Draft CPSO Policy Reinterprets Professionalism for Physicians

By Lonny Rosen, C.S. and Melina Fazzari

This month, the College of Physicians and Surgeons of Ontario (the “CPSO”) Council (its board of directors) will review its draft policy, Principles of Medical Professionalism: Guiding Values and Duties (the “Draft Policy”). The Draft Policy will replace The Practice Guide, which was published in 2007.

The CPSO expects physicians to uphold “values and duties of medical professionalism”, such as integrity, responsibility, humility, and humanity, in their daily practices. The Draft Policy outlines how physicians can demonstrate these values and duties in their work with patients, colleagues, and the public. In addition to the traditional values of honesty and integrity, compassion, service and trustworthiness, the Draft Policy reinterprets medical professionalism as incorporating progressive values which are part of modern workplace culture, including collaboration, empathy, maintenance of boundaries, embracing social accountability, showing cultural humility, implementing trauma-informed care and creating welcoming and inclusive spaces. This blog will outline some of the practices that physicians should implement to ensure they meet the CPSO’s standards of medical professionalism.

Medical Professionalism Defined

The Draft Policy defines medical professionalism as “the words and actions of physicians that foster trust and respect with patients, colleagues, and the public.” “Colleagues” is a new term in the Draft Policy, and is defined to include:

• other physicians
• other health care professionals
• hospital or clinic administrative, ancillary, and support staff
• medical students, interns, residents, and
• anyone involved in the provision of health care.

Accordingly, physicians’ dealings with their own staff, hospital administration and support staff, students and residents, and other health professionals will now be examined through the lens of medical professionalism.

Principles of Medical Professionalism

While The Practice Guide emphasized the values of compassion, service, altruism and trustworthiness, the Draft Policy focuses on the core values of trust and respect, which are fostered by:

• practising with integrity
• committing to responsibility
• practising with humility, and
• recognising and honouring their humanity and the humanity of those they interact with.

The Draft Policy outlines how physicians are expected to conduct themselves in order to demonstrate adherence to these tenets.

1.? Physicians Must Practice with Integrity

The Draft Policy defines integrity as “making sound clinical and behavioural judgments and acting in good faith for the benefit of patients, even in challenging situations.” This applies in dealings with patients, colleagues and the public, and is demonstrated by:

• considering each patient’s well-being and acting in their best interest
• prioritizing quality care (e.g., ensuring timely appointments)
• maintaining professional boundaries (e.g., abstaining from adding patients on social media);
• avoiding conflicts of interest (e.g., refusing personal gifts from industry representatives in order to maintain professional independence)
• protecting personal health information (e.g., maintaining secured electronic information systems)
• working with colleagues regardless of conflicting personal and/or professional opinions, and addressing inappropriate or unprofessional opinions, and
• upholding the profession’s reputation (e.g., using evidence-based approaches in practice).?

2. Physicians Must Practice Responsibly

The Draft Policy defines responsibility as “understanding what is reasonably expected of them and striving to meet those expectations.” This applies in dealings with patients, colleagues and the public, and is demonstrated by:

• providing safe, competent care (e.g., participating in continuing education programs to improve skills and expertise)
• advocating for individual patients (e.g., considering barriers to health care access)
• making the health care system easier to navigate (e.g., connecting patients to resources and supports to ensure a continuous caring relationship)
• communicating with patients and their circle of care
• seeking constructive feedback from colleagues
• maintaining respectful and cordial relationships with colleagues
• embracing social accountability (e.g., practicing according to community health needs)
• meeting reporting duties (e.g., understanding mandatory versus permissive reporting duties), and
• managing resources (e.g., considering medically and economically efficient treatments).

3. Physicians Must Practice with Humility

The Draft Policy defines humility as “acknowledging the inherent vulnerability of patients and recognizing the power imbalance between physicians and patients.” This applies in dealings with patients, colleagues and the public, and is demonstrated by:

• “undertaking lifelong learning in clinical knowledge, communication, and leadership” (e.g., learning how to resolve conflicts)
• identifying deficient skills and taking appropriate action
• showing “cultural humility” (e.g., learning about a patient’s culture)
• providing inclusive, culturally appropriate, and safe care (e.g., facilitating open conversations with patients to determine their preferred care)
• asking colleagues for help and, in turn, helping colleagues
• resolving conflicts with colleagues in a “productive, dignified, and safe manner”, and
• delivering patient-centered care (e.g., collaborating with the patient and their circle of care).

4. Physicians Must Act with Humanity

The Draft Policy defines humanity as “recognizing the inherent value and dignity of all people, including themselves, and keeping the varied experience of patients at the center of health care delivery.” Humanity “means caring for people, not simply treating diseases.” The Draft Policy counsels physicians that honouring their own humanity and the humanity of others creates the foundations for trusting, respectful, and empathetic relationships. This applies in dealings with patients, colleagues and the public, and is demonstrated by:

• showing self-humanity (e.g., recognizing your own needs, taking breaks when needed, seeking support from colleagues, seeking support through the CPSO’s wellness resources)
• recognizing that patients with decision-making capacity can make their own health care decisions
• implementing trauma-informed care into practice and creating a safe space for patients (e.g., informing patients what can be expected during an appointment, allowing trusted companions to attend an appointment)
• creating “welcoming and inclusive spaces for everyone” (e.g., using a patient’s preferred name and pronouns), and
• striving to combat discrimination in the health care system.

Takeaways

Once the CPSO’s Council reviews and approves the Draft Policy, it will replace The Practice Guide. Patients, colleagues, and the public will expect physicians to practice according to the CPSO’s medical professionalism standards outlined in the Draft Policy. Accordingly, physicians must learn, understand, and implement the four main pillars of medical professionalism discussed in this blog post: integrity, responsibility, humility, and humanity.

The Draft Policy incorporates many progressive values that were not often discussed when The Practice Guide was published, and reflects expectations imposed on professionals in modern workplaces. Physicians unfamiliar with any of these terms or expectations will be expected to read up on them, or risk being accused of unprofessional conduct. For more information about the new Draft Policy, or for advice on how to implement practices that meet the CPSO’s standards of medical professionalism, please contact us.