Physician Behaviour in the Professional Environment – General Consultation – Discussion (Consultation Closed)
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suggest change of policy name from “Disruptive physician policy” which is prejudicial
why do we need such a policy?
we already have codes of conduct at hospitals, CPSO complaint process and (heaven forbid) the criminal code.
This document opens the door to false accusations of disruptive behavior …. the colleague with a grudge who reported you because you muttered “darn” to yourself at the end of a long call shift, etc.
This “policy” is open to abuse.
Anytime a nurse decides not to obey an order, you answer them to do it just as written. In the old days, there could be small discussion.
Now they can use this policy as a tool to accuse you of professional misconduct.
What is the true scope/definition of professionalism? It’s such a broad term and agree it opens up physicians to be discredited/reputations stained even if determined nothing could be proved. Then what is the burden of proof and who determines this? What standard is required to be on the panel reviewing complaints of professionalism- there could be inherent biases in interpreting complaints ESP in era of cultural context and diversity where words, tones can be biased towards one culture and way of conducting “professional” ways. The committee overseeing this issue should be highly transparent in their methodology when evaluating professionalism and this should be posted in the CPSO website for all to see and systematic screening methods before even evaluating the complaint should be determined to assess validity of concern and the lens screening the concern should also be held to a very strict methodology and standard. But I like the concept in spirit- operationalizing this is tougher
It’s very easy to point the finger on an isolated angry outburst and call it professional misconduct and drag it through the complaints process to oil the economic engine of the College.
But what about the more covert and sinister disruptive behaviour? What about the preceptor who bullies the resident with extra tasks, makes them stay awake for 36 hours and yet puts them down in front of peers every chance they get?
What about the College itself? The same College that has the audacity to suggest increase in membership fees? The same College that stresses physicians by investigating meritless complaints. The same College that holds consultations but proceeds with a predetermined outcome nonetheless. The same College that denigrates physicians rights.
Who is going to hold those who abuse their power accountable for their professional misconduct?
Working in a methadone clinic, myself and staff are subject to verbal abuse and aggression by patients at least 2-3 times a week.
wouldn’t it be fair for the College or some other gov agency to also have a Patient behaviour in the medical environment manifesto? or are we just supposed to take it?
If we go the route of discharging the patient, then we risk getting a complaint more, as we have before, and getting bogged down in that process for months and months. So I guess we just bow down and take it?
Why blame the patients when there are security and law enforcement available to deal with threatening patients?
You are being paid to serve patients and be accountable to the public. The public doesn’t owe you anything. If you believe that you want regulations and code of conduct to be abolished, then the public should rethink about who they are going to for medical services.
You surely sound like you want code of conducts abolished to encourage medical malpractice and abuse by authority figures such as yourself.
I’m sick of hearing this sort of attitude. In Ontario I have NO RIGHTS to any health care, by that I mean my only two rights are to abortion and assisted suicide as of June 2016. I have to find doctors on my own that will take me and they can refuse pain medications or refuse to treat my migraines or generalized anxiety which they can and do. They can refuse to treat any patient they wish including all chronic pain and all mentally ill patients.
I have NO RIGHTS to any private pay option. Then if I get addicted through self-medication I have NO RIGHTS to any treatment to get off the drugs. So this arrogant behaviour and no patient choice has to stop. If you want to terminate patients then we need the choice to private pay clinics like Quebec has. I’m sick of hearing this sort of patient trash talk.
On first glance, it seems that the Physician Behaviour guidelines are motherhood and apple pie. On closer reading, they are concerning for several reasons.
1. It is unclear how these guidelines are meant to be implemented. Will they prospectively target disruptive physicians, be applied to all physicians as a background big brother condition, or only implemented when there is a complaint?
