Discrimination has no place in medicine

College of Physicians and Surgeons of Alberta CPSA, Latest News, Medical Matters, Messenger 21 Comments


Two weeks ago, when I originally wrote this article for the July Messenger, I intended to address the concerns we all feel about systemic racism and discrimination in health care. Since that time, CBC has written two stories about an incident in Grande Prairie. Regardless of the timing, I’d still like to share my thoughts on how all of us can reflect, and move forward. In fact, it’s more important now than ever.

First and foremost, CPSA acknowledges our management and response to the QEII incident was significantly delayed. Although we are bound by the Personal Information Protection Act (PIPA) and cannot comment on details of the situation, we can acknowledge we moved too slowly.  Let me say that we do our absolute best to not pass judgement until we have all the facts. That is part of the reason we need to take our time. However, we did not get the balance right in this case.  We take ownership for this error and have enacted plans to improve our process moving forward.

Thank you to the physicians who shared their feedback with us about this incident. We appreciate your honest input to help CPSA do better in the future.  As a regulatory body that supports physicians in their continuous development, it’s important that we look at how we can do better as an organization. One of CPSA’s core values is continual learning, it’s important that we reflect on our own processes to acknowledge where we must do better in the future, for Albertans and physicians alike.

After hearing about many experiences people are having in health care and hearing your concerns around the Grande Prairie incident I’m left feeling both concerned and aware that I need to start a conversation with our profession about discrimination. We need to recognize that everyone has a bias, and unless we talk about it and educate ourselves, these harmful biases will continue to be expressed both consciously and unconsciously.

CPSA is not the only player in Alberta’s healthcare system; however, I can assure you that we will strive to improve by recognizing and addressing our own implicit biases and reducing the time it takes to address complaints. We can’t fix this just by using our disciplinary authority over doctors who receive complaints. We need to address it every day in all that we do.

As CPSA looks honestly at our own practices and commit to change, the entire medical profession should also work to protect the public and healthcare workers from discrimination in healthcare.  Wherever we encounter discrimination of any kind, our goal is to be a proactive part of the solution.  We are so incredibly fortunate to have a team of talented physicians from every background providing exceptional care in Alberta, and as the CMA Code of Ethics and Professionalism mandates, physicians must treat our colleagues “with dignity and as persons worthy of respect.” We also can’t forget this includes patients as well. The code goes on to say “Always treat the patient with dignity and respect the equal and intrinsic worth of all persons.” We all should take this seriously as guidance to live and work by.

I’m calling on all physicians to help be a part of the solution. Learn about discrimination, talk about it, evaluate ourselves andmost importantlywhen you see it, speak up and stop it. Rather than ostracizing and passing judgement on your colleagues when you witness it, start a proactive conversation. If that doesn’t work then bring it to someone’s attention. Physicians are leaders in society, and we have an enormous impact on how society behaves. Of course, all of us, including CPSA, make mistakes. Let us look at our own actions with clear eyes, and all continually strive to make healthcare more equitable, more inclusive and more just. I can assure you the CPSA will be doing that.

Your comments are appreciated.

Scott

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Henry Ogbuehi

Touched by the humane perspective of this write up. So consoling that such issue would be discussed in the medical community.
Thanks Scott!

Scott McLeod

Hi Henry,

Thanks for reading and commenting—I’m glad you found my message meaningful. No matter the industry, this is an important and crucial conversation we all need to have. I’m glad we could help get it started and thank you for joining in on the conversation.

