Who Are You Going to Call? CPSA!

College of Physicians and Surgeons of Alberta CPSA, Latest News Archive, Medical Matters, Messenger 30 Comments


I would like to share a short story that raised several concerns for me just before Christmas. On Tuesday, Dec. 24 at around 11 a.m., a woman called CPSA upset because her mother was being denied a prescription for her pain medication. In her words, the doctor said, “CPSA would come after him if he prescribed any opioids.” According to her, they were told if they want a prescription, they would have to go to the emergency department.

Not only would it be an inappropriate use of the healthcare system to send the patient to emergency, this type of practice does not support the concept of the patient’s medical home.

Now, I realize this is only one side of the story, but it didn’t surprise me because it’s not the only time I’ve heard a story like this.

Since I had only the one side of the story, I wanted to be sure the doctor was aware that CPSA would not “come after him” so I gave him a call in hopes of reassuring him that he would be okay to prescribe this patient her pain medication over the holidays.

As I expected, there was more to the story, but it was clear the physician had provided care to the patient in the past and was aware of her chronic pain needs. It was Christmas Eve and it seemed reasonable that he provide a short-term prescription for follow up after Christmas, so I reassured him CPSA would not be coming after him. I assured him that I would make a note of that on his file. What surprised me at that point was that he had already called the Canadian Medical Protective Association (CMPA) to ask for legal advice. According to him, they had recommended he not provide the prescription.

Over the past few years, I’ve been very impressed with the quality of information CPSA advisors provide to physicians, so I suspect there is more to that part of the story as well. What amazed me though, was the fact that the organization he chose to reach out to was CMPA, not CPSA.

It’s not my intention for this anecdote to come across as a negative comment about this physician’s choice to contact CMPA. Rather, I am sharing this story because of what it tells me about the approachability of CPSA.

Last year I shared with you CPSA’s new logo and brand, and what it represents. I discussed how this was not about a change in a logo or the work that we do, but a change in how we do things. Our goal is for CPSA to be understood as transparent, approachable, informed, thorough, collaborative and consistent in our work—something our whole team works towards each and every day.

My conversation with this physician confirmed to me that this change was necessary and I believe that CPSA is headed in the right direction.

If a physician’s first instinct is to call their lawyer instead of CPSA when they are unsure of best medical practice, CPSA is not very approachable. CPSA should be the place both physicians and Albertans think of first to call for advice, which is why we are committed to doing things differently.

We envision a future where CPSA is the first call people make to get the advice, guidance and support they need when it comes to the practice of medicine in Alberta.

Your comments are appreciated.

Scott

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Jane Lemaire

Thank you Scott, and I appreciate your leadership! This is an important narrative. It is good to hear that the College is committed to doing things differently and wants to be a source of support and guidance.

Graham Hunter

One of the reasons that many may harbour animosity to the CPSA has nothing to do with any issue at hand, but to do with its website. In this modern age of digital technology the website is the “face” of the College, not the registrar. We do not deal with him; we deal with the website. The CPSA does not seem to have realized that. Therefore, the people controlling the “face” of the College are the people working in the “Communications Department”. I would suggest that these people are entirely unsupervised and that the College has permitted a website of… Read more »

Graham Hunter

I have read the comments and I am party to those who view the CPSA with suspicion. This is based on 40 years of experience. My own, long-time, now retired, physician once told me , “The College is not your friend.” When I first started practice the CMPA approached us and asked if we wanted CMPA services to extend to defence against our provincial regulatory authorities. (At the time the CMPA was only helping us with civil litigation launched by patients.) I was one of the many who said “Yes”. I am glad I did. I think it was one… Read more »

Graham Hunter

The final, and perpetual, insult, is, of course, the fact that the “Communications Department” leaves us a postage stamp space to write our comments so that we cannot clearly review them before sending. This is an insult that is repeated year after year.

Graham Hunter

And if you phone an office directly you are likely to get a message that the person is away from his/her desk. But when you contact the CMPA you always get through to a physician advisor. Your call is more important to the CMPA than to the CPSA. The CMPA is, after all, a business, while CPSA is not. The difference in the degree of “professionalism” exhibited by both entities is staggering.

Mary Ellen McColl

I think it will take a long time to restore any semblance of “ caring” from the College. I applaud your first steps on this long journey.

