Updates to the CPSO’s Physician Behaviour in the Professional Environment Policy

Following public consultation, the College of Physicians and Surgeons of Ontario (the “College”) updated its policy on Physician Behaviour in the Professional Environment in May 2016. This policy sets out the College’s expectation that physicians working in a professional capacity act in a respectful, courteous and civil manner towards their patients, colleagues and others involved in the provision of health care and not engage in unprofessional and/or disruptive behaviour. In essence, the amendments to the policy clarify and simplify, but do not alter, existing principles and expectations. In this blog post, we review what has specifically changed in the most recent version of the policy and, in doing so, aim to provide a reminder to physicians of their responsibilities in the workplace.

Definition of Disruptive Behaviour

The policy slightly amends the definition of “disruptive behaviour”, which now provides that behaviour, such as the use of inappropriate words or actions and inactions, will be considered disruptive when it interferes with a physician’s ability to collaborate, or may interfere with the delivery of quality health care or with the safety or perceived safety of others. Previously, patient safety was not specifically included as a factor to consider. The new policy, however, makes reference to recent literature that shows that disruptive behaviour can have negative impacts on both the delivery of quality health care and patient safety and outcomes by eroding effective communication, collegiality and collaboration that is necessary for good medical practice.

According to the policy, while it is possible that a single unacceptable act may amount to disruptive behaviour, it is more common that a series of events that demonstrate a pattern of behaviour will be identified as disruptive.

Examples of Disruptive Behaviour

Under the updated policy, the list of behaviour that may be considered disruptive has been consolidated and narrowed down to include the following conduct:

• Rude, profane, disrespectful, insulting, demeaning, threatening, bullying, or abusive language, tone, innuendos, and behaviour;

• Arguments or outbursts of anger, including throwing or breaking things;

• Use, attempted use, or threat of violence or physical force with patients, colleagues, and others involved in the provision of health care;

• Comments or actions that may be perceived as harassing or may contribute to a poisoned professional environment;

• Mocking, shaming, disparaging or censuring patients, colleagues, and others involved in the provision of health care;

• Repeated failure to promptly respond to calls or requests for information or assistance when on-call or expected to be available; and

• Failure to work collaboratively or cooperatively with others.

The policy notes that this list is not exhaustive and that unprofessional behaviours captured by other College policies, such as sexual abuse, sexual misconduct, or discrimination, are not included, but physicians are expected to be aware of and comply with the College policies covering other conduct.

Responsibilities of Medical Professionalism

The updated policy summarizes the College’s expectation that physicians uphold the standards of medical professionalism and not engage in disruptive behaviour. With respect to medical professionalism, the College outlines a number of responsibilities for physicians, which have not changed from the original policy, including the physician’s responsibilities to the patient, to other health care professionals and to the profession. The updated policy highlights that the physician’s primary responsibility is to act in the best interests of his or her individual patient.

Both the original and updated policies noted that physicians have a responsibility, individually and collectively, to advocate for their patients and that this responsibility has the potential to lead to disagreements or conflicts with colleagues or the administration of the institution in which they work. Previously, the policy stated that each physician should carefully assess whether his or her advocacy effort was impairing his or her ability to deliver quality health care to patients and, if it was, re-evaluate whether this conduct was in fact in the patients’ best interests. The updated policy removes this requirement and simply reminds physicians that the expectation for professional behaviour is still present even in the context of advocacy or conflict. Furthermore, the updated policy notes that the College views advocacy as an important part of the physician’s role and recognizes that disagreements in this context will not necessarily amount to disruptive behaviour.

Addressing Disruptive Behaviour

The updated policy specifically provides that where a physician’s behaviour is at odds with the dual expectation of upholding the standards of medical professionalism and not engaging in disruptive behaviour, the physician is expected to change or cease his or her behaviour accordingly, and to seek assistance in doing so if necessary. In particular, the College advises physicians to contact the Ontario Medical Association’s Physician Health Program to explore resources available for obtaining assistance – advice which was also present in the older version of the policy.

For the health care institutions and organizations in which physicians work, the updated policy notes that the Guidebook for Managing Disruptive Physician Behaviour (April 2008) provides them with advice and tools for identifying and effectively addressing disruptive behaviour. This guidebook was developed in response to an increasing body of literature that raised concerns about the impact of physician behaviour on patient outcomes and has been endorsed by the College and the Ontario Hospital Association.

While the updated policy provides clarity to the Colleges expectations of physicians and the type of behaviour that may be considered disruptive, disputes are bound to arise when attempts are made to manage conduct that is labelled as such. It is critical that physicians and health care institutions seek legal advice in these circumstances.