for establishing sexual relationships with them.

The doctor-patient relationship is very crucial for the practice of medicine. It is a relationship that forms the basis of ethical standards within the medical field. Patients have to have confidence in the competence and professionalism of their physicians and any other healthcare practitioner. However, for some physicians, such as family doctors and psychiatrists, emphasis on the relationship is more as compared to others. The development of a good rapport with a patient is essential, but nothing further from that is expected from the engagement between the two.  The quality of the relationship between a doctor and a physician is critical to the success of the medical service provided. A good relationship leads to the development of sound values and perspectives on matters of disease, service, and life in general.  It results in the provision of efficient healthcare service that positively builds up the provision.

Various factors are improved, thanks to the establishment of a good patient and doctor relationship. It enhances the process of diagnosis for which a physician gets to understand better the problem affecting the patient. Based on this case, Dr. Topchain would get a better understanding of the issues that the patient wants to be changed and would help develop a good plan of action. It also enhances the understanding of the patient about the procedures and conditions affecting them. The patient could have had a good understanding of how the procedures would be done, the consequences, and the plan of action the future. A poor relationship between a doctor and a patient leads to the development of problems in the assessment of the problem. The patient may come to have little trust in the diagnosis and treatment plan. The situation of Dr. Topchain and the patient is characterized by a lack of sustainability of procedures done on the patients which resulted to the need for carrying out multiple procedures, and it is a clear indication of problems between the two as a result of little regards on professionalism. Patients sometimes fail to comply with instructions given to them by physicians and also medical advice, and this builds up to more problems.

The demand for money by the patient from the doctor is a representation of a professional relationship that has already been destroyed.  The doctor-patient relationship had now turned personal, and the patient did not consider any boundaries when it comes to dealing with the doctor.

The professional misconduct by Dr. Topchain is based on violations of legal requirements well defined within the National Law in section 5. The conduct by the doctor was less than expected of him as a healthcare practitioner. The board alleged, and at the same time, the doctor admitted, to have taken part in unethical behavior that violated his professional ethical standards. Ethics within the medical field are fundamental. This is because of every day; physicians encounter situations associated with ethical matters. Ethics can be defined as the study associated with principles that are conflicting with one another.  Physicians, therefore, need to have an excellent understanding of ethical vocabulary to ensure that their actions are in line with established and strict ethical standards of the profession. Ethics is a factor that permeates all aspect of the medical field.  Medical training is based on various vital doctrines on ethical matters that have developed over time with the aim of providing the best healthcare service.  However, the terminologies associated with matters of ethics are usually tricky, and sometimes most people fail to recognize them in their everyday activities. There are various issues of ethics within the field of medicine, and they include features such as beneficence, autonomy, fidelity, and non-maleficence. In the situation involving, Dr. Topchain, factors of fidelity came up where the doctors focused on his own sexual needs before the needs of the patients and ultimately led to the development of sexual relations between the two.  There exist very many challenges within the healthcare field that reflect on ethical matters, and the case of Dr. Topmain is a tremendous example. It is a case of lack of ethical considerations on professional matters that led to illegal activity as a result of professional misconduct.

Consequences

The existence of ethical problems within organization reflects negatively on the image of the organization, its employees and the field in general. Lack of ethical considerations is what creates scandals and other significant problems within organizations. It, first of all, leads to legal issues that have the effect of tainting the image of the organization from which the ethical problem occurred. A good example is the reputation of Dr. Topchain was put at high risk as a result of his actions. The organization in which it occurred was also significantly affected.  Legal issues include aspects such as cancellation of license of operation for both the practitioner as well as the organization for which he operated in.  The actions of the doctor risked the revocation of the license of the organization where he worked. There are legal guidelines for ethical matters, and a good example are the two laws in the case. They include the Health Practitioner Regulation National Law act of the year 2009 and also the Health Professions Registration Act. These are two laws that offer adequate guidelines on professional conduct as a doctor and actions that go against the conduct can be described as illegal. The case of Dr.Topchain and the female patient reflect on violations of legal requirements which have consequences such as the suspension of the license to practice and reprimand. Another consequence of lack of ethics within an organization is the reduced performance which is evident in the case where the threats by the patients forced the doctor to focus on o0ther matters other than the ones associated with his profession.

