Try to imagine a program that gave you individualized (and group) feedback about your practice – an amalgamation of PAR results, your IPAC (office infection prevention and control) review, your prescribing practices report, and other data – in a way that helps identify where you’re doing very well as compared to peers, and areas of practice where perhaps you’re not doing as well (or, at least, deserved a deeper inspection of your practice). What additional information or feedback would be helpful to you?
Last month I alerted you to the impending changes to our continuing competence program. We are serious about bolstering our competence work to make sure that practicing physicians are competent and performing well. We’re also very serious about incorporating your feedback into our work.
Your first opportunity to provide us with advice and feedback will be our practice review survey, coming in late June. For more details about the survey and the resulting pilot design process, see the article “We Need Your Feedback” in this issue of the Messenger.
The Supreme Court of Canada decision in Carter v. Canada has caused shock waves in medicine and in governments across Canada:
- Many organizations, including the Canadian Medical Association, which very early on identified and generated dialogue about this issue, are stepping up to provide guidance for physicians
- Some physician groups and specialties, most notably palliative care physicians, have staked out positions.
- Governments are either planning what steps they might take or turning to the medical regulators – the Colleges of Physicians and Surgeons in this country – for direction.
- The regulators, including this College and its Council, are developing frameworks (what are the issues we must address?) and mapping our plans for developing our policy framework and its subsequent roll-out.
At its meeting at the end of May, College Council received a legal analysis of the Carter decision and reviewed the literature as well as a policy paper that framed the issues we’ll have to address. Staff laid out a process plan, mapping the steps needed to provide direction to our members. While some will be embedded in Standards of Practice; much will be in an advice document.
Both will benefit from consultation and feedback but, because of the formal consultation process we use in developing and modifying Standards of Practice, we expect the advice document to precede the Standards by many weeks.
In my analysis, the following standards will require review (and, perhaps, revision):
- Informed Consent
- Moral or Religious Beliefs Affecting Medical Care
- Patient Records
- Assessing the Mental Capacity of a Patient
Consent will require, in my estimation, the most specificity– how much detail must it contain? Over what period of time must the consent be sustained? How many physicians must be involved in the consent process?
While the SCC decision made clear that physicians cannot be coerced into assisting a patient seeking death, it will be important that the College reviews its Standard of Practice on Moral and Religious Beliefs Affecting Medical Care if only to ensure it adequately addresses the challenges that physicians will face.
Physicians who participate in PAD will need to carefully document their interaction with the patient seeking assistance in dying – documenting the consent discussion, documenting the options presented, documenting the patient’s request, and so on.
Finally, the public and patients we serve will want to know that there is credible oversight of this process. Where will that happen? Who will provide the oversight? What reporting will be required?.
Will we be ready for February 2016? I suspect not completely, but I also think we will have our advice document well in hand by that time, so that the public will know we’re getting prepared and the profession will know how the College is thinking about physician-assisted dying.
Continuity of Care
For as long as I can remember – and I graduated from medical school in 1974 – physicians have had a duty to be available to their patients after regular working hours.
A short time ago, Council approved the revised Standard of Practice on Continuity of Care which reiterates the professional duty of physicians to have a system in place to provide after-hours access for patients and to ensure a physician or ‘surrogate’ is available to respond to critical test results.
The CPSA was complicit in physicians failing to follow the standard: we didn’t take sufficient steps to ensure our members complied. Well, that has changed.
Over the Christmas break we randomly called about a hundred offices in Alberta after hours– rural and urban; family physician and Royal College specialist. Only one-third had a message that met our requirements.
That has to change. That will change. Kudos to those already providing after-hours access and support. For the rest of you, now is the time to make the necessary changes.
As always, I welcome your feedback below or by email.