In this issue: July 2015

• More information available online
• Protecting patients from sexual abuse
• What do you think?
• Be informed before you consent

More information available online

When it comes to your healthcare, the best results come from being open with your doctor. It’s also important that you have access to relevant information about your doctor to help you make informed choices.

After receiving extensive feedback from the public and the profession about making more information available about physicians, we have approved by-laws to make the following information public:

• Criminal charges
•  Cautions-in-person
• Specified Continuing Education or Remediation Program orders (SCERPs)
• Licences in other jurisdictions
• Discipline findings in other jurisdictions

Some of these terms are self-explanatory while others may be unfamiliar to you.

Cautions-in-person are ordered when we have a significant concern about a doctor’s conduct or practice that can have a direct impact on patient care, safety or the public interest if it is not addressed.

A Specified Continuing Education or Remediation Program orders (SCERPs) might include a doctor taking educational courses (e.g., opioid prescribing, medical record-keeping, and communications) or one-on-one instruction with another physician. There may also be a reassessment component to ensure that remediation has been successful.

You can find a glossary of what all of these terms mean on the Public Register.

The College’s public register already includes extensive information about physicians in Ontario, including discipline referrals and outcomes. This new information will be posted online as it becomes available.

If you have questions about anything you see on the public register, please contact our Public Advisory Service.

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Protecting patients from sexual abuse

Our foremost responsibility when dealing with sexual abuse by physicians is to protect victims. We are considering several changes to bolster our ability to do so.

We are currently asking for feedback on draft principles to guide our approach toward physician sexual abuse of patients. Your feedback is important to us and you can easily participate in our consultation by leaving comments online.

In addition to recommending changes to the sexual abuse provisions in our governing legislation, we are also reviewing our own processes and practices to determine what we can do better. To that end, we are developing:

• A Rights and Responsibilities document for patients that would focus on the duties and obligations that physicians owe their patients.
• A multilingual education brochure about sexual abuse to provide information about the College's role and to encourage patients to come forward.
• A survey to better gauge the experience of patients who have been involved in the investigative/discipline processes.
• We are also making improvements to our website to make it easier for patients to find helpful information and resources online.

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What do you think?

Give us your feedback on policies

College policies outline the values and principles of medical professionalism, and provide assistance to doctors in determining specific duties and the reasons for those duties.

For every policy, it's important that we hear from the public and the profession to ensure we've struck the right balance.

Our Accepting New Patients policy sets expectations for physicians when accepting new patients into their primary care practices. The policy emphasizes that physicians must accept new patients in a fair and professional manner to ensure equitable access to care.

Our Ending the Physician-Patient Relationship policy sets out expectations for physicians who end the physician-patient relationship for any reason other than the physician’s retirement, relocation, leave of absence, or as a result of disciplinary action by the College. We expect physicians to follow certain criteria when ending the doctor-patient relationship. Let us know what you think.

We are also seeking feedback on our revised draft policy Physician Treatment of Self, Family Members, or Others Close to Them. This policy only permits physicians to treat themselves, family members and others close to them in specific circumstances. This position is supported by the research on this issue and has been adapted by many medical regulators. Namely, that it is inappropriate for physicians to treat themselves and family members, as well as others close to them, as the standard of care may not be met due to the physician's compromised objectivity.

We review policies to determine how they can be improved to ensure they reflect current practice issues, embody the values and duties of medical professionalism, and are consistent with our mandate to protect the public. Visit our Consultations page for more information and to share your feedback.

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Be informed before you consent 

Everyone is entitled to determine what happens with his or her health. That’s why health care professionals can’t do treatments or procedures without your agreement. Informed consent is a fundamental duty for any health care professional. Respecting patient autonomy means supporting their right to make informed choices.

In other areas, people often give consent without fully grasping what they’re agreeing to. Studies show that only 10% of people read terms and conditions before signing up online for products or services. In health, consent is more than just reading the fine print – it’s at the core of the standards for any health care profession.

Are you making the best decisions about your health? Here are three important principles about consent:

1. For consent to be valid, patients need sufficient information.

This includes knowing the nature of the treatment/procedure, expected benefits, alternative options, side effects (probable ones, and possible ones that can have serious consequences) and material risks. In other words, what potential results would a person need to know to make an informed decision to consent or refuse consent. Material risks include those that have a high severity or a high frequency. It’s also up to your doctor to discuss the likely consequences of not having the treatment/procedure.

2. Consent must be voluntary.

Nobody can force you to give consent. You’re entitled to ask questions, think about it, give your answer, and change your mind. Anyone can withdraw consent even after giving it.

3. The obligation is on the doctor.

Consent can be expressed (when you agree in writing or orally), or implied (like when you offer your arm for an injection or to draw blood). Either way, your doctor has to look for signs that you understand the information provided.

The bottom line is that you can’t consent without being informed. When visiting your doctor, remember that it is an ongoing process, where he or she carefully explains what’s going on and lets you be heard. This helps to ensure that you not only agree with it, but truly understand your care.

We recently passed a revised version of our Consent to Treatment policy, which emphasizes that consent is a process that involves a dialogue between the physician and the patient or substitute decision-maker; not simply a piece of paper to be signed.

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We want to hear from you!