Imperative to put patients’ voices first

Opinion

AS a former course conductor for Hockey Canada’s “Speak Out” program, I am all too aware of what others refer to as “the mechanisms of silencing.”

These mechanisms function to frame violence in ways that discredit survivors and shield perpetrators. It is not surprising, therefore, that a woman in St. Anne who tried to sound the alarm about an allegedly sexually abusive doctor was not believed.

According to a recent Winnipeg Free Press article, she was quoted as saying: “Why isn’t my voice important? Why didn’t they take this seriously?”

It is disturbing to note the doctor she alleged assaulted her practised medicine with conditions imposed by the College of Physicians and Surgeons of Manitoba (CPSM) for almost two years after she complained about him. The doctor in question was eventually charged with 22 counts of sexual assault involving female patients, some of which were alleged to have happened after he returned to work with these college-imposed conditions.

Recently, another physician was allowed to continue practising for three years with CPSM-imposed restrictions after allegations surfaced about him. His licence has now been revoked because, among other concerns, he created false and misleading medical records related to the presence of a chaperone for 36 female patients for whom he provided care.

These facts alone would seem to ring serious alarm bells regarding the process the college follows when it investigates allegations of sexual abuse against physicians. As a patient advocate, the following questions occur to me:

• What are the qualifications of the college’s investigators as it pertains to allegations of sexual abuse?

• How comprehensive are these investigations in examining professional, personal, family and community dynamics?

• Are these physicians required to undergo a multi-disciplinary evaluation using outside experts trained in sexual abuse assessments?

• Would the investigators be comfortable if members of their family were referred to a physician practising with the college-imposed restrictions?

• What has been done to assess why these practice restrictions didn’t work?

• Why aren’t the voices of patients making these allegations being taken more seriously?

The answer to this last question is a complicated one involving the hands-off approach provincial governments take to professional self-regulation, and the patriarchal and paternalistic traditions of medicine.

Indeed, historically, the profession of medicine hasn’t always functioned in the best interests of its patients. In his book Bad Medicine: Doctors Doing Harm Since Hippocrates, David Wootton points out that major discoveries that could save lives were met repeatedly with professional resistance. He attributes this resistance to wilfulness and arrogance.

At the same time, governments have allowed professions to regulate themselves, often in the professions’ best interests as opposed to the public interest.

The result of these two dynamics has been the reluctance of the medical profession to hear the voices of their patients and make changes accordingly.

If provincial governments took the time to examine how medical colleges function, they would see these organizations are failing in their mandate to serve the public interest and, in the process, to create better and safer services for patients. Quite simply, these colleges talk the talk but rarely walk the walk.

Patients typically experience the medical-college complaint system as impersonal, bureaucratic and adversarial. It is a system where the deck is stacked in favour of doctors, who hold all the medical knowledge cards. And it is one where the benefit of the doubt falls to the physician, often at the expense of the patient.

But the reality is that medical mistakes are made regularly. Patients can play a huge role in providing feedback that will help physicians learn from their mistakes and assist medical colleges in making informed decisions in their investigations.

Unfortunately, for too long the voices of patients have been ignored, suppressed and disparaged. A patient’s voice should be valued and heard.

As King Lear said to Cordelia: “Nothing will come of nothing: speak again.”

Mac Horsburgh is a patient advocate who lives in Winnipeg.