To All Ontario Family Physicians                                    January 17, 2008

A COFP BULLETIN REGARDING THE CPSO

THIS IS NOT THE SAME AS THE OMA MEMBER ALERT

The College of Physicians and Surgeons of Ontario (CPSO) has proposed a new policy that will impact family physicians, called “Establishing a Physician-Patient Relationship” and modified an existing policy on “Ending the Physician-Patient Relationship”. The Ontario Medical Association (OMA) has cautioned the profession about 3 other different CPSO policy proposals. We will not repeat the thoughtful concerns the OMA raised about those particular policy proposals. Please read on.

“Establishing a Physician-Patient Relationship”

This policy is intended to apply to all physicians who exercise discretion in accepting new patients. We are particularly disturbed to see the CPSO include, as a principle, the idea that “Physicians as a profession have a collective responsibility of service to the public.” We disagree with this statement. Individual physicians have obligations to individual patients but no collective responsibility to the public in general. This would open the door to a level of responsibility that the government would be sorely tempted to take advantage of.

Some of the CPSO proposals:

•  You are obliged to communicate your selection criteria in advance to any potential applicant to your practice (Risk: this dogmatic approach dismisses your right to use and apply your judgment during an interview process)

•  You should communicate (verbally or in writing) reasons why the applicant is not accepted (Risk: complaint if the applicant deems your reasons inadequate)

•  Screening interviews without provision of medical service are deemed uninsured services and therefore are not billable to OHIP. Furthermore, the CPSO has stated it is inappropriate to bill the patient directly for such an appointment.

•  If you do provide any medical care during the visit, you can bill OHIP but you may have now created a relationship, unless you are explicit with the patient that you have not.

•  The CPSO has suggested a list of criteria and questions that you cannot ask. These include questions about the patient's criminal record (history of aggression or violence towards former health providers), questions about previous complaints or lawsuits against physicians and questions about previous history of compliance with medical advice. How you can protect your staff and yourself, and how you can reach an opinion about your ability to provide good medical care to the patient in such circumstances is not clear to us. You can, apparently, ask these questions (if appropriate) after you have accepted the applicant as a patient.

“Ending the Physician-Patient Relationship”

Some of the CPSO proposals:

•  You will now be expected to “use reasonable efforts to resolve any issues affecting the relationship with the patient prior to any final decision”. (Risk: another ground for complaint – failure to use what the patient deemed reasonable efforts).

•  If the patient exhibits violent or aggressive behaviour to you or your staff or other patients, you “should carefully consider whether the patient's behaviour is treatable and/or transient” before ending the relationship. (If you feel uncomfortable or threatened, that alone should be grounds for dismissal)

•  For those who need to downsize a practice if the patient numbers are too large are now handcuffed by a need for the physician to consider “the consequences terminating the relationship may have on the health of the patient” (Risk: a complaint based on failure to properly consider the consequences)

•  The CPSO is aware that “it may be impossible for a patient to find a new physician” and you should not be expected to provide care indefinitely, but they would expect you “would provide emergency services that would otherwise be unavailable to the patient”. (Risk: the time period to provide emergency services is not defined)

What you can do

The profession has until February 15, 2008 to express its concerns to the CPSO. We urge you to review these policies for yourself. Full “pdf” versions can be downloaded from these pages on the CPSO website:

Establishing:    http://www.cpso.on.ca/Policies/consultation/establish_background.htm

Web Extra Link to Full Draft PDF:

http://www.cpso.on.ca/Policies/consultation/Establishing%20_Draft.pdf

Ending:

http://www.cpso.on.ca/Policies/consultation/end_background.htm

Web Extra Link to Full Draft PDF:

http://www.cpso.on.ca/Policies/consultation/Ending_draft.pdf

We ask that you contact the CPSO in writing and make your views known to them. You may use the attached draft letter appended below.

In summary, these proposed CPSO policies are intended to provide guidance to physicians in the areas of establishing and ending physician-patient relationships. We believe that they will confuse physicians and achieve the opposite effect. We need a supportive environment to work in, not further bureaucratic obstacles. Beware the law of unintended consequences.

Sincerely,

Douglas Mark MD, President

and the Board of the Coalition of Family Physicians of Ontario

Date: _________________, 2008

Ms. Sharon Vanin

College of Physicians and Surgeons of Ontario

80 College Street
Toronto, Ontario M5G 2E2

Telephone:   (416) 967-2600 ext. 216

Fax:   (416) 967-2644 fax

Email:    svanin@cpso.on.ca

Dear Sharon Vanin,

I am a licensed physician, registered with the College of Physicians and Surgeons of Ontario (CPSO).

I wish to advise the CPSO that I support the concerns of the Coalition of Family Physicians of Ontario (COFP) regarding “Establishing a Physician-Patient Relationship”; and “Ending the Physician-Patient Relationship”. These concerns are enunciated in a letter from their Board dated January 17, 2008.

I also support the concerns of the Ontario Medical Association (OMA) raised in the OMA President's Update (Volume 13, No. 1), dated January 11, 2008.

These policies are not reasonable or fair.

Sincerely,

Signed _________________________________________________

Printed Name ___________________________________________

CPSO Registration Number ________________________________

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