Health Professions Council Of South Africa Research Articles

Trust me, I’m a ‘doctor’: Of bogus doctors, medical impostors and medical fraudsters

Local newspapers have recently carried vivid headlines following the arrest of several individuals at the hands of the Hawks. Quite who among those arrested hold valid qualifications, who were impostors, who were legitimately registered and accredited with the Health Professions Council of South Africa (HPCSA) and who were fraudulently borrowing practice numbers to defraud the medical aid services, and whether they were operating as part of a syndicate (or syndicates), is still to be established. Reassuringly, the magistrate before whom the alleged miscreants appeared demanded proof of the medical qualifications and the Department of Health and the HPCSA are undertaking their own investigations, as is the Board of Health Care Funders (an industry body for medical aids), since some are accused of using other doctors' practice numbers in order to claim monies from medical aids. Patients of the alleged bogus doctors are now also supplying evidence.

The potential market demand for biokinetics in the private health care sector of South Africa

Objective: Biokinetics, a profession registered with the Health Professions Council of South Africa (HPCSA), address inter alia chronic diseases of lifestyle (CDL) with exercise as treatment modality. The purpose of this investigation is to determine the potential market demand for biokinetic services in the private health care sector of South Africa. Methods: Data from a pharmaceutical benefit management system (PBM) were analysed to determine the prevalence of chronic diseases in the private health care sector for 2007. Telephonic interviews on a sub-sample of 50 biokineticists revealed the average number of patients that can be treated monthly per biokineticist. The number of biokineticists with active practice numbers was obtained from the Board of Health Care Funders (BHF). Results: The results indicate that 47% (747 199/1 600 000) of the patients managed by the PBM are treated with medication for one or more CDL. Non-steroid anti-inflammatory medication (21%), medication for cardiovascular diseases (13%) and bronchodilators (11%) had the highest prevalence. The sub-sample of biokineticists indicated that one biokineticist can treat an average of 100 patients per month. The potential market demand calculated from the above numbers indicated that 7 472 biokineticists are needed in the private health care sector, while only 625 active practice numbers were registered with the BHF in 2007.Conclusion: In conclusion, it is estimated that only 7.6% of patients with CDL can potentially be treated by the current number of registered biokineticists. Therefore an enormous market potential for biokinetics exists in the private health care sector of South Africa.

Position statement: Pre-hospital rapid sequence intubation

The Professional Board for Emergency Care at the Health Professions Council of South Africa (HPCSA) has approved pre-hospital rapid sequence intubation (RSI) as part of the scope of practice for registered emergency care practitioners (ECPs). RSI is an advanced airway management process that facilitates endotracheal intubation in adults and children. Features of this technique include pre-oxygenation, rapid pharmacological induction of unconsciousness, and neuromuscular blockade to enable the placement of an endotracheal tube. RSI has become widespread as the procedure of choice for definitive airway management by pre- and in-hospital emergency care personnel worldwide. In the emergency department setting, RSI is superior to intubation with deep sedation, a technique not incorporating pharmacological paralysis as part of the intubation sequence. For this reason, the implementation of RSI in the pre-hospital environment is supported, provided that it is practised within an appropriate framework of clinical governance.

Private hospitals offers wide-ranging NHI assistance

The Hospital Association of South Africa (HASA) has mooted the idea of training critically needed specialists in its member hospitals while reaffirming its commitment to helping patients stranded by State shortcomings. The idea is being jointly explored by HASA’s CEO, Advocate Kurt Worrall-Clare and Marella O’Reilly, the Acting Registrar of the Health Professions Council of South Africa (HPCSA) to iron out legal obstacles, Izindaba reliably learnt. The move, on the back of HASA members saving lives during the recent public service strike when 1 300 often-unattended babies and adults in State facilities were transferred to private facilities, is a further potential watershed moment in critically important future public/private partnerships. However, its efficacy in terms of the current regulatory set-up was questioned by veteran clinicians and academics at the coalface. They said the fee-for-service of private surgeons, together with HPCSA rules, prevented registrars from obtaining the vital incremental hands-on experience in private hospitals. According to the 2007 SA Health Review, 73% of general practitioners and 75% of specialists work in the private sector where they – and 40% of nurses – cater for only 15% of the population.

