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being a doctor is a job. doctor’s should be expected to behave professionally in their work environment and treat patients and co-workers with respect. outside of the work environment a doctor is just like anybody else. i don’t think what a doctor says or does outside of his/her work environment should be the focus of the college unless it clearly impacts on patient care. if the college investigates every single allegation against one of its member , it creates undue stress for the doctor which can impact on patient care causing more harm than good to the public. doctors are humans and make mistakes. only the most serious offences with a clear and direct impact on patient care should be the business of the college. otherwise the college risks demoralizing its members, creating more stress for doctors and ultimately compromising patient care and public safety.
I think the CPSO opening statement in the Background says it all ….”physicians are expected to act in a courteous, dignified and civil manner”. I’m not sure what more there is to gain from providing more verbiage around the topic. I think that is a basic tenet of professional practice and doesnt need elaboration. In the end those that want to manipulate the policy or professional behavior will find a way to do it. Ultimately leaving it general allows for action against those that abuse it on a case-by-case basis. Adding more layers only serves to alienate physicians and does not allow for frank discussion with some patients. Just as not all doctors being the same, patients, and how one responds ie. firmness with which something is expressed, is also variable. As far as behavior outside of the work environment, that is the choice of the individual as long as it doesnt impact on patient care, or break any laws. The CPSO needs to stay out of the arena of how physicians behave in their own time. We dont need parenting, I think we are quite mature enough to handle our own lives.
I heartily agree with all of these comments. “Simplicity is the ultimate sophistication”.
I often think there should be a college of patients, where we could report breeches of their non-compliance or self-harming behaviour, or more significantly the frequent verbal abuse, discourteous and undignified behaviour towards nurses and physicians. Perhaps the health card could be suspended for 3-6 months or revoked in more egregious circumstances!!
You should hang your head in shame! Your comment certainly depicts an arrogant attitude, a lack of compassion and clearly indicates that you have deficiencies especially in regards to morals and ethics. Courtesy, respect and dignity works both ways. May I suggest that you contact the college for some assistance so that your deficiencies can be appropriately addressed or alternatively hang up your stethescope.
respect and dignity works both ways…exactly.
I agree with the above statements. Physicians are subjected with enormous amounts of stress including that engendered by our own CPSO. Rude behaviour on the part of patients needs to be considered and reported and as for our lives outside of the practice, that is absolutely no business of the College.
The enforcing the logic of the health care system is not in question. The higher orders of the intellectual conscientiousness are at stake, and that is to promote life not advance medicine and dare I say it, the companies that profit. People have to remember we have a capitalist system that is motivated by profits. So the real question is, “Who’s promoting this and what are there motives for forcing doctors to comply?”
The issue of physician behaviour outside of the workplace is a complicated one. I see the side of the argument that outside of work we are private citizens and should not be scrutinized any more than the next person. However, we have ourselves to blame as well as the media. How may of us act as “privileged” people outside of the workplace, booking restaurant reservations as Dr … If we want to be treated like everyone else (outside the workplace), then we should always behave as one. As for the media, they love to label us as physicians, even when it has nothing to do with our professional practice. That, too, impacts how we represent the profession on our own time, like it or not.
After 31 years in this profession, that has tried in its changes through time, to dehumanize me, I sincerely recommend that we sit down for 10′ and by looking at each one of us, see the real women and men in all of us. Not just only the M.D. within us. We are also human beings that so happened to study for a profession with some rewards and little comprehension. We are parents, we have families, we buy the same groceries and the same gasoline that every body buys. There are times that society expects too much for so little in return. While there should be some guidelines, I would not favor any more restrictions to practice medicine, for if we do we continue the path of dehumanization.
Perhaps we are entering more and more in the robotic era.
I agree. There is no profession dehumanised by regulation as much as we are. Outside of patient care, I do not think the College should have any jurisdiction over the private lives of physicians unless patient care is directly impacted.I would go as far as thinking this would be a violation of one’s Constitutional freedoms begging to be challenged.
Teachers are held to this standard
no teachers are not- that’s another discussion
1.Conscious awareness of boundaries with patients, colleagues and co-workers.
2.Anger and stress management course for physicians with repetitive , disruptive behaviour determined by department head, nurse manager and/ or as reported by members of the public.
3.Fundamental elements of civility and compassion,taught in
medical school , should be compulsory.
4.Annual” C.C” Award.(civility and compassion)…to a hospital staff physician.
The commentary by a Member of the Public, ,June 5 , 2014, at 9:45pm. is a refreshing perspective.
I could not agree more with all that you say. I am a patient and wish to be treated with civility and respect from all physicians.
I’m also pleased to read the member’s of the public take on the issue, however my perspective is that if we are recognized as physicians — or are involved in a situation where we will become recognized as physicians — then our behaviour should be civil, polite, and thoughtful.
Can a physician be a healer and smoke? How about drink – in moderation – or is that an opinion open to interpretation. What if the physician is cheating on their spouse – but honest to their patients. Where exactly is the line between personal and professional life? It may not exist. . . .
Can a physician be obese and advise their patient on lifestyle? Where does it end? Or must a physician be a sinless saint with a perfect record of behaviour to heal others? I don’t know but daresay the public does not expect such nor do they all accord doctors the level of respect this would entail.
By their very nature, humans sin and are less than perfect and doctors are human. Whilst an excellent moral and behavioural standard is ideal, it is not practical. If you remove every physician from practice in Ontario with a personal flaw or who make mistakes, you’d be left with nothing but angles to take care of the population and I have not seen any angels lately. Similarly if you reprimand a doctor everytime they make a mistake you are denying their right to be human and creating unnecessary stress. I advocate for humanity and compassion rather than punishment and fear.
Just a new mechanism to police physicians. My free time is my free time and there is no business for the CPSO to put their nose in my personals affairs.
My only comment is that the college should not apply this policy when a physician is not at their workplace or involved in patient care. The laws that apply to everyone else should be relied on in those circumstances when a physician is in the role of a private citizen.
The College should have no jurisdiction over a physician outside of medical practice/ patient care unless patient care is directly impacted. Physicians live their lives as any other member of the public and should not be regulated even in their private lives. I would think that this might be a violation of ones Constitutional freedoms and could be challenged as such. There is no other profession dehumanised by regulation as physicians.
physicians are human too, and sometimes humans can have a bad day. Yes a physician should act professional but that is not the issue. The issue is the process by which College handles complaints. People would abuse such a policy and increase number of frivolous complaints against physicians. The College pretty much fully investigates every complaint, which is kind of like if the police arrested someone every time there is a complaint. The fact is most complaints to the police do not end up in an arrest and somehow the officers resolve the matter by simple counseling measures.
