Why the complaint process is necessary for the profession

Dina Baras CPSA, Medical Matters, Messenger 13 Comments

This Messenger has several articles related to complaints and complaint outcomes. For that reason, I felt it was a good opportunity to talk about the role the College has in complaints and why it’s a necessary requirement for the profession.

When talking to practising physicians, it sounds as though the CPSA is perceived to spend most of its time on complaints and disciplinary actions. I hear often that a physician’s greatest fear is getting a letter from the College marked private and confidential. I would love to say we want to get out of the business of investigating complaints, but that is just not realistic. We are however, looking at better ways of carrying out this responsibility.

We know the vast majority of physicians are doing excellent work every day looking after Albertans. For those who do get complaints, rarely are those complaints of such an egregious nature that we need to refer the matter to a disciplinary hearing. In 2017, only six of the 826 complaints received were referred to a hearing.

As you know physicians have a unique position in society which is dependent on the trust we have earned as a profession. Part of building and maintaining that trust is through self-regulation. That means we as a profession have a responsibility to investigate complaints and take action when required. We take every complaint seriously and we do our very best to ensure both the physician and the complainant feel they are listened to, supported and treated fairly and honestly throughout the process.

We also recognize that providing health care in a health care system means you can rarely point the finger at one person or one event when there is a concern. We see complaints as opportunities to learn and improve as a profession and a health care system. You can see from the 2017 Complaint Statistics (in this issue of Messenger) that most complaints are related to quality of care and practice management. That is a key reason why the CPSA is developing a more robust Continuing Competence Department, so we can focus on supporting physicians to improve their practice before complaints occur. This will ultimately improve care and protect the public.

The CPSA takes the role of self-regulation very seriously and we know we have a mandate to protect the public, but we also believe this can be done in more ways than simply focusing on discipline. Supporting physicians to improve their practice is an important first step.

I look forward to your comments,


13 Comments on Why the complaint process is necessary for the profession

Don said : Subscribe Mar 13, 2018 at 9:03 PM

The comments here come from doctors so let me put some patient perspective on the issue.  In our experience with the CPSA complaint process ‘self-regulation’ is not working at all.  There was no accountability or transparency and proven facts and evidence were ignored.  When it is clear basic standards of care were not met and the doctor clearly contravened the rules of the HIA the CPSA chose to ignore it.  The CPSA form asked for contact information of other medical professionals who have knowledge of the situation but the CPSA never bothered to contact these other sources of information.  When an investigation was carried out the CPSA selected for their “Expert Opinion” a doctor with a huge and obvious conflict of interest and who is therefore clearly biased.  There will be no accountability, transparency or justice unless the complainant/victim can afford the same legal representation the doctor and the CPSA are provided by the government.  At this time self- regulation has proven to us it is impossible for valid and serious complaints to be handled fairly or justly.  The CPSA process is hugely failing patients.  The CPSA process re-victimizes the patient and makes the patient pay and continue to suffer for the lack of competence, standard of care and ethics shown by the doctor.             

    Sabastine said : Subscribe Mar 11, 2018 at 11:02 PM

    Dear Scott , thank you for kick.-starting this conversation. I believe that is good that we can  self-regulate rather than every case going to the court. In this way  not only do we learn form each case as Scott rightly pointed out, money and time are saved as well when compared with dealing with   matters elsewhere like the court s.

    Having said that, my concern is that, the anxiety physicians face when there is complaint against us is enormous. Some colleagues may say that we do not need to fear if we did not do anything wrong but the issue is not that but fear of unknown. Even if you think you did not do anything wrong, that is your opinion but not the opinion of the college yet or the client in question, that brings the anxiety. This anxiety has adversely affected many colleagues irrespective of the outcome of the complaint . More severe when the outcome is not favourable. Some of these adverse effects ranges from depression, to allowing patients to get whatever they want and so on. I think there is the need for the college to look into this and see if there is a way to reduce the impact. Let’s face it, no physician I know will like to sit hours to reply to a complaint and wait weeks or months again for the resolution. The natural default behaviour is to try to avoid such complaints when we can. This means sometimes letting go our rights and good medicine practice.

    My suggestion is for the college to encourage complainants to first try and settle the dispute within the clinics, hospital or institution the complaint originated from. This the college can do by making mandatory that before they handle any complaint , there should be some evidence that resolution at the  source was attempted but failed. This will help not only reduce the case load at the college but will reduce some of the anxieties physicians face. Of coarse, there could be exceptions to the rule,

    lastly, I feel that physician do not have any forum to complain about patient that abuse them, emotionally or verbally  All we have is to say the we will not see the patient again. But if the table were to turn around, the physician will be disciplined severely. I just feel that it is un-fair

    Thank you all.