Targeting disruptive physicians might seem like the most invasive strategy, but I would argue it is the most honest and effective method of fairly addressing disruptive personalities. Everybody knows who they are, all you have to do is ask. I suggest the first place to start is Criticall staff, ask for their top most difficult physicians. I believe disruptive doctors represent a tiny percentage, but their influence in poisoning the work environment can be devastating. I would never have believed how toxic one individual can be to an institution until observing it, thankfully always peripherally.
If these professional guidelines are always expected as a sort of background threat from the College, it could have a poisonous influence on honest communication in our institutions.
It seems most likely that these guidelines would only be implemented by complaint. I see huge problems with this, as it will only randomly catch the bad apples, and cast many stressed-out doctors as bad guys, when the true sociopaths go undetected.
2. There is no recognition of the influence of mental illness and burnout on blowing a gasket occasionally. It is a red flag, a cry for help. This could have the very real possibility of driving physicians under stress deeper underground and away from communication with colleagues and possibly lifesaving intervention.
3. There is no recognition of the extreme stress that the health care system is under on a daily basis. For example, many tertiary care hospitals are well over 100% average inpatient capacity, and small rural hospitals cannot access specialist care because “I’d like to help you but I don’t have a bed”. Of course, you will never have a bed under those conditions, so it forces the rural FP to go in way over their head, in conflict with their license restrictions on treating only the conditions they are competent to treat. Administration does just about everything except effectively addressing these problems. Under these conditions, any physician who advocates for quality patient care is occasionally going to lose it, because no one has their back. I don’t mean they “feel” like nobody is there to help, it’s the reality. Fancy initiatives like “life or limb” are only slightly helpful for these situations.
If these behaviour guidelines are adopted without discussing the above concerns, I fear it will be a futile and potentially harmful initiative.
The last thing the profession needs right now is to adopt a policy of superficial professionalism while ignoring serious system problems which challenge even the most capable and patient-oriented caregivers.
I feel that the CPSO has shown a long term pattern of excessive focus on individual physician behaviour, and has ignored system deficiencies which have a huge influence on patient outcomes and physician stress. It is not enough for the College to support physician advocacy (line 88), the CPSO itself needs to advocate for improving system deficiencies.
As the gov cuts fees and resources, the College increases its scare tactics against doctors. The inept gov gets a terrific deal via the “self-regulated” scheme in which it spends nothing on regulation, yet gets more regulation than it could otherwise provide if it were the regulator itself.
As the corrupt Liberals cut resources from healthcare, they rev up the College. at zero cost, to subdue doctors not to go on strike, not to speak up and not to misbehave, as this policy is entailing.
Having worked in emergency medicine, family medicine, and addiction medicine, I could tell you that for every 1 episode of mild disruptive behaviour from a physician, there are at least 100-200 severe cases disruptive behaviour from patients. There is not a day that goes by without a patient getting disruptive with a physician or the staff, in the exam room, on the phone, in the waiting room etc.
They almost always get disruptive because they cannot get what they want: the disability form, the narcotic medication, the antibiotics, CT scan, MRI, or urgent dermatology referral that are not needed. They yell, call staff profanities, threaten, and hit objects, etc.
This policy looks like it has not been written by physicians or physicians that work every day on the front lines with such a demanding population. If a physician gets “disruptive”, it is usually just a raised voice in response to a very disruptive patient. But the physician cannot complain to anyone about the patient, the patient can and often will do so by lying and not saying anything about what led to the disruptive situation to begin with. They will not mention that they demanded rudely something that was not warranted or available, and that they were the first ones to raise their voice and call the physician and their staff profanities.
The College is still living by an old paradigm of “physicians have the power in the doctor-patient relationship”. This is something that perhaps was true 100 years ago, but by no means today. Yes, if a patient is cut open on the operating table, one could say the physician has the power in that situation. But in the majority of other cases, patients have many options and face no repercussions for their extremely abusive behaviour toward physicians. They can simply change physicians, clinics, etc or they can also vindictively complain to the College free of charge, and with no effort (e.g., by sending an email), thus threatening the physician’s career and sole way of livelihood. There is a huge imbalance of power here between the physician and patient, and it is not in favor of the physician. So for the sake of reality and practicality, stop saying that physicians have the power in the doctor-patient relationship. An overly elaborate policy to take down a physician for disruptive behaviour, must be balanced by addressing patient disruptive behaviour, which is far more rampant, severe and destructive.
very well put
the College should balance this policy with making it easier for physicians to discharge abusive or “disruptive” patients.