Extortion or self-defence? - tempers rise in claims row

Are embattled medical aids indulging in bully-boy ‘extortion’ tactics or merely recouping losses from suspect health care practitioners whom the industry claims cost it R7 - R10 billion (10% of payouts) in fraud, abuse or over-servicing every year? The issue of suspect health care practitioners being pressured to sign once-off ‘acknowledgement of debt’ notes to avoid potentially ruinous criminal and business censure was brought centre-stage by the Health Professions Council of South Africa (HPCSA) last month. Without naming anyone, it publicly slammed ‘a large number of leading medical aids’ for what it termed ‘criminal extortion’ or ‘acting as debt collection agencies’ whenever health care practitioners were suspected of over-servicing or fraud. HPCSA spokesperson Bertha Peters-Scheepers said that over the ‘last couple of months’ the Council had received a surge of “at least 20” complaints from aggrieved doctors. The South African Medical Association (SAMA) backed the HPCSA, saying that while it did not condone fraudulent activities, it had ‘always been concerned’ by the investigation ethics of schemes that so often soured doctor-patient relationships.

The Training Institutions of Black African Clinical Psychologists Registered with the HPCSA in 2006

The investigation was undertaken to provide an indication of the number of black African clinical psychologists in the country and the institutions that have trained them. The register of Psychologists of the Health Professions Council of South Africa (HPCSA) was examined to analyse (1) the number of black Africans registered as clinical psychologists, and (2) the universities that trained them. Methodologically this was a challenging exercise, since black African clinical psychologists had to be identified by their names, with the result that a margin of error is expected, albeit rather small. A total of 325 black African clinical psychologists were identified in the HPCSA registers up to November 2006, reflecting 14.2% of all registered clinical psychologists in the country. Fifty-nine (18.2%) of the 325 were trained in the years up to 1994, while the rest (266 or 81.8%) were trained in the years following the official demise of apartheid. Almost one out of six was trained at the Medical University of Southern Africa (Medunsa), which together with the University of the Witwatersrand trained over one quarter of the black African clinical psychologists registered at the time. In total, the historically black universities trained 153 (47.1 %), but in the post- apartheid period from 1995 they trained the majority (136 or 51.1%). The results are discussed in terms of their implications for future training and the broader needs in South Africa.

Surgical Education in South Africa

Medical training has been well established in South Africa since the 1920s. This was initially undergraduate only, and specialist training required study overseas until the early 1960s. The first formal specialist training circuits were developed in conjunction with the formation of the Colleges of Medicine of South Africa (CMSA) in 1955, which was established largely as an examination body to oversee standards of training. Since then the member colleges of the CMSA regulate the standards of training and examinations of General Surgery, Orthopaedics, Urology, Cardiothoracic Surgery, Neurosurgery, Plastic and Reconstructive Surgery, Ear, Nose and Throat Surgery, Ophthalmology, and Obstetrics and Gynaecology, as well as the nonsurgical disciplines. A variety of bodies are responsible for the different stages of training. The universities train undergraduates and award the first degree (e.g., MB, BCh). This is followed by a two-year internship in all the major disciplines in a hospital accredited by the Health Professions Council of South Africa (HPCSA), and one year of community service (usually in relatively unsupervised rural hospitals), overseen by the state’s Department of Health. On completing these three years, the doctor is fully registered with the HPCSA as a medical practitioner. The Colleges are primarily a professional examining body and oversee subsequent postgraduate training which must be accredited by the HPCSA. Training in general surgery is delegated by the College to the academic surgical departments of the eight medical schools of South Africa [Witwatersrand, Cape Town, Stellenbosch, Nelson Mandela (Durban), Medunsa/Limpopo (Garankua), Walter Sisulu (Mthatha), Pretoria and Bloemfontein], where it occurs in the teaching hospitals of each university. There are differences in the training depending on the school, but each candidate must be a registrar (resident) for not less than four years (most require six years), must pass the College examinations [the Fellowship of the College of Surgeons of South Africa, or FCS(SA)], or, alternatively, an internal, university-specific MMed examination [similar to the FCS(SA)], and demonstrate (through a logbook and a report from their department head) sufficient practical experience to be registered as a specialist surgeon by the HPCSA. The examination for the Fellowship in General Surgery comprises three parts: Primary, Intermediate, and Final.