      Scott McLeod said : Subscribe Mar 12, 2018 at 4:28 PM

      Hi Sabastine, You have brought up some very important points. We know the process is very hard on physicians as it is on the complainant and in fact it was a point of discussion at our last Council meeting. We are currently in the process of reviewing our support to physicians and complainants throughout the process, so I'll share your thoughts with the Complaints Director. Thanks for taking the time to write in. Scott

        Chemmy said : Subscribe Mar 09, 2018 at 2:23 PM

        It's great to have a self regulatory body that will treat everyone fairly and ideally, members don't need to be scared of being reported to the College if they are doing the right things. It's however unfortunate that some colleagues don't follow the rules of reporting a colleague and they use their influences unduly and unfairly like reporting a colleague about matters that have not been verified. The College indulges such people by meting out judgemental actions before even hearing an accused person at all. It's disheartening to say the least.

          Scott McLeod said : Subscribe Mar 12, 2018 at 1:12 PM

          Hello Chemmy, Your comments are certainly concerning and if you have examples of where the College went ahead with judgemental actions before hearing an accused person's side of the story, please feel free to email me more details so we can look into that. Scott

            riam said : Subscribe Mar 08, 2018 at 6:45 PM

            The college to invest in a system to better weed out frivolous complaints and true allegation of misconduct must be dealt with. We spend alot of time seeing pts and then doing administrative duties for our patients then we are suppose to put our energy into responding to really poor claims.  The college should support docs when we are always under pressure to provide great care to a demanding population.

              Scott McLeod said : Subscribe Mar 12, 2018 at 1:08 PM

              Hi Riam, Thanks for sending in your thoughts. We recognize the vast majority of physicians are working very hard to do their best for patients. We are looking at ways to support physicians as you suggest because we believe that can in the end protect the public and improve the care Albertans receive. We still do have a mandate to protect the public and therefore determining what is frivolous to the public and what is frivolous to physicians may be two different things, but we do keep an eye on this. Scott

                JO said : Subscribe Mar 08, 2018 at 1:16 PM

                I commend the college on its approach of supporting physicians in the first instance and not taking a punitive approach - "We favour an educational or training approach, but apply discipline if necessary". Some other regulatory bodies will "sentence" the doctors even before "trial"- Keep this Mantra, Scott and you d be heading in the right direction. 

                  Scott McLeod said : Subscribe Mar 12, 2018 at 7:24 AM

                  Hi Jo, Thanks for writing in. Scott

                    Frank said : Subscribe Mar 08, 2018 at 1:07 PM

                    I believe it is a good thing that the Profession self regulate itself. 

                    But I have seen a major issue that we have left not addressed, which is Physician bullying. A lot of times frivolous complaints are made to bully colleagues and scare them out of a place. Most times the accused Physician is treated as guilty until proven otherwise. What bothers me the most is that even when the allegations are determined as baseless especially coming from a Physician, there is no process in place to give feedbacks to discourage such Physicians from doing same in future. A lot of Physicians have developed Mental health issues as a result of bullying by their colleagues. These issues need to be addressed.

                      Scott McLeod said : Subscribe Mar 12, 2018 at 7:23 AM

                      Hi Frank. Thanks for taking the time to write in. I agree with you that the complaint process can be used as a bullying tactic and we try to take that into consideration when looking into complaints. If physicians are feeling they are guilty until proven otherwise then clearly we need to review our process. We will take your concerns into consideration as we look at the complaint process in more detail.

                        Rick said : Subscribe Mar 08, 2018 at 12:32 PM

                        My experience is that the complaint process is an industry that employs a lot of people who make $$ because of the complaint process. The growing socio-political environment where patients have zero responsibility and physicians have all the accountability is asymetric and is indicative of a system of administratorship but void of leadership. If physicians were paid for the time they spent to defend themselves it would be more reasonable and also may detract from the endless social vilification that physicians are enduring by proclaiming that a physician's professional time has value. It would also allow for the creation of a metric that can used to gauge the costs of frivolous complaints and the effectiveness of administration to deal with such issues.  

                          Scott Mcleod said : Subscribe Mar 09, 2018 at 9:29 AM

                          Hi Rick, Thanks for sending in your comments. We at the College recognize that some complaints are frivolous, but with any complaint there is still an opportunity to learn from them, both from an individual perspective and a College perspective. We are looking at ways to improve the existing process. Please stay tuned over the next several months. I would be interested to know what you mean by "the endless social vilification that physicians are enduring" and get some examples. The unfortunate reality is that when you have a profession built on trust, it only takes a very small number of people not representing the profession appropriately to diminish the reputation and trust of the entire profession. That is one of the reasons why we need to be very good at self-regulations. Thanks again for writing in. Scott

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