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Given that we will be expected to provide care in a potentially dangerous environment with significant risks, we should be offered compensation both for our services and for any illnesses or deficits that may occur as a result of providing this care. This would include a compensation plan for death or disability. For example if myself and a nurse attended to a patient with a SARS like condition, followed by our deaths from contracting this disease, would not be appropriate that our families both be offered compensation for our deaths. This of course should also include disability and not just death.
Ultimately I believe it would be highly inappropriate not to ask for this compensation especially given that other emergency providers will be given and offered such compensation.
A physician has duties towards his family and his patients. Usually there is no conflict between these duties: you go to work and see patients in order to earn money to support your family. All the duties are in alignment. However, if there is a disaster which “seriously disrupts the functioning of a community or society and results in human, material, economic or environmental losses that exceed a community’s or society’s ability to cope” and which causes these duties to come into conflict with each other, then a physician’s primary duty is towards his own family, not other people and their families. If that means evacuating himself and his family from the area, then that is what he must do.
The current policy reflects this, saying that “…physicians also have obligations to themselves and their families, which may need to be balanced with their obligation to provide care to patients. The College is confident that physicians will use professional judgment when balancing these obligations.” That is a reasonable policy.
The new draft policy says “physicians must provide physician services during disasters and public health emergencies” but qualifies this slightly by indicating that the health of a family member may limit the physician’s involvement to “performing administrative or other support roles”. This is both unreasonable and unrealistic. The main effect of the new wording would be to facilitate complaints by patients and relatives after the disaster is over, that the physician should have prioritised them over his own family.
In this response, for “he and “his” please read “she” and “hers” etc.
“There may be reasons related to the physicians’ own health, that of family members or others close to them which may place limits on the physicians’ ability to provide direct medical care to people in need during a disaster or public health emergency. In those instances, physicians who have a personal health and/or ability limitation must lend support during disasters and public health emergencies.”
While I appreciate that the policy recognizes that there will be circumstances when physicians cannot provide direct medical care, it strikes me as harsh that they MUST still lend support. In a public health emergency, there should be some accommodation of professional expectations when a physician is coping with the severe illness or death of a child or spouse. I do not know how it serves the public good if a physician in such a situation is forced to do administrative work.
Given that British Columbia declared a Public Health Emergency in April of 2016 (i.e. 18 months ago) regarding the opioid crisis, that there is no sign of it being cancelled any time soon, and that there is pressure on Ontario and the federal government to follow suit, the CPSO policy should anticipate such extended (and “no exit strategy”) uses of PHE powers. It remains unclear to this reader whether the opioid crisis even meets the WHO definition as listed in the Terminology section of the policy, but it would be problematic to require physicians to continue to provide services (or allow physicians to practice outside their scope) for *years* in response to political gestures, including for example long queues for essential services triggering a PHE declaration.