Changing gender profile of medical schools in South Africa.

Since 1994, higher education policy has been committed to equity of access for all, irrespective of race and gender. We investigated progress towards these goals in the education of medical doctors, with an emphasis on gender. Databases from the Department of Education (DoE), Health Professions Council of South Africa (HPCSA) and University of Cape Town (UCT) Faculty of Health Sciences were used to explore undergraduate (MB ChB) trends at all eight medical schools and postgraduate (MMed) trends at UTC. Nationally women have outnumbered men in MBChB enrollments since 2000, figures ranging between 52% and 63% at seven of the eight medical schools in 2005. However, the rate of change in the medical profession lags behind and it will take more than two decades for female doctors to outnumber male doctors. A study of UCT postgraduate enrollments shows that females had increased to 42% of MMed enrollments in 2005. However, female postgraduate students were concentrated in disciplines such as paediatrics and psychiatry and comprised no more than 11% of enrollments in the surgical disciplines between 1999 and 2005. The study provides a basic quantitative overview of the changing profile of medical enrollments and raises questions about the career choices of women after they graduate and the social factors influencing these choices.

Teaching medical ethics to undergraduate students in post-apartheid South Africa, 2003–2006

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during...

Disclosing the HIV status of deceased persons - ethical and legal implications.

The ethical rules of the Health Professions Council of South Africa (HPCSA) provide that confidential information about a deceased patient should only be divulged 'with the written consent of his or her next-of-kin or the executor of his or her estate' - except where such information ought to be disclosed in terms of a statute or court order, or the disclosure is justified in the public interest.

Guidelines prescribed by general practitioners to patients with acute low back pain regarding ‘return to work’

AbstractBackgroundThe traditional treatment protocol for acute low back pain (ALBP) primarily used by healthcare professionals has in the past decade been strict bed rest, corsets, traction and ‘back schools’. However, current research has led to dramatic changes in the traditional treatment protocol. The literature suggests that the protocol should be replaced by parsimonious imaging, early return to normal activities and greater emphasis on exercise to prevent recurrences of ALBP and to treat chronic pain. The aim of this study was to investigate the guidelines prescribed by general practitioners (GPs) to patients with acute low back pain (ALBP) regarding ‘return to work’.MethodsA systematic sample of 212 GPs, selected from a list supplied by the Health Professions Council of South Africa (HPCSA), was selected to complete questionnaires. The highest qualifications of the GPs were MBChB or MFamMed, and all of them practise in the Bloemfontein area.ResultsSixty-three respondents stated that 40% of ALBP pa...

HIV-positive status among surgeons - an ethical dilemma.

HIV/AIDS is a manageable disease with a reasonable expectation that affected individuals might be able to experience both reduced mortality and morbidity. Within the socio-political context of the illness there has been a very strong emphasis on human rights issues, especially in relation to discrimination, which has seemingly been influenced more by emotion than science. This article explores and addresses the potential risk of an HIV-positive surgeon transmitting the virus to a patient. We argue that the Centers for Disease Control (CDC) and Health Professions Council of South Africa (HPCSA) guidelines are too restrictive, especially against a background of limited transmission risk, and hence that these guidelines could be more harmful than beneficial to our health systems.