There must be a more expeditious and less painful process of dealing with complaints.
I would advocate for requiring a fee for anyone to register a complaint, this may deter frivolous complaints with questionable motives.
The current system requires investigation of even some the most ill-intentioned complaints from some of the most pathological of personality disorders costing the doctor months of stress not to mention wasted time.
It seems the college rules by inducing fear of the unknown in its members. Instead I think it should have in mind the best interest of its members and deal with matters in a much less cumbersome and anxiety provoking manner.
If you want to see what is appropriate (or not) behaviour then put a video camera in the room and tape the doctor patient inter-action. Other than the rare mentally ill/predator MD, I suspect most physicians are now standing up to the verbally abusive and lazy patients that blame their obesity/cad/diabetes,etc on their doctors care(while the patient hasn’t lost an ounce of weight in the past 10 years, still eats Mc Donalds regularly and doesn’t make any attempt to know why he takes each of his meds).
We doctors watched as the CPSO threw doctor __ (and others) under the bus with the help of the Ont. Conservative gov’t ,claiming the doctors over-billed without any type of judicial review. The negative attitude from the Ont gov’t, CPSO and patients is 2/3 of the “doctor behaviour problem.” A lot of doctors are simply ready to leave Ontario given the general disrespectful attitude displayed toward them (eg. doctors are over-payed when we get 33.75$ for a consult, not to mention seeing doctor __’s dead body dragged out of lake Ontario). No other group in Ontario has been treated with the same degree of disrespect as Ontario doctors – this is the result of a socialist system taking away our ability to strike (not to mention the CPSO is NOT politically neutral, and the OMA is also in bed with the gov’t). When you watch a family lose their father/husband and a community lose their doctor because the Gov’t is trying to save 80 000$ , then you have a system that has zero respect for the difficult job we physicians do , and zero respect for our lives, our families and our ability to retire comfortably with a pension package like the ones given to police, firemen, teachers,etc. If push comes to shove, and the narcissits at the CPSO continue to believe the behaviour problems are 100% the doctors fault, then we will simply leave Ontario. The doctors I have spoken to have little respect for the CPSO and Ontario conservatives since the death of doctor __. Dr __’s death was the ultimate example of how much respect the gov’t, OMA , and CPSO have for the difficult/stressful job we do.
I myself often deal with personality disorders and sociopaths who ,when confronted with their disrespectful behaviour, will attack the doctor verbally or physically and then write a letter to the CPSO saying the “doctor is the problem”. When a police officer or judge confronts sociopaths, the cop or judge doesn’t tolerate verbal or physical abuse , not to mention a letter of complaint written by someone in prison to retaliate (try to make the cop or judges life unpleasant) against someone who is doing his job as expected by society under those circumstances. The non-MD’s (and non-psychologists) at the CPSO haven’t a clue of the stress levels of a doctor today in socialist Ontario where patient’s expect everything free and can behave any way they want because the CPSO will back their fight against those “mean, selfish, over-payed doctors”. The disrespect towards doctors (Dr __), and narcissistic behaviour of the CPSO, is just as much the problem as any rude or unprofessional behaviour from doctors. Unfortunately , for the past 30 years, problems in the socialist system have been laid at the feet of the doctors. If this doesn’t change, I suspect we will see serious court battles between the MD’s and anti-doctor types at the CPSO who couldn’t give a hoot that a community lost their pediatrician (not to mention a child losing his father) over some Ontario pocket change. Dr __ taught us a lot about the CPSO and Ontario gov’t attitude / level of respect for the work/care we doctors provide without any paid sick days,vacation or pension package. The lack of kindness and disrespectful behaviour is as much a problem of the CPSO, gov’t and OMA , as it is of the doctors.
you said it right!
Can a defendant file a “disruptive in the workplace” complaint against a judge?
Many judges say things they way they are. They can be blunt and brash. In many ways, a physician acts like a judge. physicians are given information and expected to make a decision, esp in mental health, addiction, pain, adolescent, and even family medicine. In this day and age of “patient-centered care”, those patients that don’t get what they want are left upset, and if there is or isn’t a heated conversation, then the easiest thing the patient can complain about is “disruptive physician behavior” like “awwwh, the doctor yelled at me, was mean to me, etc. etc”. The smart ones will not complain with the facts of the case, but will seek revenge by saying the doctor was rude, not listening, bullying etc.
This is why this policy in its present form is not objective and thus flawed.
The behaviour of the public has changed a great deal in the past fifty or so years. In this period doctors’ behaviour had changed mostly in a passive way; reactive to what the public or the regulatory body demanded.
There are doctors not living up to the expectation of the profession, but they are very small in number. Very often it is the public that started an event that cascaded to become an unhappy encounter. Don’t forget a doctor sees many patients in a day, how can a doctor remain effective and be an instigator at the same time.
The triggering event can be an unreasonable demand or expectation from patient or poor manner of patient.
I think regulatory body has a duty to advise doctor how to stand down from a tense situation; such as an advice to walk out of to walk out of the room as a last resort; rather than to act professionally to explain or defuse an hopelessly tense moment.
To advise doctors to act professionally just not going to help doctor when patient is acting irrational or confrontational.
“inappropriate words, actions or inactions by a physician interferes with his or her ability to function well with others”
The imprecise mildness of this wording opens us up to abuse-by-complaint, particularly in the current anti-doctor climate increasingly dominated by other health care providers. Objecting to the “Team” decisions, which in our nursing-dominated administration here proceed without doctor imput regularly, is viewed as disruptive.
A geriatric case of metabolic encephalopathy was refused admission to geriatric rehabilitation because her current functioning was too low. The team did not understand the difference between status and prognosis. My repeated “stubborn” refusal to accept this team decision was objected to with copious disrespect until they were “astounded” by her (predicted and expected by me) improvement.
I had a written complaint brought to me by Chief of Staff because, after being backed into a corner of the nurses station by a Homecare/Discharge planner I reinterated my earlier complaint that doctors are repeatedly being left out of the team: “Do not make discharge arrangements with my patient without first advising the charge nurse and thereby myself. That is an order. Is that clear?”
- The complaint went all the way to the top without my knowledge, without any stepwise attempt to address it with myself at earlier levels.
- The patient care issue involved was never addressed and persists still.
- A recent similar case involving Homecare changing my discharge plans resulted in a dangerous situation causing harm to the patient.
- I quit. My rural practice closes 30/6/14 and I am moving back to the city.
Does CPSO have any mandate to oversee inappropriate leadership behaviors in health care and its implications.
Bullying, intimidating, coercing, playing favors, cheating, lying, not taking responsibility for their action, promoting self serving agendas, financial conflict of interest due to private affiliations.
