On or Under the Bus

College of Physicians and Surgeons of Alberta Messenger, Professional Conduct Parapet Leave a Comment

I received valuable feedback on my March column about physicians’ responsibilities in preventing follow-up care failures. Thank you to those who responded! Most of the feedback came directly to me rather than via the website; the majority was positive, reinforcing the importance of physicians adhering to this Standard to provide high quality patient care.

Positive comments suggested the College should go beyond reinforcing just the expectation for managing critical results to reinforcing the College Standard on consultation completion – apparently an even bigger issue amongst the profession. I was told this Standard has an even lower compliance and a greater negative impact on patient care. Good advice. To remind everyone, in the Referral Consultation Process Standard the expectation is:

13. A consultant or service must respond verbally or in writing to a request for a non-urgent consultation from a referring physician within thirty (30) days of receipt of a request.

I also received one negative comment that gave me pause to contemplate metaphors. The concern by one physician was that reporting a colleague to the College for non-availability for a critical lab test, is akin to ‘throwing them (the colleague) under the bus.’ I wondered what this meant. According to Wikipedia, ‘throwing under a bus’ means “to sacrifice another person (often a friend or ally), who is usually not deserving of such treatment, out of malice or for personal gain”. I doubt this is what was meant.

Besides, this is not what I am suggesting be done. Rather than throwing someone under the bus, I would suggest that asking colleagues to adhere to Standards is akin to asking them to join the profession on the bus. The bus of good patient care!

Maybe the better metaphor comes from Jim Collins in his book Good to Great wherein he highlights the importance of getting the right people on the bus, on the team. For those who have not read this book, Mr. Collins also talks about Level 5 leadership and the importance of focusing, something he calls the hedgehog. Be it in my clinical practice, my administrative roles or here in my College role, I remain convinced that the overwhelming majority of health care professionals have this sharp hedgehog focus on doing what is best for patients. The lengths people go to at times to provide high levels of care in spite of obstacles in their way, is awe inspiring.

I do not disagree that a College complaint or a College “Big Brother” approach to monitoring is at the end of a spectrum. The College, at the end of the day, is each of us who has been given the privilege to be a self-regulating profession. In a manner, each of us is the College.

So, what can you do? On the macro side, review Standards to ensure they reflect what we expect from each other. On the micro side, have those respectful conversations (focusing on what is best for patients) with colleagues about Standards and expectations. I believe this is the way forward. If this gets you nowhere and patient care is suffering, the offer remains that, on behalf of the profession, I would be happy to have such a conversation, be it formally or informally.

Leave a comment below or email me at owen.heisler@cpsa.ab.ca.