Physician Behaviour in the Professional Environment — Update: New Policy Approved

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    Stakeholder feedback

    View the feedback we received to our online survey

    View the comments posted to our online discussion page

    Our Process

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    The College’s Physician Behaviour in the Professional Environment policy received final approval from Council on May 30, 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

    • 78 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 Canadian Medical Protective Association.
    View the feedback: Survey reportWritten Comments

    What we heard

    Other important considerations

    • The feedback received was mixed. Overall, the majority of respondents expressed general support for the policy.
    • Of those respondents who supported the draft policy, many noted that the expectations of professional behaviour were reasonable and agreed that disruptive behaviour can negatively impact the delivery of quality health care as well as patient safety and outcomes.
    • Among respondents who objected to the draft policy, some felt that there was no need for the policy because of hospital codes of conduct, for example. Others questioned how complaints about disruptive behaviour would be investigated, especially given what they saw as the subjective nature of assessing this behaviour.
    • Specific suggestions on how to revise the draft policy included:
        • Clarifying the definition of disruptive behaviour.
        • Including expectations of appropriate behaviour for patients and advice for physicians on how to manage disruptive patients.
        • Modifying the examples of disruptive behaviour.
        • Elaborating on the causes of disruptive behaviour.
    • 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 behaviour in the professional environment.
        • A review of relevant legislation.

    The literature indicates a strong relationship between disruptive behaviours and poor patient safety and
    outcomes.


    How we responded to your feedback

    • The main policy positions were retained; however, revisions were made to the draft policy to enhance clarity and comprehensiveness. These revisions and two instances where revisions were not made, are highlighted below:
    Policy decision Rationale
    • Reference to the confidentiality provisions of the Physician Health Program (PHP) were added to the policy.
    • It now reads, “Physicians should note that their interactions with the PHP, if any, are confidential unless a mandatory reporting obligation applies or the physician has signed an agreement with the PHP to release information to the College.”
    • This revision provides important clarity for physicians with respect to the role and involvement of the Physician Health Program.
    • Deletion of “Refusal to comply with accepted practice standards” from the list of examples of disruptive behaviour contained in Appendix A of the policy.
    • Physicians’ adherence to different but equally acceptable practice standards is acceptable and is not disruptive behavior.
    • Should such deviations be problematic, it was felt that other College mechanisms would be better placed to address those concerns.
    • No revisions were made in response to feedback that the policy includes a statement about disruptive patient behaviour.
    • The College’s jurisdiction relates to physicians only; it is not the College’s role to set expectations for patient behaviour.
    • No revisions were made in response to feedback that more information about the causes of disruptive behaviour be included.
    • While serious consideration was given to this request, it was ultimately decided that the existing statement listing the broad categories of potential causes (personal, professional, or situational) was adequate.

    The final policy

    • Physician Behaviour in the Professional Environment policy received final approval from Council on May 30, 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:

    • Physicians are expected to act in a respectful, courteous and civil manner towards their patients, colleagues, and others involved in the provision of health care. Specifically, physicians are expected to uphold the standards of medical professionalism, conduct themselves in a professional manner, and not engage in disruptive behaviours.
    • Behaviour that is unprofessional and/or disruptive undermines medical professionalism, the trust of the public and negatively impacts patient safety and outcomes.
    • The College defines disruptive behaviour in the following way: Disruptive behaviour occurs when the use of inappropriate words, or actions and inactions, by a physician interferes with his or her ability to collaborate, or may interfere with, the delivery of quality health care or the safety or perceived safety of others.