And hospitals poorly supporting clinical activates…
Where does accountability ends and where does it begins…this is not on shoulder of physicians only…
I am a newly graduated resident starting PGY-1 in a month. What I would like to see most in the standards for physician behaviour is explicit and unequivocal mention of learners as entitled to courteous and respectful interactions with superiors.
Specifically, learners should be protected under the code from intimidation, harassment and bullying, including malicious forms of public embarrassment and malicious “pimping” in keeping with new standards increasingly being developed by experts and their growing awareness of this problem. Seminars on learner bullying are now being held at AFMC schools, such as Dalhousie this past year.
Yes, absolutely. I have witnessed unprofessional behaviour towards learners and between learners both as a patient and as a non-physician educator.
Professional, courteous, and patient behaviour towards learners is of the utmost importance because it shapes the learning environment and provides an example to learners of how they should act as physicians. Negative, bullying, “pimping” styles of teaching will only continue to perpetuate this way.
The Physician Behavior in the Professional Environment Policy is appropriate. The implementation requires some work
1. EDUCATION- Professional Behavior in all years of Undergraduate Medicine
2. EDUCATION- Same throughout ALL years of Resident Training- all specialty!
Behavioral Education is essential in all years of training.
Increasing use of drugs and alcohol needs attention asap
How can we affect the behavior of our colleagues in practice. ( NO ALCOHOL SERVED AT THE NEXT MEETING, BETTER STILL-ALL MEEINGS)
As an academic teacher for 30yrs, I have noted a progressive increase in lack of respect for each other students, residents, Nursing, other hospital staff. Behavior at dinners or other events is overwhelmed with alcohol. Poor behavior is being reported in complaints.
We need to deal with this increasing CRISIS -NOW! We need to act TODAY!
I think professional behaviour is common sense and does not have to be taught.
I think it’s entitlement to a parenting attitude and the perceived need to control our colleagues behaviour that is part of the issue with the College and why so many have expressed concern over the College’s ‘over-doing’ of things.
I think it’s safe to say that as doctors we are by far and large responsible law-abiding citizens. Having a beer or a glass of wine at a party does not mean we are a bunch of disrespectful drunkards in crisis. Maybe if the College learned to deal with our mistakes in a less punishing manner, perhaps with more humanity and forgiveness, we would all relax our guard and move on with our lives instead of turning everything into a big deal.
I would like to comment on the matter of “disruptive behavior” as it related to words spoken –speech – that is deemed “disruptive”. No one would ever deem speech that curses patients or suggests that they should question the legitimacy of their birth or the fact that they might have a canine relative or should indulge in intercourse with themselves or the devil as appropriate in the setting of a doctor’s office. Similarly no one would one ever accept referring to a patient as a body part – whether an excretory or reproductive organ as acceptable speech. These instances are fully consistent with the idea of disruptive behavior and are disgraceful to the profession. These sorts of terms clearly are beyond the pale of acceptability. On the other hand language evolves constantly as do social mores and our concepts of decent as opposed to indecent language must evolve with the changing times. In the 1930s in the film “Gone With the Wind” Rhett Butler (Clark Gable) says to Scarlett O’Hara, (Vivien Leigh) “Frankly my dear, I don’t give a damn,” the world was shocked and controversy ensued. From our perspective this was a quaint and a silly tempest in a very small teapot. The evolution of speech has continued and is reflected in public media: cable TV stations, popular magazines and the like. I often begin my encounters with patients with the question, “How do you feel?” and the most common answer I get is ,”S%*&@#”. This might pertain to the fact that I am a gastroenterologist and fecal material is always on the minds of my clientele but I daresay other specialists, far removed from the digestive system are treated to the same response. I surely have no expectation that my patients will say that they feel like fecal material or excrement, scat or poo. No, the appropriate adjective in this case is s%*[email protected]# and we accept that in even the most polite societies. Further, in common speech on television and in the movies and in print in books and in most but not all publications often uses the f word as an adjective to describe or to emphasize a point. Trudeau said it and Vice-President Biden said it and in context the word suitably emphasizes a point that might otherwise be taken as unimportant. I stress that the use of the adjectival form of the word is emphatic. The verb is still considered vulgar and should be avoided unless absolutely necessary. I believe the CPSO should take these ideas into consideration.
There are some parts of the Current policy that are are too broad, non-specific, and too subjective to serve as a basis for disciplining physicians.
The word “disruptive’ itself is too broad and subjective. While most of the examples are pretty specific and objective (e.g. throwing objects, or using racist language or profanities), some of them within the 2 categories of words and actions, are too broad and undefinable.
Instance of these are:
“Inappropriate rudeness”. Well, when is rudeness appropriate? And how does the College define rudeness? When in disagreement, or when they cannot get a certain favor from doctors, some patients will interpret disagreement as rudeness, and often even make it up when complaining about the physician. Often times voices may be raised when there is a disagreement. Is that really “rudeness” and grounds for a physician’s disciplining? Also a physician may be really tired and not appear very friendly. Again is that rudeness and disruptive behaviour? Some doctors have good bedside manner and some don’t. So are all physicians now without good bedside manner, “rude” and hence guilty of disruptive behaviour or even professional misconduct?
“Outbursts of anger”. This is again very subjective like “rudeness above”.
“Shaming others for negative outcomes”. This is too broad and open-ended. Doctors hire staff in their offices to do their jobs. How does the College define “shaming”? When a staff member makes repeated mistakes and the doctor criticizes that staff in private and/or fires him/her, is that “shaming”? Disgruntled and fired employees use this clause and mount frivolous complaints about physician employers. Instead of using the Ministry of Labour mechanisms for labour disputes, some disgruntled employees use this avenue for exacting revenge after being fired.
“Does not work collaboratively or cooperatively with others”. This is again a very broad area that can be very subjectively interpreted. What is the degree of cooperation that a community physician is expected to show toward another community physician?
If the College would like to protect the public against physicians whose behaviours prevent providing quality care, it is hoped that the College define very specifically what such “disruptive behavour” means. Otherwise too many frivolous complaints keep pouring in from patients and non-patients alike. Many physicians already feel alienated from the College due to such often vengeful complaints. So a very clear and well-defined policy would help not just physicians but the College’s investigators in sifting through all the many complaints.
this policy is already madness. now the College wants to make it tougher. Most other jurisdictions in North America don’t even have such a policy. California Medical Board says if your doctor is rude, get another one !!
I am retiring early from this literally sad profession. No wonder it has the highest suicide rate !!!
Having a broad and overreaching definition for “disruptive” behaviour does not help healthcare. It has the opposite effect.
Having lost family and friends to addiction and overddose, I have seen any physicians scared of complaints. They try to avoid any situations where they may be accused of being rude or similar interpreted as “disruptive”. Such fears contribute for the over-prescription of narcotics, when physicians are scared to say no.
