Sharpening our tools

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

The importance of reviewing standards & getting your input

Since introducing a new standard on Marijuana for Medical Purposes, patients have complained about physicians choosing to use or not use marijuana to treat their medical conditions. We also have complaints about physicians billing for assessments and/or form completion before authorizing marijuana. As Complaints Director, my team and I consider the new standard within the context of each individual complaint. Inevitably, even with such a well-written standard, ‘grey’ areas arise requiring judgment.

For example, my interpretation of the standard is that marijuana is but one choice for treating a medical condition. The patient comes to the physician with a medical issue, not a request for a product. Therefore, I see completing an authorization to possess marijuana as an insured service. Physicians should not charge patients for filling out a form for marijuana just as they should not charge patients for filling out a requisition for a CT scan or for writing a thyroid hormone prescription.

I expect to get pushback on this interpretation that may, some day, in the right context, need a Hearing Tribunal to resolve it. I do know this is the interpretation in Ontario, but I need to listen to all feedback to ensure my interpretation is consistent and fair.

This highlights the need to have the greatest clarity possible in our CPSA Standards of Practice, for me and more importantly for the profession.

In 2010, when we migrated from the Medical Profession Act (MPA) to the Health Professions Act (HPA), we consolidated various documents outlining expectations of physicians into ‘standard’ documents. The CPSA Standards of Practicerepresent the minimum standard of professional behavior and ethical conduct expected of all physicians registered in Alberta. We expect physicians to know these standards and to adhere to them as failure to do so is unprofessional conduct. (All standards are all available on the College’s website under Resources.)

Although the transition to CPSA Standards of Practice under the HPA worked well (a testament to the work and skill of those who initially compiled them), time and application of the standards to actual concerns has identified opportunities for improvement. For example, in some instances standards do not fully capture the intent we meant to address. In others, the evolution of medical practice has made some standards outdated. We have also identified the need to split some standards into two (such as the Patient Records standard into one on record content and one on record management) and consolidate others into one (where we found redundancies).

We hope to achieve greater clarity by reviewing the wording of all standards and by creating companion advice documents, where necessary. At its June meeting, Council endorsed a plan to update all the CPSA Standards of Practice. This includes asking physicians for input via our standards consultation process. We are anticipating three consultations per year over the next three years. There will likely be three to four standards to review in each consultation.

I wrote this article for three main reasons:

  1. To reinforce that, as an Alberta physician, you must know about the CPSA Standards of Practice and where to find them.
  2. To encourage you to let me know of ANY concerns you have with the standards at any time. Are there issues you want incorporated into existing standards? Are there any issues you feel warrant a new standard? I will post the proposed 3-year schedule to review standards on our website shortly. If there is a lot of concern with a particular standard, I can adjust the schedule to review it sooner.
  3. To encourage you to provide feedback during the consultation process. Your input is absolutely critical to make sure the CPSA Standards of Practice fairly capture our expectations of each other. We need to ensure they are clear and fair. Having your input as a physician is vital to achieve this goal.

Confucius said, “The expectations of life depend upon diligence; the mechanic that would perfect his work must first sharpen his tools”. The tools are our standards.

I hope you will apply your experience and knowledge in sharpening the standards by taking part in our upcoming standard consultations.

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