All the best,
Scott

Anas Benmokhtar

The “presumption of innocence” is one of the most important rights in our justice system. In my opinion, it is a good opportunity to increase awareness and the same time we should not assume that the accused is guilty while the investigation is pending. The evidence collected in the conventional crime scene ends up with numbers called the probability. in order to get a number with good predictive value you need more than a single act of potential discrimination by the same person, then you do the math of the probability of occurrence of multiple independent variables and you end… Read more »

Rajesh Sood

Dr McLeod, Our health minister is on a crusade. He is motivated by the desire to shake up healthcare and end doctors self regulation. His motives don’t excuse the fact that the college has mishandled this case to the detriment of the profession. In essence the CPSA was unable to investigate a matter where the accused confessed in writing to his infraction? Sir the college is now on trial. This case is public knowledge and frankly a PR disaster. Any reasonable person would ask why it took over 3 years and ministerial intervention to address this seemingly straightforward matter. Some… Read more »

Scott McLeod

Hi Dr. Sood, Thank you for taking the time to read Medical Matters and share your thoughts with me. I want to assure you and all physicians that we are taking this matter seriously. CPSA recognizes we did not do our best in managing this situation, and we will learn from this and do better moving forward. Because we are bound by legislation not to publicly share information about complaints and investigations, the story as presented in the media does not reflect the entire story and I urge you not to assume CPSA has dismissed this situation or intentionally dragged… Read more »

Rajesh Sood

Mr McLeod, Thank you for the reply. I sincerely hope the minister will respect the processes at the CPSA and not undermine it’s mandate by investigating in parallel or using his ministerial powers to render punishment without involving the CPSA in due process. I trust that once this investigation is concluded the CPSA will publish a detailed report as you do for other cases. I am sure you will agree that the extra publicity afforded to this case requires a more detailed report once all matters are concluded. Lastly I hope the College will do their upmost to rehabilitate Dr… Read more »

Stanley

Open conversation is good. The “incident” in Grande Prairie was a racial incident and the unsatisfactory response to it was a result of racial bias. Our college responds to complaints from the public and physicians with alacrity (as it should). The delay by the CPSA in addressing what happened in Grande Prairie suggests a bias in its response to the nature of the incident and this in turn begs the question, why the bias? Without passing judgment we can and should openly acknowledge that we are talking about an apparently racial incident and racial bias in the various responses. If… Read more »

Scott McLeod

Hi Stanley, Thanks for taking the time to read and comment. One of the many conversations I’ve had following the recent media attention of this incident was about recognizing not only the implicit biases we all hold, but working to identify why we hold those biases and working to stop them. You’re absolutely right that this is a critical part of ensuring health care in our province is safe, inclusive and welcoming for all. CPSA recognizes its shortcomings with the handling of this situation with regret and is committed to doing better in the handling any future cases (one means… Read more »

Pauline Alakija

Dear Scott, Thank you for this honesty and courage. This is a great start. I note that CPSA Council will be discussing this at the next meeting on July 15. I am wondering how CPSA can have a productive And meaningful conversation about such an incident without any black or African heritage physicians at that Council table.

Scott McLeod

Hi Pauline, Since we published this article last week, many physicians have reached out to CPSA to share their own stories of experiencing discrimination in health care and in their personal lives. I agree that hearing from physicians who have experienced discrimination and systemic racism firsthand is very important to CPSA better understand this issue and recognize how we can help influence change. The upcoming special Council meeting is a preliminary step in identifying how we can effectively capture these experiences and stories, and once we’ve done so, develop a plan to address and work to eliminate systemic racism and… Read more »

Pauline Alakija

Thank you Scott. I am very happy with that answer. I hope all Council members come to the meeting with open minds and empathy for what many doctors and patients have endured. Many people have been harmed by racist/sexist treatment, and then harmed again because nobody listened to them, or acted in their defence.