The current policy is too broad, fear-mongering, does NOT help good healthcare and needs to be made more specific.
The guideline is appropriate and deserves wide recognition among the profession and public.
These all appear quite sensible – I would note that correcting a mistake, especially when this mistake has an immediate effect on care, is not disruptive; it should be done respectfully, but telling someone they are doing something wrong when a patient will suffer is actually disrespectful to the patient
The policy, from my read, emphasizes repetition and interference with care. And, as such, is reasonable and appropriate. I don’t see this as punitive or ‘picking on physicians’. I also don’t read this as having any jurisdiction over behaviour outside of the professional setting.
As for interacting with challenging patients or families, we have colleagues in other professions such as social work who have lots to teach us about managing those situations effectively without resorting to the behaviours described. And, many hospitals already have policies in place to deal with abusive behaviour on the part of patients or families.
The piece of the policy about a lack of response to requests for information seems out of place. The College has had policies in place for that issue for a long time and I don’t think that needs to be repeated here.
I can categorically tell you that the College will and does investigate matters of ‘professional misconduct’ which occur out of the clinical practice setting and have absolutely ZERO impact on patient care.
This can include, for example, investigating something as ludicrous as a complaint arising from yelling at the referee at your child’s soccer game or getting into an argument with somebody over a parking spot at the mall.
The College will even go so far as to invoke an order to obtain your medical records without your consent if they believe on ‘reasonable and probable grounds’ that you have committed an act of ‘professional misconduct’ which is very loosely defined and at their whim to interpret.
Be warned! The College can and will violate your privacy at their tyrannical whim, doctor-patient confidentiality is an illusion, protect yourselves!
I believe that the current policy is quite comprehensive but like every policy a review is welcome. However , I have seen where good physicians go bad and bad ones get worse and I have consistently seen organizational incoherence and lack of consistrnt approach to concerns as stipulated in the policy whereby some physicians are over represented at the receiving end. I have also seen quite a lot of racial and cultural misunderstandings as reasons for which some physicians receive complaints but disguised as something else.
Hence, I feel that rather than just addressing concerns against the physician, the College should come up with a rigorous method by which organizations are assessed by the way the handle complaints thereby sending a message that discriminatory approach will not be tolerated. So that physicians can feel that as much they ought to behave professionally, they. An also feel protected against unjust treatment .
The edict must be simplistic and echo keeping up with times,we used to lose registration for doing abortions once!
Doctoring is a Profession not a life of penury ,compare us with the lawyers and teachers ,and The Politicians ,how many of the latter have had their position removed for mismanagements,so why victimize us? Yes we do make mistakes but the CPSO tends to make worst ones by using a heavy hand and victimizing their members on the finding of a Nurse employed who feels unearthing disagreements with the medical profession ,which today is rampant ,is the way to justice!.
WE need a more just approach of care for both the provider and the recepient..not the latter only!
I am currently practicing as a physician and have been doing so for the past twenty years in Ontario. My practice has been mostly centered around hospitals, and I have faced varying degrees of bullying and harassing conduct from the physicians throughout. Interestingly enough, I had to leave my current practice because of such behaviour and the fact that the environment had become unbearable for safe existence. I think it is important to have easy access to educational material and information for physicians to be aware of what supports are potentially available for dealing with such situations. Code of comradery, as perceived by most physicians, prevents the like of myself to pursue any high level legal action. However, there needs to be simple and quick processes that can be easily accessed by all physicians to address disruptive physician conduct, before it takes roots and becomes the culture of a physician group. Physicians also need to be educated about common disruptive practices and have some form of dialogue and network discussing their experiences. Current services available through the OMA are not sufficient and the CPSO regulatory strength needs to back up any true initiative.
I think the guidelines on professional behaviour are appropriate and I’ve downloaded them to my computer to have them at hand.
Two areas of commentary.
Two items in the area of “inappropriate words”
• 1. Boundary violations with patients, family members, staff or other care providers;7
Boundary violations can include inappropriate actions as well.
2. Behaviour that others would describe as bullying
The statement introduces a moral relativism. There should be tenets of a universal concept of bullying rather than an individual opinion. One example that would be personally relevant is the parent who claims a physician is “bullying” for disagreeing with a parent’s stance on non-vaccination. Disagreement should not constitute an act of bullying just because a patient or guardian holds a contrary view and resents someone questioning their rationale.
The College needs to be absolutely clear in stating that these guidelines apply to the “professional environment”, and not to our lives outside the office.
It’s reasonable enough to expect us to behave in an appropriate manner, as described fairly well in the guidelines.
However, there is a risk that these guidelines may be interpreted as being relevant to how we behave outside the practice, in our personal lives, based on “upholding the standards of the profession”.
So, does that mean that if I get into a fight with a neighbour over some disagreement, they can report me to the College for “unprofessional behaviour”? Or that if I get drunk in public, someone can report me for that? I don’t plan to do either of those things, but it would be absolutely Orwellian for the College to have the power to judge our daily lives outside of the office. It would be a gross violation of our human rights and freedoms.
Poking their nose into our private lives is a power that the CPSO does not need.
Anyone, absolutely anybody, can complain about you to the College for absolutely any vengeful reason and you can bet the College will dutifully investigate. It’s like there’s an unofficial spy-system with ‘moles’ in unpredictable places; these could be your patients, your ‘colleagues’, your ‘friends’, your neighbours and even your family members, ex-spouse and all. Each is equally capable of reporting you to the College ‘super-police’ absolutely free of charge and without risk of countersuit or harm to reputation.
If you can be identified by name as a doctor, you better think twice about how you behave in any setting…all it takes is one ‘mole’ (or rat) and you could be thrown deep into a College investigation for ‘professional misconduct’, a very dark place indeed.
Is this Orwellian? Of course it is!
Is this a gross violation of our rights and freedoms? Of course it is!
The question is are we, the doctors of Ontario, going sit down, paralyzed by fear and to do nothing about it? Or are we going to stand up for our rights, make our voices heard, and help put an end to this corruption?
“The policy also addresses unprofessional conduct, including disruptive behaviour. It states that disruptive behaviour occurs when the use of inappropriate words, actions or inactions by a physician interferes with his or her ability to function well with others to the extent that the behaviour interferes with, or is likely to interfere with, quality health care delivery.”
Two comments. We are all humans – and physiologic features must also be considered. There is plenty of evidence in the neurology field that stress hormones do affect cortical censorship function. In other words, high level stress does affect behavioural control mechanisms in the prefrontal brain area. We cannot tell a physician “don’t sweat when you are under stress”. In this regard unprofessional behaviour must be evaluated in terms of past history and the circumstances under which unprofessional behaviour may occur. Training can and will improve stress-induced prefrontal dysfunction but we cannot expect total control at all times, when physiologic data indicate otherwise. Many thanks for this consideration.