Why blame the patients when there are already security measures in place such as the Mental Health Act and Criminal Code to deal with patients at-risk of harming themselves or others?
We are losing the rights to switch doctors via Price-Baker. I have used a walk-in clinic for many years in a different LHIN as I was terminated for migraine care because I refuse cancer screening. I’ve tried the privacy commissioners and was told to lobby my MPP to get the law changed.
In my area you can’t find a doctor who gives you personal choice. They won’t refer you to another doctor who will treat your headaches without a pap test or mammogram. I’m supposed to spend my time going from doctor to doctor. The walk-in doctor says he can’t believe they don’t respect your wishes but they can and do.
So bring on private options so I know where I can get care because when Price-Baker is implemented I will have to go the ER every week for migraines until age 74 when the screening police stop harassing me. So yeah I am difficult because you don’t respect my rights to decide what care I want or don’t want.
It is important for physicians in the professional environment to behave as civilized as possible. This basic tenet applies not only to doctors but to everyone.
However I disagree with the policy as proposed by the CPSO.
By instituting an overarching College policy regarding physician behavior, physician autonomy will be further reduced. We have all had the experience of resorting to curt measures in establishing a care plan or order with a rebellious ancillary staff member. Instituting such a policy would act as a rebuke or retort against physicians who may have angered particular ancillary staff or administrative members while acting in the patient’s best interest. Overall this would contribute to a lowered freedom of patient advocacy for physicians, and an increase in patient harm risk.
By instituting this policy, it takes physicians a step closer to practicing medicine as per the “mission of the organization” and a step away from the patient.
This physician has summed it up. Good behaviour applies to EVERY job, everywhere.
When a physician applies for hospital privileges it is an expectation that disruptive behaviour will not be tolerated. This is outlined in hospital By-laws. You have a Code of Conduct. What a shame this Policy even exists. You would do well to examine where the sense of privilege, to be disruptive as a physician, is coming from in the first place.
I have seen true disruptive physician behaviour, working in an administrative capacity. The fact that it was a physician should have made no difference in how long it was left to continue on for years. If that person, at ANY OTHER job had behaved in that manner, they would not have had a job for long. The hardest part was having clear guidelines available to finally do something about it.
There are tons of great physicians out there. There are tons of abusive patients out there. Nobody should get away with disruptive behaviour. But stop putting yourselves ahead of the rest of the world. Follow the rules and expect to be punished if you don’t. Like the rest of us.
Having worked in the high stress environment of the OR for over 40 years, I am concerned about the occasional perceived physician / surgeon disruptive behavior by some OR staff (nurses and their managers) at certain critical times when the surgeon insists on prompt and timely collaborative care, i.e. during some critical parts of an operation. While I do not condone the well-known forms of staff abuse and threatening physician /surgeon behaviors which obviously affect the delivery of surgical care, I am worried that in certain critical cases some of the OR team members’ heightened awareness of their sensitivities encourage biased reporting of professional medical misconduct. They perceive inappropriate physician /surgeon behavior in these instances, when in fact the surgeon is strongly advocating for his /her patient, and will not accept any compromise. I think that this caveat must be emphasized by the CPSO, otherwise patient care in these scenarios will suffer.
This document opens the door to further abuse by CPSO while doing little to improve the working relationships necessary for good patient care.
It is clear that those who sit behind the big desks on 80 College Street have too much free time and are sorely out of touch with the state of health care in Ontario.