The focus on sexual favors from the patient led to a shift in focus for the doctor that altered his performance. The relationship between the doctor and the organization he worked at was high risk because of his unethical behavior. The legal actions against him by the Medical Board of Australia led to a complete cut in ties between them. He, therefore, became unemployed as a result of his actions. Credibility is also a significant factor and is linked with aspects of image and reputation for both the doctor and the firm he was hired. The organization was put at risks of losing all its clients because of the notion that their doctors are usually involved with their patients. Credibility is a critical aspect when it comes to the success of the business. It is what attracts customers to the organization based on the services offered. The situation involving the doctor was, therefore, hazardous to the credibility of the organization because of the negative implications it had on the image of the doctor and the organization. Research ethics is a field that is focused on aspects of dignity which is rooted in ethical matters of an organization.

Mitigation

Conflicting values, ambiguity associated with decision making and ethical matters are common factors affecting organizations today.  The lack of awareness and understanding of these issues is what causes many problems when it comes to decision making. People are not aware of how ethical standards are applicable in practice and are, therefore, very prone to problems. The lack of ethical considerations in the healthcare field results in many problems in health care operations. Some of these problems violate both ethical standards as well as legal requirements, therefore, causing many problems.

Preventing unethical behavior is very important for any organization. It is a factor that managers, as well as leaders, need to take consideration. More focus needs to be dedicated to it, because of how it is influential to the success of operations within it. Ethical considerations are a factor in proper planning. Poor planning is what leads to failure in considering an ethical factor in the decision making and development of policies within an organization. Inadequate and ineffective planning leads to the development of unrealistic goals for employees. The lack of a proper guideline regarding goals and objectives for an organization may motivate people to engage in unethical behavior. The case of Dr. Topmain explores an organization that has established little to not ethical principles for its operation. It left the doctor with no guidelines on ethical matters and made it easy for him to engage in sexual relations with a patient.

The development of sustainable plans with realistic goals is expected to keep employees focused and motivated to meet the needs and objectives of the organization. Another major problem that affects employees is the lack of awareness of ethical standards and how they are influential to an organization. Lack of knowledge is a major contributing factor when it comes to violation of ethical standards. It is, therefore, necessary for managers and leaders within organizations to teach and emphasize on an ethical matter, the concepts behind them and how they are influential to the success of an organization. Most people find themselves on the wrong side of ethical matters because of the lack of knowledge of their existence, the vocabulary behind them and how they apply to their daily operations. However, for the healthcare field, ethical matters are essential aspects of training and research.

Unethical behavior can lead to the development of unhealthy behavior associated with aspects of spite and lack of trust. The development of policies against unethical behavior is very paramount in reducing instances of ethical issues within an organization. Policies which are statements of intent play a crucial role guiding the behaviors of people in an organization. Managers and leaders also play an essential role in the implementation of these policies. Discussion ethical issues within the organizations and how to go about them is also significant for successful adherence to ethical guidelines. Regular discussions ensure that managers and employees are always aware of issues of ethics and this makes it easy for them to follow them.

Creating a code of conduct is an excellent measure of controlling unethical behavior.  A code of conduct is necessary because it offers people with an overview of the expectations of the organization. It, therefore, creates specifications of what is accepted and what is not accepted in the organization. Leaders also need to offer good examples of how to behave ethically. Employees look up to their leaders and leading by example may offer them direction. Reinforcing consequences for unethical behavior is also very important because it creates accountability and responsibility for their actions. Appraisal for ethical behavior is also critical because it is a source of positive motivation. The case of Dr. Topchain is crucial in this representation of ethical matters within an organization. It is associated with a situation involving a doctor and patient relationship that goes sours because of the development of a sexual relationship.