General surgery in crisis--the critical shortage.

General surgery is facing a serious crisis. There has been a significant decline in the number of applicants for registrar posts and an inability to attract and retain general surgical specialists in the state sector. The Association of Surgeons of South Africa (ASSA) undertook this study to determine the extent and cause of the problem. The study involved a combination of desk research and structured interviews. In addition, the Health Professions Council of South Africa (HPCSA) database was reviewed and compared with the South African Medical Association (SAMA) and ASSA databases. The medical schools provided information about student numbers and demographics, and the National Department of Health pro vided information about the status of medical practitioner and specialist posts in the state sector. Overall, 26.1% of the specialist posts were vacant. The situation was particularly critical in Mpumalanga and the Eastern Cape, where 84% and 58% of the specialist posts were vacant. Using a predictive model, a conservative estimate of the need for general surgeons was found to be at least 50 per year. Currently the eight medical schools graduate about 25 general surgeons per year. The changing demographics of medical students may be partly responsible for the decline in registrar applicants. The findings from this study have revealed that the shortage of general surgeons in the state sector has reached critical levels.

Advocating programme evaluation in new problem-based learning schools

Context and setting A new system to monitor, evaluate and report on areas affecting the teaching and learning processes that accompanied curriculum change was developed through establishing an evaluations office at the Nelson R. Mandela School of Medicine (NRMSM). Why the idea was necessary The functioning of the new evaluations office was constraint by combining evaluations and implementation functions because of severe staff shortages during the implementation phase of problem-based learning (PBL). The purpose of this study was to investigate the efficacy of continuing a separate student feedback system through an evaluations office, as a means of providing direction for curriculum review as well as support for student learning and staff development activities at NRMSM. What was done To determine the usefulness of student feedback data, we conducted qualitative analysis of the feedback on 5 curriculum units in Year 2 (during 2004) and compared it with similar Year 2 student feedback (during 2005). The results were provided to student representatives, PBL facilitators and faculty members to determine the value of this evaluation system. The data were also made available to a panel of the Health Professions Council of South Africa (HPCSA) during an accreditation visit in 2005. Evaluation of results and impact After learning that student feedback had effected substantial changes in the Year 2 curriculum, students had an increased sense of their empowerment to partake in and influence curriculum decisions. They were grateful for the changes made that resulted in an improved teaching and learning climate. These included: a formally structured dissection programme; improved sequence of curricular learning units to avoid competition for textbooks; more structured feedback sessions after assessments; the inclusion of question and answer sessions at regular intervals to address issues before the conclusion of units; a noticeable increase in structured interactive large-group resource sessions; the availability of lecturers’ notes ⁄presentations, and the inclusion of subject study guides. Students were also appreciative of individual feedback they received based on facilitator reports, as were facilitators of their feedback from students. The 2005 student feedback revealed some remaining concerns focusing on the negative attitudes of some faculty members who did not allow discussion during lectures, did not make notes available, were not always audible to the class, or who cancelled classes without prior notification. Students provided suggestions to improve learning, including: more health care contacts and hospital visits during learning units; more specific objectives in PBL cases, and improved study guides in all curriculum units. The importance of the above data and the evaluations system was confirmed by the HPCSA’s recommendations. These included the separation of staff development and curriculum evaluation functions from that of curriculum implementation because of potential conflicts of interest. It is important that curriculum evaluation units demonstrate efficacy of their functions to all stakeholders, including students, faculty and administrators. The present study documented the utility of student feedback in improving the teaching and learning climate during the implementation of a new curriculum in a resource-constrained setting. Moreover, the importance of separating curriculum implementation from evaluation and staff development functions was confirmed.

Implementing infant hearing screening at maternal and child health clinics: context and interactional processes

Infant hearing screening has become increasingly widespread as research evidence a dramatic benefit when early identification of hearing loss occurs before six-months of age.
 
