Recently, Associate Minister of Health Brandy Payne announced financial support for the application by a group in Edmonton to establish safe consumption services for drug users. Informed by the success of Insite in Vancouver, a proposal to provide this form of harm reduction also received unanimous support from the Council of the College of Physicians & Surgeons of Alberta in September. This is truly an evidence-based public health initiative, and I applaud Minister Payne and our Chief Medical Officer of Health, Dr. Karen Grimsrud, for their leadership.
Just a couple of days earlier, the CPSA hosted a forum on opioids in Edmonton where, with our partners, we identified 5 key goals to address the opioid crisis.
- Focus on appropriate prescribing
- Seek additional emergency (rescue) interventions for patients in crisis
- Address addiction treatment
- Explore other options for pain treatment
- Seek access to more data and information
The entire event was recorded and a webcast of the proceedings is available on our website. I encourage you to watch the forum and look forward to hearing your feedback on our draft Standard of Practice on Safe Prescribing.
Referral Consultation Standard of Practice
Dr. Michael Caffaro has become the point person for feedback and response to the implications of this revised Standard of Practice. Mike is responding to the comments on our blog, and I encourage you to read the back and forth.
I am surprised that we are now getting such pushback when the consultation – completed between April and June – resulted in so little feedback. As we want our standards to strike an appropriate balance between serving patient needs and setting reasonable expectations, we make a concerted effort to solicit input on draft documents. For the Referral Consultation standard, we included the following:
- A specific request to section heads at the AMA, asking for their feedback.
- A mass email to all members
- Two Messenger articles (April and June)
- Posts on Twitter
- Notices in the AMA’s MD Scope and the Alberta College of Family Physicians web news.
I point this out because the revised standard is now approved. Short of another revision, and the process that accompanies any standard revision, this is (as of January 1, 2017) the Standard of Practice. Only College Council can change it, and that process takes time.
Two messages from this experience are worth stating:
- Members who don’t want to find themselves saying “Holy Cow, look what the CPSA has done” may want to pay attention to the draft standards and draft revisions when they come out.
- The revised referral/consultation standard will become operative January 1, 2017. That means Alberta physicians have less than 2 months to look at their referral and consultation processes and ensure compliance with the new standard.
This is the time of year we begin notifying members of the need to renew one’s practice permit and complete the Registration Information Form (the RIF). We’ve been working hard to reorder and simplify the RIF, and to include only that information which we need for our work.
On that front you will find that we no longer ask whether you have had a civil lawsuit launched against you or whether a finding was made against you (or a settlement made). After a two year trial, we found the information not valuable and a significant drain on resources . Our Professional Conduct staff found little value from the information gleaned from such reporting, and the work of following up, asking questions and seeking further information was significant, and disproportionate to the usefulness of the information.
As to the annual fee, it will remain at $1960, as it has for the past five years. However, we are no longer collecting $150 per year for a building fund. That means that the entire annual fee of $1960 will go to College operations.
Two items of a certain age came to my attention recently.
The first is that of so-called “Conversion Therapy”, psychological treatment or spiritual counseling designed to change a person’s sexual orientation from homosexual or bisexual to heterosexual (so says Wikipedia). I’d heard of this as a young physician in the days when any gender identity other than heterosexual was considered deviant; I’ve never heard of it being practised by medical professionals in Alberta.recent article
It was brought to my attention by a recent article published in the Journal of Medical Regulation and by an inquiry from our Ministry of Health. The Ministry official was concerned that such therapy might be offered in Alberta by physicians and, if so, wondered what stance the CPSA would take.
I assured the official that I was not aware (and have never been aware) of physicians in Alberta offering or promoting such treatment, and assured the official that the College would consider the offering or promotion of such an approach to be improper, unethical, unscientific and unprofessional. In short, we would take action against a physician who we found to be offering or promoting such practice.
The second item is that of female genital mutilation (FGM), sometimes known as ritual cutting. While the exact practice varies, it generally involves removal of the clitoris and portions of the labia, resulting in a tiny vaginal introitus, and is usually performed on girls prior to puberty.
The specific question put to me was this: Should physicians who see children who’ve been subjected to this procedure be reporting suspected child abuse to appropriate authorities?
The relevant legislation (the Child, Youth and Family Enhancement Act) says that a child is in need of intervention if there are reasonable and probable grounds to believe that the survival, security or development of the child is endangered because…(2(h)) the guardian of the child has subjected the child or is unable or unwilling to protect the child from unusual treatment or punishment.
In our society, allowing – or subjecting a child to – a mutilating procedure like FGM is clearly and obviously unacceptable. As the child’s welfare supersedes any cultural justification for such practice, two conclusions come to mind: the first is that physicians who see a girl who’s been subjected to such a procedure should report to child welfare; and the second is that no physician should be complicit in such practices. What I mean by the latter statement is that no physician should perform such procedures, irrespective of cultural norms in other societies, and no physician should be complicit in allowing such procedures to go ahead (if, for example, the physician is consulted by the parents about having the procedure performed, either by the physician or an unregulated person). And, finally, in compliance with the relevant legislation, physicians should report to Child Welfare any child who has been subjected to such abuse.
I welcome your comments