Angry outbursts, as human as they may be and regardless of the inciting factor, can and have historically landed doctors into trouble. At the very least, you can expect a lengthy College investigation with lawyer involvement in order to defend yourself against allegations of ‘professional misconduct’. The legislation in this regard (section 75) even permits the College to invade your practice and scan through your charts and shame you by asking questions to the people that you work with your regarding your character and conduct. They can even obtain your personal medical records as a patient if they think this is relevant. All they need is ‘reasonable and probable’ grounds and this could simply entail someone else’s word against yours.
Yes, the College can and will investigate virtually any complaint no matter how frivolous or unrelated to the practice of medicine it may seem. They have uninhibited power in this regard. I would go so far as to argue that they repeatedly violate our rights under the Canadian Charter of Rights and Freedoms, namely:
a) the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.
b)to be secure against unreasonable search or seizure
c) to be presumed innocent until proven guilty according to law in a fair and public hearing by an independent and impartial tribunal
d) the right not to be subjected to any cruel and unusual treatment or punishment.
Essentially our careers and livelihoods are in the hands of a regulatory body that can do what it pleases when it wants, to whom it wants, and for whatever reason it wants.
I would ask the College and my colleagues, how much does this contribute to physician stress and burnout? When will we stop the bullying and demoralization? When will we stand up for our rights?
Re: physicians act in a courteous, dignified and civil manner towards their patients, colleagues and others involved in the provision of care.
There is no debate over the preceding. It is obviously correct.
What has to be changed is the way physicians are manipulated/forced/threatened to be silent regarding hospital policies or treatment methods.
Get rid of the need to apply for privileges on a yearly basis. This is threatening.
Change the concept that physicians are not allowed to be critical of a hospitals’ policy.
The College of physicians is runaway wild wild west type of organization that does not answer to no one, when it comes to physicians’ professional rights.
All business and trades people are protected under regular law which is under the constitution and the charter of rights. But somehow professional rights are suspended when it comes to physicians’ livelihood. Sad thing there is even no insurance against that. I mean if the College deprives a physician of his reputation and livelihood, there is no insurance product out there that will cover him or her, unlike for lawsuits, or disability where one can get coverage.
When it comes to professional liability, I would much rather be sued than get a college complaint. There is a standard legal process, transparency, and cost to the complainant in the former, yet no legal process, no cost or liability to the complainant in the latter.
The worst is the College every year touts that “self-regulation” is so great and a privilege. I for one always seem to miss the reasons as there are none. It’s like an ugly person repeating to himself in the mirror that he is beautiful.
With self-regulation, the College tells the public that they are policing their own, though they are always under public pressure to show that they are doing a good job, and that they are not just an “old boys club”. Every now and then there has to be a sacrificial lamb, or an outrageous policy like this well publicized in the news to prove this to the public. Also every year, the College council comes up with new and “innovative” programs to police doctors better. Is it ever enough? or is there a point in time when the College says that yes at this point we are doing enough to police doctors and we will rest it now for a couple of years? Of course not. I assure you they don’t because they have to somehow justify going to all the meetings and pencil pushing that happens at 80 College St.).
On top of it all, because the College is self-regulated, the doctors have to ironically assume the entire cost of their operation without any gov subsidy. Isn’t this a form of self-loathing forced on the Canadian physician?
The point is that self-regulation is absolutely not a privilege as falsely touted by the College, and it is very expensive to the physicians. The Medical boards in the US states are the equivalent of the Colleges in Canada. The medical boards however are not considered self-regulated but most of their admin are doctors and they have some gov appointees. The annual membership rates for the doctors are generally 10% of their Canadian counterparts. Furthermore, the complaint processes are more transparent and standardized as opposed to Canada where the Colleges (especially Ontario) like to leave things vague and open-ended and make the rules as they go. Best of all, the Boards do not constantly have to prove themselves to the public, that they are not an “old boys club”. Neither do they constantly come up with new and “innovative” policies to police doctors.
It is time for physicians to rethink the idea of self-regulation as a liability than privilege, and strongly push to end it.
The problem is most physicians are not familiar with the law, and are ignorant of how their constitutional rights are violated by the College. Some realize it after they get a frivolous or other complaint that ruins their life with anxiety and fear for 1-2 years, kind of like slow death by a torturer.
Unfortunately many physicians that feel the pain of the College, will not stay to fight it politically. They simply speak with their feet, either leaving Canada or the profession altogether.
I could not agree with you more regarding self-regulation as a liability and I would wholeheartedly support a push to end it. Thank you for your very insightful commentary.
The biggest beneficiary of self-regulation is the government that gets to control doctors basically at zero cost.
the next beneficiary is the College itself by not being answerable to anyone regarding physicians rights to due process. A handful of cases might get appealed to Divisional court, but by and large that is rare.
Those not helped at all, and hurt by self-regulation are the physicians absorbing the enormous and ever-rising cost of running the college every year.
It would be helpful for the policy to contain some definitions/guidance as to what a professional/collegial relationship between physicians entails when the physicians have a hierarchical relationship (i.e., one is the manager of the other). Can one physician “order” the subordinate physician to do certain tasks, even when they are against the professional opinion of the subordinate? Similarly, can the supervising physician tell the subordinate physician what to do without even seeking the subordinate’s opinion on the matter at hand? In other words, does a hierarchical relationship quash the professional/collegial relationship even when the physicians are equally qualified?
To Whom It May Concern,
Regarding the College of Physicians and Surgeons of Ontario Policy Statement #4-07 Physician Behaviour in the Professional Environment I have the following comments/suggestions:
1. Section “Inappropriate Words” and bullet #1 “Profane, disrespectful, insulting, demeaning or abusive language” I suggest adding the word “tone” so it would read “Profane, disrespectful, insulting, demeaning or abusive language or tone”. Although tone is a difficult thing to “police” it is commonly used instead of profane etc. language but still can be extremely disrespectful.
2. Section Advocacy you state in the last sentence “When the delivery of quality health care is impaired by the physician’s advocacy efforts, the physician should reevaluate whether the advocacy effort is, in fact, in the patients’ best interests”. I don’t think you are being clear here because commonly what the physician is advocating for is in his/her patient’s best interest e.g. getting into surgery more quickly. So if you have him/her reevaluate, most if not all will remain with their initial position i.e. that the care being advocated is in the patient’s best interest. I believe what you are really asking physicians to do is reevaluate in light justice/fairness to all patients whether or not their efforts to get their individual patient health care, is it fair/just to other patients. Therefore, I suggest you consider changing this last sentence to read as follows:
“When the delivery of quality health care for the patient and/or other patient’s is impaired by the physician’s advocacy efforts, the physician should reevaluate whether the advocacy effort is, in fact, in the patient’s best interest and/or whether it unduly impairs the health care of other patients.