 Opsomming
 Tans word gehoorsifting van babas toenemend uitgevoer as gevolg van navorsingsbewyse wat die dramatiese voordele van vroeë identifikasie van gehoorverlies (voor die ouderdom van ses-maande) aantoon.
 
 *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Medico-legal aspects of pathology--current dilemmas regarding confidentiality and disclosure.

This article deals with confidentiality and disclosure in the practice of pathology in South Africa. The recent bringing into force of the National Health Act 1 and the proposed implementation of the International Classification of Diseases (ICD-10) codes 2,3 as well as the furore regarding the accuracy of HIV-related mortality statistics emanating from death certificates has focused the spotlight on ethical and legal problems with regard to confidentiality. Medical confidentiality is a duty cast upon a medical practitioner/health care provider (HCP) to keep secret any information, whether relating to a patient’s ailment or otherwise, obtained directly or indirectly by the practitioner as a result of the doctor-patient relationship. Confidentiality is governed by the ethical rules of the profession and the law. The ethical rules are based on the principles of autonomy and the duty not to harm patients. Rule 20 of the Health Professions Council of South Africa (HPCSA) Ethical Code 4 makes it ethical misconduct to breach confidentiality ‘…except with the express consent of the patient or, in the case of a minor under the age of 14 years, with the written consent of his or her parent or guardian, or in the case of a deceased patient, with the written consent of his or her next-of-kin or the executor of his or her estate.’ The rule has recently been amplified by Ethical Rules 24 - 26 of the HPCSA. 5

Ethical Complaints and Disciplinary Action against South African Psychologists

This study investigated the scope and nature of complaints, related to unethical behaviour, that have been lodged against South African psychologists with the Health Professions Council of South Africa (HPCSA) between 1990 and 1999. Certain biographical characteristics of the complainants and their accused also received attention. During this period, complaints were lodged annually against approximately 1% of South African psychologists, of which approximately 15% resulted indisciplinary inquiries. Only 5% of the total number of complaints and 34% of the disciplinary inquiries led to convictions. However, almost 50% of the disciplinary inquiries had not yet been concluded at the time of this investigation. Most complaints (21.3%) involved neglect to renew annual registration. As far as the rendering of services to the public is concerned, most complaints were related to accounts (16%). Other complaints included, among others, problems with psychologists' reports (13.1%), incompetence (12.9%) and improper behaviour (11.5%). It appears that complainants were family members (34%) rather than the clients/patients themselves (26%). The two penalties imposed most often were either a warning or a suspension in the form of a suspended sentence. Recommendations for reducing complaints of unethical behaviour are made.

Some Responsibilities of the Family Dentist and the Dental Specialist

Introduction: It is essential to have regular audits of the number of oral health personnel so that planning, delivery of services and training can be addressed. There has not been such an audit in South Africa (SA) for more than 10 years. Aim: To determine the demographic profile of dentists and dental specialists (DS) between 2002 and 2015. Methods: A retrospective record-based study was used and all dentists and DS registered with the Health Professions Council of South Africa (HPCSA) from 2002 till 2015 were included. Demographic data, including gender, age, race, type of practice and geographical residence were recorded. Results: There were 6,125 dentists and 481 DS registered with the HPCSA in 2015. The younger dentists tended to be Black and Asian women while older dentists were mostly White males. The majority of DS with maxillo-facial surgeons (30%), orthodontists (30%) and prosthodontists (17%). The number of dentists increased at around 2% per annum and the majority of the dentists and DS resided in the most metropolitan provinces of SA. Over the 13-year period, the number of female dentists almost doubled and the number of Coloured, Black and Asian/Indian dentists and DS increased sharply. Conclusion: The population to dentist ratio was fairly low, with the majority of dentists and DS residing in the three metropolitan provinces of SA. There has been a relatively sharp increase in the number of Coloured, Black and female dentists, which could be a result of increased admission of previously disadvantaged students to dental schools.