public expectations and medical regulation in canada (taking care of dinosaurs) dubai health...
TRANSCRIPT
Public Expectations and Medical Regulation in Canada
(Taking Care of Dinosaurs)
Dubai Health Regulation Conference
October 2014
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Overview
• Concepts
• Public expectations1) within the purview of the medical regulatory
authority
2) external to the direct role of the medical regulatory authority
3) both internal and external
• Closing directions
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Concepts
• Delegated authority
• Privilege of professional (self) regulation
• Contract with society
• Best interest of the patient
Canada
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Canada (9,984,670 km²)
=
120 X United Arab Emirates (83,600 km²)
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Delegated authority
• an authority that does not naturally exist, except that it has been obtained from a true authority
• government is usually the delegator (true authority), and this is done through legislation
• delegation = the protection of the public by ensuring that physicians are qualified, competent and fit to practise medicine
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The dinosaur was mummified.
They
named it
Dakota.
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Privilege of professional(self) regulation
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Contract with society
Sylvia R. Cruess and Richard L. Cruess (2014), Virtual Mentor, Vol. 6, Number 4,
Professionalism and Medicine’s Social Contract with Society
Society expects of Physicians Physicians expect of Society
Services of the healer Autonomy
Guaranteed competence Trust
Altruistic service Monopoly
Morality and integrity Status and rewards
Promotion of the public good Self-regulation
Transparency Functioning health care system
Accountability
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Privilege of professional(self) regulation
#1Betrayal of public
trust
#2Reaction to
public outcry
#3Modified guidance
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Back to Dakota
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Best Interest of the Patient(the patient’s needs come first)
In 1910: “The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary... It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient, each assisting in elucidation of the problem at hand, and each dependent upon the other for support.”
Dr. William J. Mayo (1861-1939)
Co-founder of the Mayo Clinic in Rochester, Minnesota
In 2014: need to insert patient / family and other members of the health care team.
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Public expectations
Group 1 – internala) Transparency
b) Revalidation
Group 2 – externalc) Physician-assisted death
d) Marihuana for medical purposes
Group 3 – internal and externale) Custody of personal health information
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Transparency
In a consumerist society with fast access to information, people want to know what they are getting before they get it-about the medical regulatory authority-about this physician
– competent, healthy, ethical, available
-I may want another physician, even if it is inconvenient for me (wait times, location, etc.)
INFORMED CHOICE
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Revalidation
Definition: A quality assurance process in which physicians are required to provide satisfactory evidence of their commitment to continued competence and performance in their practice.
Purpose: To reaffirm, in a framework of professional accountability, that physicians’ competence and performance are maintained in accordance with professional standards.
- The public thought this was happening all along. They were not amused…
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Physician-assisted death
One example of a very divisive issue- among the profession- between the profession and the public
Assuming the physician is acting in the patient’s best interest, does the contract with society mandate compliance by the physician? Or does it mandate due consideration, discussion and hopefully resolution?
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Medical marihuana
One example of a treatment or “medication” that is in high demand, but that may be of little benefit to the patient and may in fact cause harm.
Providing medicine is not retail.Dr. Trevor Theman, FMRAC President
•The physician acting in the best interest of the patient may have to say “no” at some time, and accept the consequences.•It is never acceptable to put the patient at risk for no measurable benefit.
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Custody of health information
An example of an issue that is driven both externally and internally.
-Keeping good medical records and assuring the confidentiality of patient / health information has been a hallmark of good medical practice.-The digital world is enabling, perhaps dictating, another approach, with patients in charge of their own health information (solo ? jointly ?)-What does this mean? What will be the role of the physician?
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Custody of health information
What will be the role of the physician when:-the patient sees test results before the physician (and maybe goes elsewhere to help interpret those results)-some patients do not want to look at / take charge of their own health information-patients share their information with others
At the end of the day, are patients more tolerant of loss of confidentiality than we thought? Do they think the “system” is old-fashioned? Do they think the trade-offs are worth it?
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Dakota again
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Closing Directions• For regulators:
– collaborative regulation (profession and public)– proactive approach (gauge where the public is
going)
• For practising physicians:– information sharing for better decision-making
• For all stakeholders:– the best interest of the patient is the only
interest worth considering, as Dr. Mayo said.
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one last Dakota slide