Anne

Scott McLeod: here is a link to a weighty article from the NYT. I think you and the CPSA could learn a lot from it. No more excuses from the CPSA.

https://www.nytimes.com/2020/07/01/magazine/isabel-wilkerson-caste.html

Scott McLeod

Hi Anne, Thank you for sharing this powerful article with me. The analogy of likening systemic racism to an old house gives a very thought-provoking perspective, highlighting how true it is that “Ignorance is no protection from the consequences of inaction” and how “any further deterioration is, in fact, on our hands.” We can’t be blind to the fact that systemic racism does occur in Canada, Alberta and in medicine. Each and every one of us is responsible for our actions and the way we treat others. We all need to educate ourselves, recognize our biases and take appropriate steps… Read more »

Unati(Snathi) Makiwane

Hello Scott, Thank you for this update and acknowledging there was some delayed response to the GP incident. I’m of African descent and will speak from a place of experience. Discrimination and Racism exist here. Very loud systematically and amongst colleagues and towards patients from minority groups. Moving forward, I suggested to a group of over 8k colleagues, we need to start engaging deeply, vulnerably and bluntly about this matter because I believe Canada could do better. I suggested we need to start having mandatory Diversity and Cultural CMEs and communication skills to understand and appreciate cultures in the profession… Read more »

Scott McLeod

Hi Dr. Makiwane Thank you for reading this month’s Medical Matters and taking time to write in. I appreciate you sharing your experiences with me. I’m glad to know Alberta has physician leaders such as yourself who are taking the initiative to start these conversations with your colleagues and put forward suggestions to improve health care as a whole—for physicians, fellow healthcare workers and patients alike. I agree that open and honest conversations about bias and discrimination need to take place in order for people to acknowledge and learn how we can do better. Thank you for the work you’re… Read more »

Noel Corser

Really appreciate your note Scott. To promote conversation around this: Racism (or sexism, etc) = stereotyping (seeing an individual as “black” or “woman” rather than as their individual self). This is not, by itself, bad. Treating an individual badly, because of their “category” (black, female, First Nation, gay, alcoholic, you name it), is what makes racism bad. But treating an individual, as their individual self, badly is also generally considered wrong. Perhaps that old phrase “treat others the way you’d like to be treated” makes a lot of sense? If we’re biased toward treating some groups badly, we should go… Read more »

Scott McLeod

Hi Dr. Corser, Thank you for your comment and sharing this helpful perspective. You’re absolutely right that it comes down to treating others the way you’d like to be treated—everyone is deserving of dignity and respect, period. I agree that uncovering why we have biases is an important part of recognizing the harm we may be perpetuating both consciously and unconsciously in our work and personal lives. This is a crucial conversation we all need to have and I thank you for contributing to it. I’m hopeful more of these productive conversations will occur amongst our colleagues. As much as… Read more »

Tom Sinclair

As a physician in Alberta, I appreciate the candour of your letter and the CPSA owning up to the errors in management of the complaint concerning this alleged racist act in Grande Prairie by one of our colleagues. It is important for us physicians in Alberta to have faith in our regulatory body. Acknowledging errors helps to reaffirm that faith. Yes, we all need to be aware of our own failings, biases and prejudices. We must acknowledge and confront them honestly. Unfortunately, we appear to be living in a toxic society where leaders, governments, organizations, and individuals all too often… Read more »

Scott McLeod

Hi Dr. Sinclair, Thanks for taking time to comment and share your thoughts. The first step in driving change is accepting accountability and committing to do better. I’m glad CPSA taking accountability in this situation has helped reaffirm your faith and trust in what we do as a regulator. I agree that we all need to work to educate ourselves and recognize our own inherent biases if we ever want to do and be better. We also need to hold our colleagues accountable and help educate them when we see and hear discriminatory actions and words. I hope in starting… Read more »

Dr. Joanne Tse

Excuse my ignorance, perhaps I am not following the news closely except for COVID, please send me the link to the incident in Grand Prairie so I can understand mire about the situation. Thank you

Scott McLeod

Hi Dr. Tse,

Thanks for taking the time to read Medical Matters and for writing in. Below are links to the CBC articles mentioned above:

https://www.cbc.ca/news/canada/edmonton/alberta-health-minister-review-noose-grande-prairie-hospital-1.5636090
https://www.cbc.ca/news/canada/edmonton/alberta-health-authorities-failing-doctors-public-with-response-to-2016-noose-incident-experts-1.5641340

If you have any other questions, please let us know.

Scott