The patient’s perspective on transparency and accountability in medicine

Opinion

Hey there, time traveller!
This article was published 23/01/2024 (621 days ago), so information in it may no longer be current.

A recent headline in the Winnipeg Free Press indicated that our new provincial government is “open” to making changes to legislation governing doctor oversight. The issue in this regard is the Regulated Health Professions Act (RHPA).

Critics of the medical regulatory body, the College of Physicians and Surgeons of Manitoba (CPSM), and the RHPA point out that overhauling this legislation will create greater transparency and better patient protection.

Unfortunately, too often the responsibility to examine the organizational, governance and self-regulatory structure of the medical profession falls to medical professionals and government officials rather than patients who have first-hand experience in how this system works.

Patients are the key stakeholders in the system. Attention to their concerns is crucial to the success or failure of the RHPA and the CPSM.

It is difficult to imagine a credible review of the RHPA and the CPSM system that does not include public consultations.

In 2018, in Ontario, retired judge Stephen Goudge released a report which was designed to improve the physician complaints process.

Among his findings were the facts that this complaint system was expensive, time consuming and provided “little apparent benefit to the public in terms of better or safer physician services.”

Is the Manitoba physician complaint system different from the Ontario one that was examined in the Goudge Report? From what I’ve seen over the years, the answer is no. CPSM stays out of the limelight, preferring to manage rather than lead the profession of medicine. Public consultations about important medical issues have been virtually non-existent.

Occasionally their CEO weighs in on serious issues of professional misconduct such as the Dr. Arcel Bissonnette scandal.

In this regard, CEO Anna Ziomek recently stated that “public trust in CPSM’s process to regulate the medical profession is paramount.”

Dr. Ziomek has been less forthcoming, however, about crucial questions as to why they stopped investigating the allegations against Dr. Bissonnette once the police got involved. Is it not their responsibility to investigate their registrants and, in the process, protect vulnerable patients and the public?

It is as if the college outsourced their investigation to the police.

The college investigates about 300 complaints every year. Other than licence revocations, I have rarely seen anything about the specific details of these investigations and what lessons were learned that would benefit patients and physicians.

It is as if the college has decided that the public and physicians would not profit from learning about mistakes which were made.

Where is the transparency and accountability in this system? The answer is that it is hiding behind the RHPA and a college system that has historically been focused on protecting health-care providers and avoiding getting drawn into liability issues.

In Britain, a series of medical scandals occurred in the mid-1990s which resulted in ending a collegial model of self-regulation of the medical profession.

Our college system here in Manitoba is similarly problematic. Ask any patient who has been subjected to its arbitrary, bureaucratic, and adversarial process. Ask the 22 patients of Dr. Bissonnette, three of whom were allegedly abused while he had a “chaperone”.

Manitoba’s college system has failed patients. It needs to change.

Is radical change such as occurred in Britain needed?

Will minor tweaks to the RPHA simply perpetuate a system which is already dysfunctional for many complainants/patients?

The good news is most physicians are absolutely committed to the well-being of their patients. But physicians are human; they make mistakes.

We need a college system that recognizes this reality and is willing to change and work with its stakeholders to create better outcomes for patients. In such a system every effort would be made to determine what the lessons are that can benefit medical professionals and patients.

If that happens, the CPSM will fulfil its mandate, which is the protection of the public’s interest.

Mac Horsburgh is a sepsis survivor, patient advocate and a patient partner in several medical research projects. He writes from Winnipeg.