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I recall having this important discussion with my spouse during the SARS crisis. While I was fully prepared to “step up”, it was clear she would not allow me to do so.
The afforded great conflict for me, balancing the needs of family with the potential needs of the public.
The reality is that as a family medicine teacher I meet learners every day. FEW if any would risk their lives under such circumstances regardless of any policy and it’s entrenched potential repercussions.
I few that system changes would go along way to improve physician engagement under such circumstances include top down communication, communication, communication and a real sense that proper and adequate equipment and training be delivered on time and in ample supply. SARS was a wake up call. These things did not happen.
The CPSO is advised to tread very cautiously with respect to recommendations for discipline for “failure” to comply.
Thanks for the opportunity to be a part of this discussion.
My suggestion is to edit the opening paragraph to the following:
In times of health emergencies, the public often relies on physicians to provide emergency care. Physicians providing care to those in these situations often put themselves at risk in order to care for the patient.
I think the current guidelines remain appropriate.
Physicians have repeatedly shown themselves willing to risk great personal danger to help the ill. At present, there is no obligation for the provincial government, which is effectively the employer of all physicians to whom this policy applies, to assume responsibility for the safety of physicians whose help is sought in an emergency or to provide disability and life insurance support should they become ill or die in the process of providing care in high risk emergency situations. The CPSO policy should make it explicitly clear that the government owes a duty of care to those from whom it requests medical services. (The same expectation should, of course, apply to all health care providers but, from a practical standpoint, most of those who are not physicians will be hospital employees with contractual insurance coverage.)
The current guideline does not address the issue of risk to physicians and insurance coverage in case of death during an emergency. Yes , the college is here to protect the public. The physician is a member of the public who is taking the risk to address a disaster and should be publicly protected by insurance in case of death or bodily injury , and this should be clear in the guidelines.
The other issue is , to my knowledge, there is no structured physician response team to address any form of disaster . So the systme is depending on volunteering.
Are we not effectively playing the part of an abused partner here? Are we not being mistreated, deceived, ignored, lied to, and coerced by this current government?
It seems so bizarre to be talking now about further extending ourselves, jeopardizing our own health, and potentially our loved ones, to serve this government.
I am not condoning job action, but it would be nice to think that there should be repercussions for the way in which we are being treated.
The policy starts off by saying “The practice of medicine is founded on the values of compassion, service, altruism and trustworthiness”
So if we are supposed to be trusted members of our community, why must the College set an expectation for us to work in a formal policy? We will automatically help out, and let those few who don’t feel comfortable stand down. We are over-regulated as it stands, we don’t need another directive telling us what to do. Let’s have some autonomy back.
And let’s NOT be forced to “provide in accordance with any federal, provincial and local emergency plans”. Sorry but I don’t trust the Health Ministry who is currently taking very harmful unilateral action against the profession in Ontario.
Good policy, appropriately high level.
Read in the light of the Ebola preparedness experience at local health unit level, may I suggest the following addition to the policy
- during an emergency or in preparation for such a possibility, physicians should inform themselves of guidance and directives provided by their local public health unit and/or emergency services, and provincial and federal health authorities as appropriate
In the above example, extensive guidance and advice were developed for practicing physicians such as guidance for screening patients and waiting room management. Individual physicians can adversely affect coordinated action and engender public confusion by for example, posting inaccurate messages on the door of their practice
More generically, could also add –
- physicians of all specialties are best placed to respond in emergencies if they maintain their basic and advanced life support skills
Physicians should be able to volunteer to help in times of emergency.It should be mandatory that at these times the government provides physicians insurance for death and disability as well as clear directions on expectations and resources available . It is the governments duty to provide care to the public in disaster situations .
the new Health emergency now in the news is the “opioid epidemic”. Would like to post some fallacies that are masquerading as facts by the media, and some are making doctors to be the cause of this.
Having worked with hundreds of opioid addicts, what needs to made clear is that the massive greater majority of opioids and almost 100% of the opioids resulting in death, are NOT coming from physicians’ prescriptions. It was different a few years ago but it’s changed. In the last 1-2 years the spike in deaths is almost all due to fentanyl powder (not patch) that is being masqueraded by dealers on the street as heroin and even oxycontin tablets. Its source is mostly China and maybe other countries. It results in overdose because the dealers do not cut it precisely. Mostly put very little into the product with lots of fillers, but sometimes a lot maybe by mistake or on purpose.
Also the people that are dying are almost never in a harm reduction program with methadone. The people that are on methadone do not overdose and die. But the Hoskins gov sees to be on a witch hunt now against methadone programs and wants to push suboxone which is hardly effective against a very intense opioid such as fentanyl. Most patients addicted to fentanyl powder do not respond to suboxone that has a ceiling for its efficacy around 20-24 mg. We see high dose methadone much more effective for retention in program and for stopping illicit use.
Now more than ever methadone programs are needed to combat the deadly addiction. Hoskins is on the wrong path and experts need to warn him of that, before he causes the problem to get worse.
If I am going to risk my life and possibly those of my family I feel it is the responsibility of the provincial government to provide disability and life insurance to ensure my family’s wellbeing if I become disabled or die
As a mature member of the public living west of Toronto & aware of past emergency medical events including SARS, I agree with earlier comments made about ensuring clarity at the local, provincial & federal levels (does the CMA have current guidelines on this subject for reference by OMA / CPSO?). I agree that the doctors who volunteer in or outside their scope of practice, compensation & assurance of coverage in the event of personal injury or legal liability should be established now rather than relying on this or future provincial political parties in power at time of future event.
Thank you for this opportunity to provide comments.
Response in PDF format.