The College of Physicians and Surgeons and transparency

Last week I was interviewed by the Toronto Star about how the College of Physicians and Surgeons of Ontario (CPSO) communicates with the public when there are complaints about doctors. At the moment, there is almost no reporting about complaints except for when they are very serious. Less serious complaints, even when they are successful, are not made public. The CPSO is trying to be more transparent about its activities and at Patients Canada, we support this. Patients should know more about their activities. And we are interested to know what steps they will take to make their rulings more transparent to patients and the general public.

When the article came out, some friends who are doctors told me that they disagreed with the view that all complaints should be made public because after all, some of them are frivolous or merely mean-spirited, but all can have a bad effect on a doctor’s reputation. And we agree. We do not think that it is necessary to make all complaints public or even to make all the workings of the CPSO entirely open to public scrutiny. However it would be a good idea to let people know if there are recurrent cases of bad behaviour or a litany of justified complaints about particular doctors without any change in behaviour. We know that the CPSO tries to help doctors learn from their mistakes and provides support for them to do this. It would be a good idea to also publicize these efforts and be more transparent about them as well.

As we see it, the change is from an ancient culture where the CPSO was a keeper of professional secrets and the public was never admitted into this inner sanctum. The mystery of medical knowledge was not open to public scrutiny at all because the power of medicine was to some extent dependent on this secrecy. That view of professionalism died many years ago to be replaced by a more responsive and open one. In the old world, doctors applied their professional authority to help patients without much regard for the patient’s perspective. Today, doctors are beginning to partner with their patients to come to shared understanding of health issues and how to deal with them. We expect that it is in this vein that the college is beginning to partner with patients to develop a greater transparency in its activities.

In Nova Scotia, this has gone further. The province is making the medical mistakes registry available online:

According to the government website, making the information public “raises the level of accountability – and demonstrates a commitment to transparency and openness. The goal is to share lessons learned and prevent the event from happening again.”

For the first six months of 2014, 27 serious adverse events were reported. Twenty-one of those incidents resulted in “adverse health effects leading to death or serious disability” while a patient was being cared for at a facility in Nova Scotia, including three incidents where a patient died or was injured after a fall while being cared for by a district health authority or IWK [Isaac Walton Killam Health Centre]. (CBC News)

The publication of these mistakes is not only a sign of increased accountability and transparency. It is a comfort to those who have been harmed and their families. Most often, patients and their families recognize that mistakes and bad experiences can happen, and what they want is for those errors to not be repeated. Making them public can go a long way to averting their recurrence.

“Nova Scotia Medical Mistakes Registry Goes On Line.” CBC.ca. CBC/ Radio-Canada, 14 Aug 2014. Web. 18 Aug 2014.

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