Being a doctor can be a very stressful job, and the College adds to that stress when investigating patients’ complaints. Doctors are only human and may develop drug and alcohol addictions, sleep disorders, and/or other mental health issues which have a negative effect on their behaviour. Both doctors and patients should know that the defendant doctor’s human rights are protected by legislation, while the complainants rights are not. Doctors have the CMPA; patients have no such organization to protect their human rights, and patients will be violated in order to protect the doctor. The College and the CMPA do work together to ensure the doctor’s livelihood is protected. Doctors need to know this and know also that if their colleague’s behaviour is questionable, ethically, they need to question it in a very professional manner (one that does not contribute to further unnecessary harm to the doctor and his patients), in order for that doctor to get the help he needs before a large number of patients have been harmed – physically, mentally, emotionally and financially. And when behaviour is questioned, the doctor should rest assured he can and will get the help he needs in a respectful, caring manner. The patients he has harmed are just a number to the CMPA (as in the large number of patients’ concerns dropped or dismissed), so he need not let patients’ complaints further affect his well-being. Doctors live in fear of the College (and lawsuits), and ultimately this is an unnecessary stressor which causes or contributes to unnecessary harm to both doctors and patients.
Absolutely there is no doubt being a doctor is a stressful job and complaints contribute in a big way to physician stress. I think a big reason for this is that a lot of frivolous complaints go through unfiltered and the process is drawn out and lacks transparency. This leaves doctors in the dark for months mulling over the possible outcomes and fearing the worst. Sleep may become disturbed, irritability increased and concentration diminished thereby potentially resulting in poorer patient outcomes, the opposite of the College’s mandate.
Even if the amount of complaints did not diminish, having mechanisms to deal with them in a timely and transparent manner would help reduce physician stress tremendously. For example, in cases of an isolated angry outburst (which we all have), perhaps a simple apology letter and an admonition from the College would suffice rather than a prolonged investigation, months of stress, wasted time and lawyer involvement.
I think one of the other major issues is the College’s absolute power to obtain a physician’s medical records without their consent in any investigation supposed ‘professional misconduct’ (a very nebulous entity). I think this can and does prevent doctors from seeking the help they need. This may prevent, for example, a doctor with an addiction problem from seeing a psychiatrist lest the College discovers their problem in the context of an (unrelated) investigation and then questions their fitness to practice, potentially robbing them of their career and livelihood.
As much as one would like to believe that the College would only invoke a doctor’s clinical records if absolutely required and only if directly related to the investigation in question, one simply cannot trust this to be the case when their career and livelihood is at stake. One needs only to peruse through volumes of the College’s Dialogue magazine to see how doctors are ashamed publicly by the College often in what seems a heavy handed manner for issues which could have be dealt with in a much less punishing and humane manner.
In speaking with colleagues, participating in forums and taking an avid interest in the College’s consultations, it has become clear to me that there is a significant proportion of physicians in Ontario, probably a majority, that have lost confidence in the College and are unhappy particularly in the way in which it handles complaints. I for one will continue to be actively involved in having my voice heard and participating actively in consultations with the view of hopefully improving the complaints process such that it mitigates physician stress and ultimately improves patient safety.
very well said. The College’s mandate is to protect patients. The way the complaints process is handled can lead to poorer patient care as you described.
I should add that within this context of “disruptive physician behaviour”, many instances are caused by disagreement between the physician and a patient, or between the physician and other providers. Often times the other party may have been just as disruptive if not more. It’s just that they have the option of complaining, whereas the physician doesn’t.
The side effects of a heavy handed and broad policy of “disruptive physician behaviour” are that it would lead to more frivolous drawn-out complaints, and to physicians that are “softer” and eager to avoid instances of disagreement at all costs. While the latter may sound good, it may actually hurt patient care. The result will be physicians that for fear of drawn-out complaints, agree to demands that may not be best for patient care. An physicians of this would be a physician bullied into prescribing powerful opioids that may not be warranted.
Response in PDF format.
i wonder how many laboratory medicine physicians are actually ever face to face with a patient, much less an angry patient or a difficult situation. My guess is none, so not sure what the value of the organization’s input is.
The current policy would be fine, if the College’s complaint process was different. For a simple complaint to take 6-12 months to resolve is just not fair or respectful to the doctor or the complainant.
Consider that complaining about bad bedside manner or “disruptive physician behaviour” is very easy to do with no evidence needed. It is very subjective and except for some obvious acts like throwing an object, or acts done in writing, very hard to prove. Often times, patients, colleagues or employees who have no solid grounds for a complaint about the care provided, resort to these types of allegations as a way of revenge or vindication.
Most of the investigations around the current policy are going to be reduced to hearsay and “he said, she said”. How much time and resources does the College really want to spend in investigating hearsay? To cut away finite resources from timely investigations into more essential ares such as competency – how is that serving and protecting the public?
How is putting physicians into fear mode that any disagreement interpreted as rudeness can now be potentially “professional misconduct” service to the public?
Physician anxiety and cynicism are highly contributed to by this current policy on disruptive behaviour, College’s policy to investigate all complaints, and the extremely long time it takes the College to do so. How are physician anxiety and the resulting poor physician health good for the public? Do these features of the College protect the public better than having an expedient process for dealing with complaints?
In comparison, do police detectives investigate every complaint that is called into the police? Does the police arrest the subject of every call to them? No. Officers have the discretion to resolve many matters on their own, such as with simple apologies, warnings, on the spot resolutions etc. —in other words, common sense.
I am practicing in _ for last xx years. Yes there are few physicians not behaving properly during certain times with fellow physicians nurses mostly in critical units and emergency department.but most of the time things take it leave it attitude settle by itself with consultation discussion at the medical advisory committee or at medical executive level. There are times physicians are quiet miserable about his behaviour apologetic but there may be cases I ever heard of. Yes abnormal behaviour is unpleasant in hospital environment but as I know this type of behaviour do excist from other hospital staff why frustrations due to various causes overwork social tension family distress personal difficulties some may be psychiatric problems including I suspect anxiety depression
Ontario Dental Hygienists’ AssociationResponse in PDF format.
About 10% of physicians in Ontario will face a College complaint in any given year. At 6 months per complaint over a 30 year career, this means a doctor will spend on average about 18 months embroiled in the complaints process. Add on top of this lawsuits and you have a scenario in which doctors are spending a significant amount of their careers stressed and in defence mode. This is something we are ill-prepared for in medical school and residency.
