not have the right skills, you should assist where possible within your own skill set. The assistance must be provided to a reasonable level of care and skill, consistent with Right 4 of the Code of Health and Disability Services Consumers’ Rights. If you are asked to perform a duty that you would not normally undertake, regardless of the circumstances, you need to assess whether you have the skills and competency to proceed. If you do not feel it is safe or you would place the patient at greater risk of harm, then you should make your concerns clearly known. Working in another area of medicine Doctors registered in a vocational scope of practice who also have general scope are able to work in any area of medicine. However, if you are working within your general scope of practice in another area of medicine, you must have a collegial relationship for the area of medicine in which you are working. In a pandemic or RMO strike, you may be asked to work on a medical ward, for example, and you would sensibly take on a junior doctor role and be supervised by the physician in the team.
You may be asked to work in an area that is from a Medical Council perspective within your vocational scope of practice but is in a subspecialty you may not be experienced in – for example, a cardiologist being asked to run a general medical ward, or an adult community psychiatrist being asked to work in child and adolescent psychiatry. The Medical Council determines the scope of the 36 areas of medicine, and the scope of practice called psychiatry would include working in child and adolescent psychiatry. Cardiology and general medicine are both covered under internal medicine. So, from a Medical Council perspective, this is not problematic. However, if you felt you didn’t have sufficient experience, skills or knowledge in the subspecialty, you would be wise to have supervision. This can sensibly be part of advance pandemic planning. Whenever you are working outside your area of expertise, it is prudent to consult senior colleagues and keep documented records. In resource-limited environments, specialists may be asked to work in an area not within their vocational scope. An example might be if urologists are
not available, general surgeons might be considered to have the best skill set to offer limited urological care. In addition to raising concerns with management about the situation (and keeping an email paper trail), if this was outside the scope of a general surgeon it would fall under general scope and would require a collegial relationship with a urologist. What does Medical Protection provide? The purpose of Medical Protection is to provide support and assistance for issues arising from clinical practice. We are able to deal with unpredicted problems members might face such as Good Samaritan acts in an emergency, additional duties to ensure patient safety during strike action, and redeployment during pandemic staff shortages. We have the flexibility of discretion to determine the type and level of assistance we can provide. Our indemnity is not limited by ‘small print’ exclusions. ASMS also has advice on what to do if you are asked to undertake other duties, work additional hours, or work a staggered roster during the Covid-19 pandemic. It’s at www.asms.org.nz – search for ‘surge agreement’.
review that “might result in significant changes to either the structure, staffing or work practices affecting employees”. Indeed, before undertaking any review “that might impact on the delivery or quality of clinical services” the DHB is required to seek ASMS endorsement as to the “purpose, extent, process and terms of reference of such review”.
Good consultation is your right and critical to your overall wellbeing The need for timely consultation with employees in the health system is covered by law through the Employment Relations Act. Among other things, it states that “promoting productive employment relationships” requires the parties to commit “to engage constructively and participate fully and effectively in all aspects of their employment relationship”. To avoid any doubt, the DHB MECA makes this more definite in Clause 43, requiring DHBs to include formal consultation “at the earliest practicable opportunity” for any
DHBs must consult with you and ASMS about anything that might affect your patient care or your working lives. This includes things like setting or changing CME, sick leave, annual leave or other DHB policies, along with any change to staffing or model of care. Sadly, some DHBs have become very lax about fulfilling their obligations to the Employment Relations Act and the MECA. If your DHB implements or changes policies, procedures, and models of care which affect you as an ASMS member, contact your industrial officer straight away. WWW.ASMS.ORG.NZ | THE SPECIALIST
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