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The College of Patients July 25, 2006 ---------------------------------------------------------------------- On the Western Front Michael J. Schweitzer ---------------------------------------------------------------------- Amongst the first lectures we received in medical school were several on the topic of practicing as a physician in Ontario. These lectures introduced us to such concepts as billing, malpractice, appropriate professional behaviour and, most importantly, to the College of Physicians & Surgeons of Ontario (CPSO). To provide some background - medicine, in Canada, is what is called a self-regulated profession. Under the aegis of some vague sounding principles, medical professionals are expected to control their own professional behaviour and be responsibly for disciplines those doctors who are not performing up to snuff or in an inappropriate manner. This job, in Ontario, has been relegated to the CPSO. What this means is that, despite its friendly-sounding name, the CPSO is not an organization that is dedicated to helping doctors. Rather, it's mission is to weed out the bad apples and ensure that if we doctors regulate ourselves strictly enough, the government won't get any ideas about doing it for us. As the lecturer who told us about malpractice insurance said: "The CPSO is not your friend, no matter how hard they smile and tell you they are." They even publish a magazine full of their activities and the recent decisions of the Discipline Committee called "Dialogue" even though, as I read the magazine, I don't really feel I'm part of the conversation. The way it works in Ontario, any patient with a complaint or grievance against a doctor can file a formal complaint with the CPSO. Now, don't get me wrong. I am in no way against finding and punishing those doctors who abuse their trust or perform incompetently. It's just that, like people registering in the emergency room, they're no filter, no "Listen, that's a stupid thing to complain about. Don't worry, just go home." Any complaint that the patient insists on making gets investigated and, because of privacy issues, all the doctor knows (and the public if they check out his standing on the CPSO website) is that there's a complaint against him. Who wouldn't think the worst of such a situation? It recently occurred to me, however, that there is a need for reciprocity. Yes, a patient should have a right to complain about a perceived poor medical encounter. But what about us doctors? Who can we go to if we've just been verbally abused, threatened or assaulted? No one! Until now. I would therefore like to propose the creation of a new government body. It's high time patients took responsibility for their behaviour in medical settings. Imagine the time I take in the morning to make sure I'm neatly and professionally dressed only to have to face an onslaught of plaid and two day old underwear accompanied by the odour of Tim's coffee and nicotine. Is that fair? Well now doctors will have a place to complain to. The College of Patients (COP) will serve to help the public regulate themselves in their capacity as patients. It will have some lay people on staff, of course, along with doctors in many of the important positions. The first job of the COP will be to develop guidelines on how patients should behave in medical settings in terms of appearance and attitude. It can develop countless guidelines on how patients should approach their physicians. But most importantly, it will have a Discipline Committee all of its own! Yes, imagine you're an ER physician and have just seen a particularly unpleasant patient in the ER. He smelled, he swore and he admitted he didn't take the pills his family doctor gave him which is why he wound up in the hospital. You wonder what you can do to relieve your stress and also make the patient appreciate the inconvenience he's just put you through. Now you can. Just call the COP and refer the patient to the disciplinary committee. From there the patient will need a lawyer. Fortunately, the COP will have the services of the Canadian Malpractice Protection Association (CMPA) and the lawyers will certainly be motivated. Usually they have to defend doctors against various insinuations. This time, they get to go on the offence! The patient just mentioned will have defend himself from charges that his actions were unbecoming of a patient and that would be regarded by the lay public as unprofessional. Then he would have a penalty administered against him, like having his OHIP card suspended for a period of up to six months or a ridiculous penalty that's clearly motivated to line the COP's pockets. Finally, the COP would have its own magazine, "Monologue" because frankly, we don't care what you think. We just want to dish out the goods on the patients that crossed us. Okay, it's a crazy idea but I'd love to see people's faces when they get their first threatening "If you don't pay your dues to the COP by next Tuesday, your OHIP membership will be suspended" in the mail. |
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