I hope the new leadership at the College will work towards better filtering complaints and ensuring more timely and just decisions which honour physicians rights. Until then I think it’s fair to say that most doctors who go through the complaints process will do everything in their power to avoid it and as a result they will not always make clinical decisions that are in the best interest of their patients and society at large.
Take for example a doctor that goes through the complaints process after he/she refuses to prescribe narcotics to a ‘drug-seeking’ patient. Next time a ‘drug-seeker’ comes into his/her clinic, rather than put up a stand and potentially face a College complaint, the physician may yield and prescribe a small amount so as to appease the drug-seeker.
Similar situations may arise with a patient making a bogus disability claim or request for an unnecessary test, referral or medical procedure. Essentially the fear induced by the College’s complaints process can steer doctors in the direction of acceding to inappropriate requests. This can burden the healthcare system and tax-payer and lead to physician burnout not to mention poorer patient outcomes.
I would argue that wording of the current policy of ‘physician behaviour in the professional environment’ is vague and allows for interpretation by the College which can facilitate investigations into potential ‘professional misconduct’ on virtually any grounds, including behaviour outside of the ‘professional environment’. For example, a doctor who has a passionate disagreement with a colleague over a parking spot may be seen as ‘disruptive’ or not upholding ‘the standards of the profession’ and be liable to a complaint and investigation by the College. Similarly, a doctor who puts up a stand against a disruptive patient or inappropriate request may face a complaint on similar grounds.
Overall I think professional behaviour is common sense and there is no need to have a policy in this regard. I think the policy does little more than serve the College’s interest by justifying the investigation process and maintaining the status quo. Unfortunately, I fear this does more harm than good by contributing directly to fear-based clinical decisions and physician burnout and indirectly to resource misappropriation. Taken together, these and can ultimately lead to poorer patient outcomes, the opposite of the College’s mandate.
I implore the College under the new leadership to move towards trust and empowerment of physicians and act in the best interest of the public by doing away with this unnecessary policy.
This policy is causing unnecessary stress for doctors and their job is stressful enough. I recommend the College delete the reference to professional misconduct:
Under the Regulations to the Medicine Act, 1991, it is professional misconduct to fail to maintain the standard of practice or to engage in conduct unbecoming a physician.
Depending on the nature and the degree of the disruptive behaviour, as defined above (whether captured in the examples or in the definition), such behaviour may be considered to be professional misconduct.
The expectation of courteous, dignified and civil behaviour extends to interaction with the College. It is unprofessional conduct for a member to refuse to reasonably cooperate with the College. When the College makes reasonable requests for information and when attendance at the College offices is requested to deal with areas of concern, it is the professional responsibility of each member to cooperate with these requests.9
Healthcare professionals know that overwhelming stress can lead to depression. Inappropriate behaviour, sometimes due to depression, can result. If a doctor’s behaviour is due to a mental health problem such as depression, then the CMPA will ensure that doctor is very well protected. Caring for the doctor takes priority over caring for the patient and the CPSO is very well aware of this fact.
Years ago, when I complained about a doctor, the Investigator exclaimed, “He’s NOT going to lose his license!” The heart of my complaint was that the care I was given was fraudulent, and the doctor needed help. I didn’t want to say the care was fraudulent but I believed the College would not be able to ignore this fact.
The College investigation was very superficial, relying on the doctor’s CMPA supported response. I had to spend over fifty thousand dollars to learn the truth of what happened. What happened was fraud, but I dropped my lawsuit before I wasted any more of my money, and I will not be contacting the College concerning this doctor, or any doctor, ever again. I actually ended up feeling sorry for the doctor because I could see the whole picture. My complaint and my lawsuit was not the first and I could see the horror he must have been experiencing. I only wish I could have seen that years ago – but I was suffering from anxiety and depression by the time I first got to see him. Patients, who think they could have a life threatening illness, or could be losing their mind, are only human too.
With the grace of God, I was able to forgive the doctor, but I have not been able to forgive the system. If not for the fact that there was a “sheer volume” of complaints about the doctor’s “communication style”, my complaint, like another citizen’s complaint, would have been completely dismissed. The way the College treated me, no doubt driven by the CMPA, was harmful to my physical, mental and emotional health.
A policy such as this leads to stressful, yet superficial, lengthy investigations, which will, on a balance of probabilities, be dismissed. It’s counterproductive, and from what I can see, a patient safety issue. A mental health expert, with an eye for empathy for the doctor, should be considered when the doctor’s “communication style” reveals a pattern of concern. In this way, the CPSO could fulfill its mandate to protect the public. Healthy doctors lead to healthy patients. This policy does not promote doctors’ health.
Interestingly, the only other complaint I ever made was related to the behavior of an older doctor; a professor emeritus. His behavior was such that I believed he needed a cognitive assessment. The College asked him to call me with an apology and he did so. He wished my family doctor at the time, “Good luck!” More than luck was needed because the system, which supports fraud, was, and still is – crazy making.
In the name of “transparency”, I hope the College will print this for good doctors who have yet to be intimidated into committing fraud. My lawyer told me “You can’t sue a doctor for lying to you!” Doctors and patients need to know that even lies and deceit can be an acceptable standard of care, and the College, overpowered by the CMPA, can turn a blind eye.
I used to work in the States and there physicians know of the Board, but they don’t mull over it so much like here. In Ontario, working as a doctor is like walking in a mine field. You never know when you will hit that situation that will cause a complaint for you, and make your life a living hell for the next 6-18 months even with the most mundane and vexatious complaints.
This policy just adds to the mines in the field. If the College investigated complains over 2-6 weeks, this policy would be fine, but not when it is more like 6-18 months. This is not healthy and it doesn’t contribute to better patient care. It just makes lots of doctors more scared of walking in the mine field on a daily basis, and keeps them hoping to retire sooner or move elsewhere.
It often seems that the very worst actions taken by the Colleges ie. giving undo weight to concerns raised by special interests or government are taken in the name of preserving self-regulation. While most physicians naturally chafe at the idea of government regulation, we often wonder if we accept things that would be simply unacceptable if imposed by an outside agency simply in order to preserve the ILLUSION of being self-regulated.
Perhaps we should just admit that the government is, in fact, regulating (and for free) and the college should take over the role of protecting our interests. Really, the government should not be allowed to mandate anything without being responsible for it yet they do this with so much of health care and it allows them the luxury of simultaneously having their way and claiming it is out of their hands.
The physicians of Ontario gain nothing via “self-regulation”, only a bad name as being member of an “old boys club” and an almost $2000 yearly bill. Self-regulation is only good for the government and the College employees.