My advice is to retract this document and redirect efforts toward something more constructive.
Reading the comments on here, it is evident that there is overwhelming lack of support on this forum for disruptive legislation.
The CPSO should respect its members
I have read the policy and agree with the contents. Having served in an administrative role the contents of the policy are well organized to identify acceptable and more importantly unacceptyable behaivour the policy is incomplete and needs to include the teeth for those of us that need this policy to then take action.
I would strongly urge adding sections on:
1)Suggested steps when this is encountered
2) who should report this behaivour and how they should report the behaivour
3)priniciples of reporting this behavoiur and ensuring safety and protection for those reporting (similar to bullying literature in children)
4) Is this a zero tolerance policy? and if so say so, if not then discuss why not.
The missing link is after the behaivour is identified what are the first steps and principles of addressing and documentation that might be needed. I suspect that the policy makers feel this widens the mandate of the policy but if it does not belong here then where should it be? I would suggest that including guidelines for hiospitals/individuals/patients/healthcare workers on how they might consider in principle reporting such behaivour would serve our self regulating nature well.
Congrats on opeing this up for input.
As the only commnenter so far in favor of this policy and bizarrely requesting more and a “zero tolerance” aspect on this, I read more. I realized why when you said “Having served in an administrative role”. No person, whether physician, nurse, pharmacist, etc serving on the front lines of healthcare would make nonsensical comments like yours. You wouldn’t know what it’s like sitting across the table from a yelling, name-calling, belligerent patient when they can’t have what they want, not what they need. If you knew you wouldn’t write comments like these.
Even with the existing policy, which was pushed in front of me merely to show that it was to be the means by which a belligerent colleague chose to push me out of clinic, the actual process was NEVER followed by the CPSO. It’s pro ported intentions of maintaining the MD in the workplace ,etc, were not the goal. No living human ever came and checked out another side of these allegations from his apaths. Serious allegations at MDs need to be treated like allegations of true wrong doing were both sides get equal investigation , not a CPSO malpractice claim from a partner!
Some of these concerned physicians need to know that they are authority figures and are accountable to the public.
If a doctor complains about “hysterical patients” and try to claim that they are the victim while pocketing loads of money for your services, then they shouldn’t be a doctor.
Such crybaby behaviour will never be laughed at in the U.S.
the term is actually abusive patients.
by your flawed logic, everyone who gets paid for any service, should be fair game for any abuse directed at them by those receiving the service, or they are “cry babies”. very mature!
I have no concerns with the policy on physician disruptive behavior.
The Canadian Medical Protective Association
Response in PDF format.
I think the CMPA comments here are very wise and point out some key issues.
With regards to physician confidentiality in the physician health program (PHP), not only should this be maintained but the exact circumstances for mandatory reporting should also be outlined.
In a climate where physician burnout is climbing, physicians may outwardly manifest ‘disruptive behaviour’. Instead of punishing this and making matters worse by initiating a prolonged registrar’s investigations into potential ‘professional misconduct’, the College could instead see it as an opportunity to help a physician.
Unfortunately as it stands the College has the power to invoke a physician’s personal medical records without their consent, thereby discouraging physicians from seeking the help they need, particularly help with mental health, as they may fear consequences to their license.
If the College truly has the public’s best interest in mind, they must ensure physicians are healthy instead of stressing them out more with unnecessary and prolonged investigations and worsening burnout.
Policies are needed to protect physician confidentiality to encourage them to seek the help they need without fear of losing their license.
A quite unnecessary proposal. I suggest the members of the CPSO executive read and absorb the feedback, it us almost entirely negative. In my practice I also see other physicians and am well aware of rudeness and disruptive behaviour on the part of patients, sometimes leading to frivolous and unsupportable complaints to the CPSO. Anything that the CPSO does to encourage patients to complain – free of charge don’t forget – should be firmly resisted.
PARO
Response in PDF format.
Ontario Medical Association
Response in PDF format.