Doctors object to ‘vague’ patient-first principle

In an apparent first for Canada, the country’s largest medical regulator has drafted a patients’ bill of rights, but some doctors are objecting to its “vague” assertion that patients’ needs always be made paramount.

That and other rights outlined in the proposed Ontario College of Physicians and Surgeons’ document could create unrealistic expectations, some physicians suggested in feedback on the proposed manifesto. “A patient reading this could call the college and say, ‘My doctor didn’t put my needs first. I needed an hour and only got 10 minutes,’” one critic says. “Clarification is necessary.”

One commenter asks if always putting the patient first means “I will open up the office on a day the office is closed to accommodate this patient’s schedule … or bend backwards to accommodate the repetitive verbal abuse at staff by an uncompromising patient?”

Another physician simply called the outline of rights and responsibilities “ridiculous,” and added it fails to respect medical professionals.

Some medical associations, patient groups and hospitals have created patient bills of rights in the past, but the college’s report would appear unique in that it comes from a body that governs and disciplines physicians.

The three-page list says patients have a right to be treated with dignity and respect, reject certain treatment if they disagree with it, be free of sexual advances and not face requests for personal favours or loans. As part of a professional relationship, patients should not even receive invitations from physicians “to their house for coffee.”

The document stemmed from the college’s efforts to combat sexual abuse of patients. But in putting together a statement that could be readily absorbed by the public, the agency decided to broaden the scope beyond just sexual misconduct, said Dr. Carol Leet, the regulator’s president.

While colleges in other provinces have done some work in the area, Ontario appears to be first to release such a document.

“The more information the public has that’s easily understood, the more empowered they are and the less likely it is that someone is going to try to cross those boundaries,” she said.

The document is only a draft now, and may have to be adjusted in response to feedback, Leet said.

The catalogue of almost 50 patient rights and doctor responsibilities begins with relatively basic statements, such as that doctors will “always put your needs first,” and “treat you with dignity, courtesy and respect.”

It goes on to address possible unprofessional behaviour, saying doctors must never talk about their personal problems or sexual activities, ask for money or make physical contact that is not medically necessary. Another section says doctors must explain the reasons for “physical or intimate” examinations and allow a third party to be present if asked.

A patient advocate said Thursday the document is positive as far as it goes, but neglects the most widespread concerns patients have about poor service.

The statement appears to address almost entirely the kind of serious misconduct the college handles in its disciplinary process, said Sholom Glouberman, founder of the Patients Canada advocacy group.

Those are important issues but affect relatively few patients, he said. The document does not tackle much more common issues for patients, such as receiving speedy, polite service.

“It’s all about what doctors shouldn’t do, rather than what doctors should do to improve relations with patients,” Glouberman said. “It says nothing about same-day service, it says nothing about patients being able to access doctors through email, it doesn’t say anything about the doctors being there for the patient.”

Some of the physicians who submitted comments, though, worried about unintended consequences of the rights package, which says patients can contact the college any time they have questions or complaints about their MD.

Others suggest doctors are hampered in offering the “bestquality health-care possible,” the second listed right, by the system’s limited resources.

“The (health) ministry keeps cutting our fees and the (college) keeps raising the expectations,” writes one.

“Is this dichotomy between resources and expectations sustainable in reality?”