Q&A: Dr. Michael Kaufmann, Physician Health Program
 At our January Executive Committee meeting, we had the pleasure of listening to a presentation by Dr. Michael Kaufmann, who spoke about the work of Ontario’s Physician Health Program (PHP), of which he is the Medical Director. The PHP is an Ontario Medical Association member service that provides help and support to various professionals – physicians, veterinarians, residents, and medical students, among others – who may be suffering from mental health or substance abuse issues, behavioural problems, or other challenges affecting their practice of medicine. In 2016, about 5% of their case intake was medical students. We caught up with Dr. Kaufmann to get a bit more detail on the PHP, and to share some of his advice for students who may be struggling with some of these issues.
1.What is the relationship between the PHP’s work and the work of the CPSO? How do we collaborate to help doctors (and medical students) who are struggling with addiction, mental health issues, or other challenges to their career?
The PHP and the CPSO have separate but overlapping responsibilities regarding doctors who have illnesses that have a potential to impair their functioning at work. Naturally the CPSO has a mandate to protect the public. The focus of the PHP is to identify affected or suffering individuals as early as possible, provide access to assessment, treatment and stabilization so that they are able to function free of impairment. The CPSO has mechanisms to enable and support those PHP services allowing such doctors to obtain immediate help and long-term support. To further ensure accountability (to the CPSO, a university or a medical workplace) and patient safety, the PHP offers comprehensive long-term recovery monitoring and health-related advocacy for those doctors who require and request such a service.
2.Walk us through the process if a medical student calls your confidential toll-free number to ask for help. Who will they talk to? What will happen?
If a medical student calls our confidential intake line, they would have an opportunity to speak to one of our Clinical Coordinators. The Coordinator will obtain a history of the presenting problem, provide advice on the spot, and will often make a referral right away to a helping resource. The PHP has recruited many such resources, and we can often provide a choice of resource to the medical student. At times, depending upon the presenting problem, the student’s call can be transferred to one of the PHP’s Medial Directors as well. It is also possible to invite the student into our offices for an interview, or just have a supportive conversation, if preferred. We often say that our mission is to offer immediate support and to arrange and facilitate access to “the next right thing” to help the caller.
I should stress, however, that the PHP is not a clinic or treatment centre and our clinicians do not provide therapy or counselling themselves.
3.Some medical students reading this may indeed be suffering and need help, and yet may be hesitant to reach out to the PHP. What would you like them to know about what your organization can do for them?
Most students suffering from emotional or other similar problems are reluctant to confide in others because they might be experiencing a feeling of shame, or fear that they will be stigmatized if they reveal they need help. That said, many will confide in close friends, family or trusted others. If, after that, they are still feeling troubled or unwell, they can usually seek help through the undergraduate office of their medical school. Many will be reluctant to do so, however, for fear that revealing a mental health problem might interfere with their present or future medical training and career – even if this eventually proves to be a false assumption. The key, then, is to be willing and able to reach out for help safely and confidentially.
The student who calls the PHP is offered the same level of confidentiality that they might expect when visiting any physician’s office. It is even possible to support and respond to a caller on an anonymous basis in many cases. The PHP would not report a student to their university/medical school even if they do identify themselves to us.
4.One of the things we’ve been stressing to medical students is the importance of professionalism. Can you tell us a bit about your own “Five Fundamentals of Civility” initiative? What are the five fundamentals? Where did these concepts come from?
Respect and civility are fundamental to high-quality job performance, and, therefore, in the health care sector, the highest quality of patient care. Over the many years the PHP has been responding to issues of physician health, especially in the occupational context, we have become aware that professional conduct and comportment are often wanting – and that this set of skills is every bit as important as a robust knowledge base and mastery other medical skills when it comes to being a good doctor. We are now seeing students and residents being unable to successfully complete their training when there are unaddressed deficits in this area, and practising physicians are finding that concerns about professional conduct are, in some cases, putting their hospital privileges at risk.
In the past these physicians and learners have been referred to the PHP with so-called “disruptive behaviour.” The PHP can assess these problems and offer solutions. But it is preferable to understand the components of effective professional behaviour, which I think of as civility. It is just as important to learn the fundamentals of civility as it is to learn the other skills required of us. After considerable research and reflection, I chose to explore these concepts divided into five fundamental groupings:
Five Fundamentals of Civility
1. Respect Others and Yourself
Treat everyone in the workplace, regardless of role, with respect – even those we barely know, disagree with, or dislike. Respect for others requires inclusivity while observing healthy boundaries. Self-respect is key.
2. Be Aware
Civility is a deliberate endeavour, requiring conscious awareness of oneself and others. Mindfulness and reflective practice enhance awareness.
3. Communicate
Civil communication is more about how we say it as much as what we say. Or do. Effective communication is critical at times of tension or when the stakes are high.
4. Take Good Care of Yourself
It’s hard to be civil when personally stressed, distressed or ill.
5. Be Responsible
Understand and accept personal accountability. Avoid shifting blame for uncivil behavioural choices. Intervene when it’s the right thing to do.
Reference: Dr. Michael Kaufmann, in the Ontario Medical Review.
Can respect and humility be taught and learned? I don’t know for sure, but as a colleague once said to me, “The invitations will keep on coming.” So what I would say to medical students is this: respect for others and oneself is at the heart of a caring and civilized profession. Choose civility.
Please visit the Physician Health Program website for more information.
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