Public Services Health & Safety AssociationResponse in PDF format.
Thank you for the opportunity to provide feedback on this important policy. I am licensed in both Ontario and British Columbia (where I now live and work). I practiced primarily in the area of occupational medicine for 20 years in Ontario. I currently have a professional role in assisting physicians who are referred to a Physician Health Program for behaviour issues, among other things.
At the outset, I want to say that I support the existence of clear and useful policies on physician behavior, and I admire the courage and leadership of the CPSO in producing an example of such a policy. I am, however, not satisfied with the current policy (for reasons I will attempt to describe as briefly as possible here) and would like to contribute to the ongoing improvement of this policy and others like it. I will attempt to frame my comments under the headings or questions suggested by the CPSO.
• Does the policy provide useful guidance?
The goal of the policy as stated in the first paragraph is admirable, and completely on target: “to provide specific guidance about the profession’s expectations of physician behaviour in the professional environment.” It sounds as though what is to follow is a positive statement, or what would be referred to in the behavioral science literature as an “approach goal”. Instead, what generally follows is an “avoidance goal.” The primary conundrum that the policy doesn’t tackle head on, and which I think it should, is that both approach goals (respect, courtesy, dignity, inclusion) and avoidance goals (disruption, inappropriateness, profanity, insult, abuse, intimidation) are presented as being objectively verifiable, rather than fundamentally intersubjective. In other words, ones behaviour is never disruptive per se, it is disruptive to someone.
As a result the policy tends to swallow the “inappropriate” spider to catch the “disruptive” fly. More and more negative adjectives are brought out to try to clarify the picture, some of them softened by phrases like “others would describe as” or “likely”. In the end, we have a bunch of words that no one would ever own up to as internal motivators, but many might judge to be present in the behaviour of others around them.
• Are there any issues not included in the current policy that should be addressed? If so, what are they?
Under the heading “Principles”, the policy says “Professional behaviour and good clinical skills are both important components of physician performance.” In my view, this sets up a false dichotomy between professional behaviour and clinical skills. To me, professional behaviour IS a clinical skill. Let me explain this more by way of analogy.
Physicians are expected to make informed choices about therapies to offer, based on a holistic and scientific understanding their likely effects. Furthermore, they are expected to have skill in managing (with competence) the implementation of the particular therapies they offer to make available to patients.
I would argue that in the same way, physicians are expected to make informed choices about how to behave in various kinds of relationships (including the physician-patient relationship) based on a holistic and scientific understanding of how their behaviour will likely affect others. Furthermore, they are expected to have sufficient self-regulatory skill that they can implement the behaviours that they recognize will be helpful in these relationships.
When the expectations of physician behaviour in the professional environment are introduced in this way, several doors open. First, it no longer becomes necessary to label or describe a particular behaviour as “disruptive” or “inappropriate”. Instead, physicians’ attention can simply be drawn to the fact that while their behavior may have been motivated to produce a noble and intended effect, it either: failed to produce the intended effect; or produced a range of additional side effects that were unintended. Either way, the chosen behaviour can be thought of as having a “therapeutic ratio” that falls short of what is desirable.
• Are there other ways in which the policy should be improved?
There are a few other issues that draw my attention in the policy. For example, under the heading “Inappropriate Words” , the bullet point “Outbursts of anger” appears. To me, this suggests that it is unacceptable for physicians to experience anger. I understand that the intention of the policy is probably to assert that not all choices about how physicians express the anger that they will inevitably feel are equally helpful in a professional context. Overall, the wording choices of the policy make it seem like something that could never apply to oneself, only to others. I think that the policy would be much better if it was written in such a way that an average physician reader was able to experience more empathy from the policy authors.
I hope that these comments are helpful to you, because I assure you that my intention is to be nothing but! I realize that the feedback I’m offering could be construed as critical, and it is. My only hope is that you interpret it as constructively critical, and not in any way shaming, demeaning, or negatively judgemental!
College of Physicians & Surgeons of SaskatchewanThe policy states:
Examples of Disruptive Behaviour
If the behaviour described below,
• occurs; or
• occurs and interferes with a physician’s ability to work with others to the extent that delivery of quality health care may be impeded,
the behaviour is likely disruptive.
These appear contradictory. The first, “occurs”, suggests that the described conduct is disruptive whether it does, or does not interfere with patient care. The second, “occurs and interferes with a physician’s ability to work with others to the extent that delivery of quality health care may be impeded”, suggests that the described conduct is only disruptive if it interferes with patient care.
I think that needs clarification.
College of Physicians and Surgeons of AlbertaResponse in PDF format.
Professional Association of Residents of OntarioResponse in PDF format.
Human Rights Code policy states: “College is obliged to consider the Code when determining whether physician’s conduct is consistent with the expectations of the profession.” This is not mentioned in the Physicians’ Behavior policy. Cross referencing policies can be helpful.
A behavior policy should reference social conventions, i.e., common courtesies. The CPSO policy advises physicians to act respectfully and work collaboratively but what constitutes respectful and collaborative behavior is not stipulated. These behaviors are characterized by common courtesy, i.e., not interrupting a speaker, active listening, etc. Therefore a statement like: “the expectation of courteous, dignified and civil behavior …” should be the first line in a behavior policy and be prior to mentioning disruptive behavior. We recommend moving the Policy Statement. The Policy Statement should be the first section encountered. Subsequent sections can then enable interpretation.
The current structure allows unwarranted interpretation. For example the statement: “Where a physician’s behaviour is generally regarded as being disruptive, the physician is expected to cease the behaviour.” Disruptive behavior is then defined (repetition or interference with patient care). One could infer that isolated incidents of bullying, rudeness, etc. are only problematic if they form a pattern of behavior, i.e. tantamount to disruptive behaviour. Dictating that only disruptive behavior must cease allows one to infer that “bad,” “rude,” or “disrespectful” behavior, if an isolated incident, is acceptable. To effectively promote “good” behavior and discourage “bad” behavior, it should be stipulated that professionals should not swear, shame, bully, etc.
Referring to the CMA’s Code of Ethics could provide some prescriptive elements. For example, Paragraph 2 of the Code stipulates: Practise the profession of medicine in a manner that treats the patient with dignity and as a person worthy of respect); Paragraph 22: Make every reasonable effort to communicate with your patients in such a way that information exchanged is understood; Paragraph 52: Collaborate with other physicians and health professionals in the care of patients and the functioning and improvement of health services. Treat your colleagues with dignity and as persons worthy of respect.
An additional benefit of referring to the Code of Ethics is that references links behaviour and ethical obligations; helping promote professionalism. Linking ethics and behaviour justifies why physicians are expected to meet higher standards of conduct than non-professionals.
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