Jonathan Stevens

I was disappointed with the implication that the Physician was calling a Lawyer rather than CPSA. CMPA, to my understanding uses physician advisers in preference to Lawyers when appropriate and aims to support good safe practice. I would hope that the slightly different emphasis of CPSA and CMPA would mean that a physician would be able to get support and advice appropriate to their specific situation and it should not be viewed as negative to choose one source over another. Kudos to the physician for seeking advice from a supporting organization. I am pleased to have both organisations available to… Read more »

Scott McLeod

Hello Dr. Stevens,

Thank you for reading and taking the time to respond. I am glad physicians have a number of options available to them when they need resources or support and I certainly don’t begrudge anyone contacting CMPA if they feel that’s what is best for them. My hope is that as we increase our approachability in how we do our work, physicians will notice the change and feel equally comfortable contacting CPSA when they need assistance.

Scott

Richard Johnston

I am very happy to see your letter. I have encouraged doctors for years to see the College as their servant, rather than their master. I have also found that it is very useful to direct unhappy patients to the College preemptively. In my work as an intensivist, there are frequently cases that have gone badly for many reasons. After talking to families, I would often give them the College phone number. I found that this gave them a lot more confidence in what I was doing. This seemed to work better than referring them to the AHS Complaints people,… Read more »

Scott McLeod

Hello Dr. Johnston,

Thanks for sharing your experience and advice to the profession. I’m very happy to hear you’ve had good experiences with CPSA.

Scott

Dr. Han Friesen

I will share my own experience with the approachability of the CPSA. I had a patient a number of years ago who repeatedly stretched the boundaries of our patient/physician relationship and I was providing what I thought was ever-increasing doses of opiates. I entered into an agreement with the patient about how much drug I would give. However, the parameters still disturbed me so I wrote a letter about this situation to the CPSA. I was frankly astounded by the reply. I was told that my approach was commendable and that the CPSA was in full support of what I… Read more »

Scott McLeod

Hello Dr. Han Friesen,

Thank you for sharing your experience. I do believe the experience you had was not unique and, in fact is a very common experience people have with CPSA. Unfortunately those are not the stories that often get shared. The more physicians such as yourself share the positive stories the more likely it will be that other will reach out to us.

Take care,

Scott

Odili

Thank you very much. You are very right in your observation. I think majority of physicians have the view that CPSA mandate is to the public and not to the physicians. The view is that CPSA police the physicians rather than support them. You statements have somewhat made me think deeply. I will from contact CPSA for advice and guidance in my practice hopefully first. Regards.

Scott McLeod

Hello Odili,

You are correct in saying that our mandate is to protect patients, and a significant part of that is supporting physicians in their practice. We don’t want to punish or “police” physicians, but rather work with them to ensure Albertans are receiving high-quality care. I’m glad to hear you will feel comfortable contacting CPSA for support in the future.

Scott

John Fernandes

Wow! I was very pleased to read a post like this. Glad about the “new direction” the CPSA is taking, which is very positive. I think that it may be inaccurate to term the Physician’s reaction as a “instinct”, but rather a smart and reasonable choice that has been based upon a long experience with the CPSA that has been traditionally agnostic of a relatively adversarial relationship with Alberta Physicians. The lack of trust that the CPSA has cultivated – intentionally or unintentionally – with Alberta Physicians over the past decades has resulted in this very understandable and sensible reaction… Read more »

Scott McLeod

Hello Dr. Fernandes,

Thank you for taking the time to read Messenger and share your thoughts. While we are here to protect patients, we want physicians to know that supporting them in their practice is key to that. We know it will take time to change the negative perception that’s out there, but we are committed to learning from the past and making positive changes going forward.

Scott

John Fernandes

Thank-you for your reply. It is hard to express how reassuring it is to have a CPSA Registrar that is at once approachable and sensitive to contemporary issues. It is exactly what the Profession needs in this time of rapidly evolving challenges on every level in daily medical practice.

Please don’t ever hesitate to reach out to us individually for ideas. There are a lot of us out there that would be very pleased to assist.

Your efforts and outreach to the profession is not lost upon deaf ears and is making a very positive impact.

Scott McLeod

Good Morning Dr. Fernandes,

Thanks for your comments and support. I will be sure to let our Communications team know you’re interested in helping us out.

Take care.

Scott

Mohamed Foda

Dear SIR I have come across an explanation that SIR is an acronym for “Slave I Remain”. This is unfortunately how many of our colleagues view the CPSA. It is the perception of a heavy-handed organization that unfortunately made our colleague resort first to the CMPA and not the CPSA for advice. I was very pleased to read the story and your expressed thoughtfulness to make the CPSA more approachable for advice From a personal experience I have requested the CPSA in the early 2000s to get involved in a significant conflict I had with a Regional Health Authority then.… Read more »

Scott McLeod

Hello Dr. Foda,

I am glad to hear your interactions with CPSA in the past have been positive, we always strive to be supportive of physicians but realize that in the past, our efforts haven’t always come across that way. We’re confident that our new direction will change that, so more physicians have experiences similar to yours.
Thank you for reading and sharing your thoughts with us.

