 When a physician feels intimidated
Of interest to all physicians Intimidation can be a feeling born out of fear and a lack of understanding of one's rights and responsibilities. Physicians are not immune to intimidation, and it can affect their ability to practice medicine. A review of 100 cases involving calls to the CMPA about intimidation revealed that physicians often feel threatened or intimidated by their patients, their patients' family members, other health care providers, other physicians, the media, the police or lawyers. They are often overwhelmed, concerned about the impact on their personal and professional lives, and looking for direction and/or help to resolve the situation. The many sources of intimidation Patients When a patient's demands are unreasonable and the physician refuses to comply, the patient will sometimes try to intimidate the physician by threatening to complain to the regulatory authority (College), take legal action, or do physical harm. Physicians facing intimidation can be concerned for their physical safety, or for that of their family or staff. It is very important to keep documentation of any such encounters. If safety is an issue, physicians are well-advised to terminate the doctor-patient relationship, in keeping with the College's guidelines. They should call the police if the threat is serious and imminent, but report only the incident and the threat, including the patient's name but not any patient medical information. Physicians should also take precautions for personal and staff safety. Family members of patients Family members of patients can also sometimes be difficult to deal with. They may demand information about a patient without the patient's consent, or disagree with proposed treatment of a patient in critical condition. It could also be that the family's expectation of the care and needs of the patient are not met. Medical officers at the CMPA can help physicians determine the best approach to defuse the situation. If the patient is in a hospital setting, physicians can access resources such as social work, patient advocacy and pastoral care to help resolve any issues. The CMPA may ask legal counsel to intervene in certain cases as required. Health care providers Most of the calls the CMPA receives about intimidation relate to physician-physician conflict. It might be within a health care group or between a senior and junior physician. It may be complicated by underlying factors such as power struggles, monetary compensation, or pride. In these situations, physicians are often disenchanted and discouraged that a fellow physician could treat them in such a manner. More and more physicians work in collaborative care settings where they are members of a team of health care providers, and disagreements about care of the patient may occur. Occasionally this has led to confrontation, especially when expectations of care are beyond the role of the physician, beyond the capabilities of the other health care professional, or are not realistic. This may intimidate some individuals. Physicians need to understand the environment in which they are practising, and see that their own behaviour does not contribute to conflict or intimidation. The CMPA's advice when intimidated is to stay calm, evaluate the situation to identify what the issues are, and deal with others with respect and non-confrontation. The CMPA recommends that physicians in these situations seek help from a peer who is respected by all of those involved in the conflict. This person may then be able to assist all parties to come to a reasonable solution by identifying the issues that led to the conflict and finding common ground to resolve problems. In situations where there is a threat to a physician's hospital privileges, license or safety, legal counsel may be asked to intervene. Other professionals Sometimes a conflict arises when a third party, for example a lawyer or insurance adjuster, requests information about a patient and there is no written or valid authorization for the release of the records. In this situation, physicians are less likely to be intimidated if they take the time to understand the process under which they can release information, and only give factual information within their expertise. Dealing with the media can also be an intimidating experience. The best advice is to stay calm. It is imperative not to release any patient information without written consent of the patient, and to be clear and concise when communicating with the media. Members may wish to call the CMPA for guidance on how to deal with the situation. Part of the solution The CMPA often assists in situations of intimidation by helping physicians focus on the issues rather than on personalities. Its medical officers can also help physicians evaluate the "pros and cons" of their decisions, and thus work towards finding a mutually acceptable solution between the physician and those with whom they are in conflict. We physicians, as professionals, need to look at how we interact with our fellow physicians and others, therefore becoming part of the solution and not part of the problem. We must take the lead by treating physicians and other health care professionals with respect, dignity, courtesy and compassion. This will go a long way to ensuring that we as physicians keep the true meaning of the word "care" in the changing world of health care. The bottom line
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DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.
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