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    Is clinician refusal to treat an emerging problem in injury compensation systems?

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    Author
    Brijnath, B; Mazza, D; Kosny, A; Bunzli, S; Singh, N; Ruseckaite, R; Collie, A
    Date
    2016-01-20
    Source Title
    BMJ Open
    Publisher
    BMJ
    University of Melbourne Author/s
    Bunzli, Samantha
    Affiliation
    Surgery (St Vincent's)
    Metadata
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    Document Type
    Journal Article
    Citations
    Brijnath, B., Mazza, D., Kosny, A., Bunzli, S., Singh, N., Ruseckaite, R. & Collie, A. (2016). Is clinician refusal to treat an emerging problem in injury compensation systems?. BMJ Open, 6 (1), pp.e009423-. https://doi.org/10.1136/bmjopen-2015-009423.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255365
    DOI
    10.1136/bmjopen-2015-009423
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735202
    Abstract
    OBJECTIVE: The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. DESIGN: Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. SETTING: Compensable injury management in general practice in Melbourne, Australia. PARTICIPANTS: 25 GPs who were treating, or had treated a patient with compensable injury. RESULTS: The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. CONCLUSIONS: In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries.

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