As reported by The Sydney Morning Herald, Australia
"Ethics, financial probity for review
March 18, 2008
FORCING sick, vulnerable patients to see a doctor in the presence of an unrelated third party was both dangerous and potentially unethical, the Australian Medical Association warned yesterday.
Young women who entered Mercy Ministries' residential care program were required, as per the organisation's policy, to see a doctor in the presence of a ministry staff member or volunteer, it was revealed yesterday.
"I wasn't allowed to talk to the doctor by myself; they had a staff member or volunteer with us at all times, and the doctor never mentioned my anxiety or the other conditions I was suffering," said Megan Smith*. She was in the organisation's Sunshine Coast house for three months because of anxiety disorder, obsessive compulsive disorder and other mental health problems.
"The staff used to bring our folder, which I guess contained our medical records, but the doctor would just flip through it and we were in and out in five minutes," she said.
The executive manager of programs at Mercy Ministries, Judy Watson, confirmed that all doctors' visits were monitored.
"Monitoring of a general practitioner visit is to assist with accurate medical information relayed and received for the benefit of the resident in their ongoing care whilst at Mercy Ministries," she said.
But the AMA's president and chairwoman of its ethics committee, Rosanna Capolingua, said patients must be able to talk freely to their doctor about how they are feeling, without the potential influence of a third party.
"It may be that the patient is under some kind of … duress or coercion to have that person accompany them," she said.
Without the ability to disclose that, their doctor might be none the wiser. "It would be very difficult for the doctor to determine whether the patient is freely requesting that the person be in the room with them."
And even if the doctor did ask the patient whether they had consented, the patient may not be able to answer.
"They are already vulnerable, they are coming in potentially under duress and they have another layer of fear on board … they might not have the courage to answer."
Such is the wider concern that Dr Capolingua has referred the matter to the AMA's federal ethics committee for consideration, aiming to advise doctors how to manage the situation.
Meanwhile, an investigation into the transfer of Centrelink benefits to Mercy Ministries is under way, after allegations that young women were signing over their benefits, but also encouraged to go onto a disability support pension so the organisation could collect carers' payments as well.
The Minister for Human Services, Joe Ludwig, has asked Centrelink to investigate the allegations and report on its pay arrangements with Mercy Ministries.
* Name has been changed to protect her identity."
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