Ontario Medical Association (OMA)
Response in PDF format:
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I am writing to comment on the seemingly lack of oversight by the CPSO with respect to recent acts of anti-semitism allegedly committed by Ontario physicians. If the CPSO has taken any action, it is certainly not know by the members at large.
[redacted]
If these are not examples of over-stepping boundaries by the profession, then what is??
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Hello,
As a mature member of the public and a patient in an established group family health team practice in [redacted] since late 2003, I am grateful for my general practice physician and the staff in his group practice.
I think the patient - any age or sex - has an obligation to be prepared for an appointment and to be aware and to respect boundaries.
Useful: yes and with consideration of the Ontario Trial Lawyers Association (OTLA) message.
Reasonable: yes
Issues not addressed: for a patient in ER setting, referral to specialist, other in person interactions with a doctor other than a general practice doctor as well as virtual as introduced during the COVID YEARS. Also with more legal/illegal street drug use becoming more prevalent, it is possible a patient might keep an appointment under the influence which could complicate the doctor/patient interaction.
Further, if patient referred for a consultation with specialist or medical need to attend a walk-in clinic after hours or to ER, those infrequent but important doctor/patient interactions and boundaries should be considered from both doctor and patient perspective.
Ontario Trial Lawyers Association (OTLA)
College of Nurses of Ontario (CNO)
Thank you for the opportunity to review and provide feedback on the Boundary Violations policy, the Delegation of Controlled Acts policy and Advice to the Profession companion documents. Overall, we found the documents to be clear, comprehensive and relevant. The information shared in all documents provide important accountabilities for physicians that will serve to protect the public from harm.
Please see below considerations that may support your update of these resources.
Boundary Violations policy
Our feedback relates to “non-sexual boundaries”. The focus on sexual boundary violations is very clear however, the “non-sexual boundaries” content at the end of the policy is less clear. There is content in the Advice to the Profession document that you may consider adding to the policy to create a better understanding on “non-sexual boundaries”. For example, in the “Background” section from Advice to the Profession it includes these two statements which may also be appropriate in the policy:
‘…a physician must only act in the patient’s best interests and must take responsibility for establishing and maintaining boundaries within a physician-patient relationship.’
‘If physicians do not do this, individual patients may be harmed and the public’s trust in the medical profession may be eroded.’
Thank you for the opportunity to review.
Professional Association of Residents of Ontario (PARO)
Dear CPSO Policy Department,
Thank you for the invitation to provide feedback on the CPSO Boundary Violations policy draft.
We found the draft policy and advice to physicians to be very well written and very much reflective of the College’s mandate to protect patients. We have reviewed the document and do have some suggestions.
Guidance on digital and virtual care boundaries in this policy is missing, such as the expectations around texting, social media, or use of patient messaging platforms like MyChart and virtual appointments. As virtual care is a large part of the healthcare system now it would be important to include information regarding this in the policy.
Also missing in the policy are clear expectations for physicians supervising medical learners and the boundary standards in these situations, for the physicians, medical learner and patient.
Finally, in the Endnotes the 'minor care' exemption is vague and open to interpretation. Clarifying this with a more detailed definition or specific examples (eg. wart removal, brief walk-in consults, etc.) could help reduce potential misinterpretations.
We once again appreciate being included in the CPSO's consultative process.
There are many older male physicians who have been practising for over 30-40 years and having been doing breast exams or prostate exams in checkups with similarly older patients without chaperones for years in the past without any discomfort to the patient. Often asking such a patient now if they would like a chaperone for their breast exam or the prostate exam each time this scenario occurs may create a more uncomfortable environment. The CMPA recommendation in these scenarios to say 'Is it ok " to do the exam before starting makes a lot of sense.
I realize wording is difficult in writing policy but the current wording of "must" as in -
must give patients the option of having a third party present during an intimate examination-
could be replaced by "should" in some situations depending on the context of the situation.
Please consider special risks of boundary violations to disabled persons
