Physician Treatment of Self, Family Members, or Others Close to Them – Update: New Policy Approved

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    Stakeholder feedback

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    View the comments posted to our online discussion page

    Our Process

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    The College’s Physician Treatment of Self, Family Members, or Others Close to Them policy received final approval from Council on February 26, 2016, and is now an official policy of the College of Physicians and Surgeons of Ontario.

    We would like to thank all those who submitted their feedback and contributed to this policy review. While not every comment or suggested edit was incorporated into the final policy, all comments were carefully considered in light of current practice issues, the values and duties of medical professionalism, and the College’s mandate to protect the public.

    Below is a brief summary of the policy review process, including an overview of the feedback received and revisions undertaken:

     

    people

    Who we heard from

    • 84 submissions were received in response to this consultation.
    • Feedback was primarily submitted by physicians, but we also heard from members of the public and the following organizations: the Ontario Medical Association, the Professional Association of Residents of Ontario, and the College of Physicians and Surgeons of Alberta.
    View the feedback: Survey reportWritten Comments

    What we heard

    Other important considerations

    • Broadly speaking, the feedback was mixed. While some respondents (approximately 30%, most of whom were physicians) objected to the draft policy position that physicians must not provide treatment for themselves, family members, or others close to them, except in certain circumstances, the majority (approximately 60%) were supportive of this position.
    • Of those respondents who supported the draft policy, many recognized the need to preserve the standard of care by ensuring physician judgment and objectivity is not compromised by the existence of personal or close relationships.
    • Most respondents felt the draft policy was clearly written and comprehensive (73%), and clearly set out the expectations (71%).
    • Just over half of respondents (54%) felt the draft policy set reasonable expectations. Of those who thought the expectations were unreasonable, most objected to the policy position that treating themselves, family members or others close to them would compromise objectivity and the quality of care provided, and others felt that the draft policy would not be workable in rural or isolated communities.
    • Of those respondents who provided constructive criticism on the draft policy, suggestions included:
        • Clarifying the definitions of “others close to them” and “minor condition”.
        • Clarifying whether prescription refills and referrals are permitted under the policy.
        • Allowing treatment for minor conditions for reasons of convenience.
        • Allowing the prescribing of controlled drugs and substances in certain circumstances (e.g. in palliative cases, in rural or isolated settings and in emergencies).
        • Creating an exemption for physicians who practice in rural or isolated communities.
    • In addition to the feedback, we considered a wide range of other information while developing the final policy. This included:
        • Policies and guidelines of other organizations, including other Canadian medical regulators.
        • A review of the literature on physician treatment of self, family members and others close to them.
        • A review of relevant legislation, including the Controlled Drugs and Substances Act.

    The literature indicates that personal or close relationships can compromise physicians’ emotional and clinical objectivity, making it difficult for physicians to meet the standard of care and to provide the best quality treatment.


    How we responded to your feedback

    • Key revisions were made to the draft policy in response to feedback. The majority aimed to improve the overall clarity of the policy and the expectations set out within.
    • Two of the more significant revisions are highlighted below, as are three important instances where revisions were not made:
    Policy decision Rationale
    • The definition of “minor condition” has been rephrased and now emphasizes that complex and chronic conditions would not be considered minor conditions, even if their management is episodic and minor in nature.
    • Specific examples of minor conditions have been added to the definition.
    • These revisions and additions enhance the clarity of the term and the specific examples were added in response to respondents’ requests.
    • The statement “physicians must only provide treatment in the limited circumstances set out in this policy, and not for reasons of convenience or to obtain preferential access to health care” has been deleted.
    • This deletion was made because the motivation behind why physicians provide treatment for themselves, family members and others close to them isn’t relevant to the policy position.
    • The reference to preferential access to health care was also deleted because it is tangential to the policy position.
    • There is more of a focus now on the policy position: that physicians’ objectivity is compromised when they provide treatment for themselves, family members and others close to them, and as such, treatment must only be provided in limited circumstances.
    • No revisions were made in response to objections to the draft policy position: that physicians’ objectivity would be compromised when they provide treatment for themselves, family members and others close to them.
    • No revisions were made to the policy position as it is well supported in the literature.
    • The literature indicates that personal or close relationships can compromise physicians’ objectivity, making it difficult for physicians to meet the standard of care and to provide the best quality treatment.
    • As such, the policy continues to limit the circumstances in which treatment can be provided.
    • No revisions were made in response to feedback that the draft policy should allow the prescribing of controlled drugs and substances in certain circumstances (e.g. in palliative cases, in rural or isolated settings and in emergencies).
    • The legislation governing controlled drugs and substances (the Controlled Drugs and Substances Act) prohibits prescribing or administering controlled drugs and substances to non-patients, and does not provide for any exceptions..
    • No revisions were made in response to feedback that there should be an exemption to the draft policy for physicians who practice in rural or isolated communities.
    • An exemption was not granted for physicians who practice in rural or isolated communities because the risks to physicians’ objectivity and the standard of care would apply in all practice settings, including in urban and rural or isolated communities.

    The final policy

    • The Physician Treatment of Self, Family Members, or Others Close to Them policy received final approval from Council on February 26, 2016 and is now an official policy of the College of Physicians and Surgeons of Ontario.


    Read the Final Policy

    Key messages of the final policy:

    • The literature indicates that personal or close relationships can compromise physicians’ emotional and clinical objectivity, making it difficult for physicians to meet the standard of care and to provide the best quality treatment.
    • In order to meet their professional obligations to practise medicine safely and effectively, physicians must only provide treatment for themselves and family members in limited circumstances. Physicians must not provide treatment for themselves or family members except for a minor condition or in an emergency situation, and when another qualified health care professional is not readily available.
    • The College recommends that physicians carefully consider whether it is appropriate to provide treatment to others close to them because it may attract the same risks of compromised objectivity and difficulty meeting the standard of care. Where a relationship could reasonably affect the physician’s professional judgment, the physician must not provide treatment to that individual, except in accordance with the circumstances set out in the policy.