Public Expectations and Medical Regulation in Canada (Taking Care of Dinosaurs) Dubai Health Regulation Conference October 2014

2 Overview Concepts Public expectations 1)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

3 Concepts Delegated authority Privilege of professional (self) regulation Contract with society Best interest of the patient

Canada 4 Canada (9,984,670 km²) = 120 X United Arab Emirates (83,600 km²)

5 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

6 The dinosaur was mummified. They named it Dakota.

7 Privilege of professional (self) regulation Public Gov’t Physician Regulator

8 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 PhysiciansPhysicians expect of Society Services of the healerAutonomy Guaranteed competenceTrust Altruistic serviceMonopoly Morality and integrityStatus and rewards Promotion of the public goodSelf-regulation TransparencyFunctioning health care system Accountability

9 Privilege of professional (self) regulation Public Gov’t Physician Regulator #1 Betrayal of public trust #2 Reaction to public outcry #3 Modified guidance

10 Back to Dakota

11 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 ( ) Co-founder of the Mayo Clinic in Rochester, Minnesota In 2014: need to insert patient / family and other members of the health care team.

12 Public expectations Group 1 – internal a)Transparency b)Revalidation Group 2 – external c) Physician-assisted death d) Marihuana for medical purposes Group 3 – internal and external e) Custody of personal health information

13 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

14 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…

15 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?

16 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.

17 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?

18 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?

19 Dakota again

20 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.

21 one last Dakota slide

22 Thank you Fleur-Ange Lefebvre Executive Director & CEO x2602