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In accordance with subregulation 67.060(1)(b) of the CASR, a DAME must observe the Code of Ethics of the Australian Medical Association, as that Code is in effect from time to time.
The AMA Code of Ethics is designed to guide the conduct of medical practitioners in a general context and does not relate specifically to the statutory function assigned to DAMEs, DAOs and COs under the CASR.
This code of conduct supplements the requirements of the AMA Code of Ethics in order to address the particular role that DAMEs, DAOs and COs play in the process of medical certification under Part 67 of the CASR.
For the purposes of subregulation 67.060(1)(a) of the CASR, it is a requirement that each DAME, and DAO must comply with this code of conduct in the performance of his or her duties and functions as a DAME, or DAO. This code of conduct serves as a best practice guide for COs (as they are not currently covered by Part 67).
For ease of reference, the use of the term DAME in this document should be taken to mean DAMEs, DAOs, and (where applicable) COs. The term doctor should be read to mean “doctors or optometrists where applicable”.
The purpose of a medical examination performed by a DAME is to assist CASA in determining the suitability for medical certification of medical certificate applicants. The DAME may perform these medical examinations as the applicant's own doctor (also referred to as the treating doctor) or purely in the capacity as a DAME (non-treating doctor).
As a DAME, the examination will include a consultation with the applicant, a physical examination and where necessary a file review of the applicant's medical history.
As a DAME performs a medical examination and provides an impartial medical opinion to CASA. The DAME's role does not include providing any form of treatment to the applicant.
Decisions made by CASA will be influenced by the DAME opinion and the outcomes of the medical assessment and this may affect the certification outcome for the applicant. Therefore in making a recommendation, the DAME has a responsibility to ensure that professional opinions and recommendations are accurate, objective and based on all the available evidence.
If the DAMEs do not consider themselves suitably qualified to conduct an examination, or identifies a conflict of interest in relation to the examinee, the DAME must decline to examine the applicant. The DAME does not have to provide CASA with an explanation for doing so.
The basis of the relationship between the applicant and the DAME is not the same as that within an established doctor-patient relationship (even when the DAME is also the applicant's usual doctor). However applicants being assessed are often vulnerable and DAMEs are still required to maintain a professional standard of care. In this regard, the DAME must adhere to the principles in the Code of Health and Disability Services Consumers' Rights.
As such, the DAME should treat the applicant with respect, and ensure that they are not coerced, discriminated against, harassed or exploited. During any consultation with the applicant, the DAME is required to respect the applicant's dignity and communicate with the applicant in an appropriate professional manner that enables him or her to understand the information provided, and the role of the DAME.
Some recurring problems in medical examinations performed by non-treating doctors are those related to poor communication with the applicant. This can lead to unmet expectations, misunderstandings and confusion about the DAME's responsibility to the applicant. Therefore:
An applicant may want to record the consultation by video or audio tape. The DAME should consider such a request carefully and, if the DAME does not consent, ask the applicant to arrange for another DAME to conduct the examination.
Once the medical examination has been completed, the DAME who performed the examination must provide the medical examination form (and where necessary, a written report) to CASA with his or her medical findings and/or opinion . The report must be accurate and objective. In doing so:
In some circumstances the DAME may be the applicant's treating doctor as well as the DAME. This may be because the applicant lives in an isolated area where another DAME is unavailable. In this situation the DAME should clearly explain the difference in their role, so that the applicant understands that the usual dynamics of the doctor-patient relationship are different.
The DAME must ensure that any medical examination of a applicant for the purposes of medical certification under Part 67 of the CASR is accurate, objective and based on all the available evidence.
The DAME must not allow for their interests or the applicant's interests to influence their examination, opinion or recommendations.
DAMEs must ensure that any reports that they provide to CASA for medical certification purposes under Part 67 of the CASR are objective and expressed in professional terms.
Conflicts of interests should be actively managed. DAMEs must not carry out medical examinations for members of their family, and should avoid doing so with persons with whom they have a commercial or other relationship .
Due to the paucity of aviation medicine specialists in Australia, DAMEs may occasionally find that they are requested by applicants or holders to provide evidence in support of reviews or appeals in tribunals or courts.
In doing so, DAMEs must use their best endeavours to identify and disclose actual and potential conflicts of interest and manage the conflict between their appointment as a DAME and that as an expert witness appropriately.
In the performance of any functions and duties, or the undertaking of any activities related to medical certification under Part 67 of the CASR, DAMEs must ensure that they remain objective and independent at all times and do not act as partisan advocates for the interests of medical certificate applicants or holders.
More information about Conflicts of interest is available in “Good medical practice” available from the Medical Board of Australia website: http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx
DAMEs must ensure that they maintain an appropriate professional relationship with CASA and that they do not engage in conduct which might bring CASA or any of its staff into disrepute.
This includes by:
There will be occasions where applicants or DAMEs may be dissatisfied with the way CASA has processed a medical application or about the decision that has been made.
Applicants should be provided the details of the website to enable making such complaints.
Where the DAME has a complaint, the first point of contact should be the Clinical Governance Co-ordinator (CGC), with escalation to the Principal Medical Officer (PMO), the Industry Complaints Commissioner, and the Director of Aviation Safety.