Scott

Andrew Swinton

HI Scott. I agree the physician in the story above doesn’t appear to have acted appropriately. On the other hand, there may be reasons why physicians have come to distrust the CPSA. When the CPSA declared it’s new strategy on Opioids in 2016, it appeared that the recommendation of the Annals of Internal Medicine were adopted carte-blanche. Policy was followed by policing, with little opportunity afforded to education. Under threat of loss of TPP licensure, it should not be surprising that some physicians took drastic measures to be above reproach. While the College has softened its tone and language towards… Read more »

Scott McLeod

Hello Dr. Swinton,

Thank you for reading the messenger and providing your feedback. We understand there have been misconceptions on CPSA’s expectations regarding prescribing and we’ve taken steps over the last six months to clarify our position. I encourage any physician who is still unsure to read our standards of practice on prescribing (which all promote good patient care) and reach out to us with any questions.

Scott

Richard Martin

Wow… impactful from the sheer level of disappointment this engenders. I share the same sadness regarding CMPA being the ‘most trusted advisor’ for best medical practice for this physician in this moment of patient care. But it speaks to the broader culture of ‘fear of being judged’ – by patients, colleagues AND our own regulator. I look forward to the time when we all can feel comfortable speaking with each other openly about struggles or questions. I would assume the first call would be to a colleague but I hope CPSA becomes at least a close second. I applaud the… Read more »

Scott McLeod

Hello Dr. Martin,

Thank you for sharing your perspective. I also look forward to developing a more trusting, open relationship between CPSA and physicians. I believe we can get there, but it’s going to take time and dedication—if we can consistently demonstrate that we’re committed to approachability through our actions then eventually, physicians will start to notice a change.

Take care,

Scott

Myron Stelmaschuk

The CPSA unfortunately is negatively viewed by many physicians in Alberta. Although I don’t have any gripes about the CPSA personally, it is a common belief that the CPSA is “out to get physicians” and certainly not a supportive organization for them. All physicians are guilty until proven innocent is certainly the perception of the CPSA — the CMPA appears to be the only logical step to obtain sound advice on almost any matter with respect to management of patients/problems that sporadically arise.

It will be a formidable undertaking for the CPSA to change this perception.

Scott McLeod

Hello Dr. Stelmaschuk,

I agree that making this kind of change takes time and a lot of effort, but it is a change we are committed to. Having an open, trusting and supportive relationship with physicians is an important part of CPSA meeting its mandate to protect Albertans.

Thank you for reading and taking the time to comment.

Scott

David Lendrum

Myron,

I completely agree. I have thankfully only had very limited interactions with the CPSA and was told by all my mentors that the CPSA is in place to protect patients and not to help physicians. I am now in my 13th year of practice and would most definitely call the CMPA before calling the CPSA for any legal advice or advice regarding a challenging patient situation. If the CPSA is trying to change how they are perceived by physicians, they have a huge task ahead of them.

Scott McLeod

Hi Dr. Lendrum, Thanks for reading Messenger and for sharing your thoughts. CPSA’s mandate is to protect patients, however, we feel the best way for us to do this is by supporting, educating and empowering physicians in their practice. Especially those who are struggling with their practice. Discipline should be a rare event not a common occurrence. We would prefer to work with physicians to ensure that all Albertans receive good, safe medical care. We recognize that it will take time for us to change negative perceptions, but we are committed to improving our approachability and making positive changes moving… Read more »

Salim Sabir

My name Salim Sabir and I am a General Surgeon . I read your note with interest. I agree with you that we all should work like a team members and in fact I feel proud to be member of cpsa . Your attitude is highly commendable and we all should take a lesson from this. Rather than working together, some feel obliged to contact CMPA.

I am 78 year old and puzzled by this bizarre attitude of some. I can only pray for a sensible world.

Scott McLeod

Hello Dr. Sabir,

I think the first step towards changing the negative perception some physicians have about CPSA is understanding why they feel that way. This was a large part of the research we did before rolling out our new brand last year and has informed the changes we’re making in how we do our work.

Thank you for taking the time to read Messenger and share your thoughts.

Take care,

Scott