Safety of care
Safety and the practice of medicine
An article for physicians by physicians
Originally published Fall 1998 / Revised May 2008
Steps to create a safe working environment.
Of interest to all physicians
Physicians have always maintained that prevention is the best medicine. When it comes to safety in medical professional life whether it is the safety of their patients or prevention of violence against themselves or their staff, physicians should take the necessary steps to improve safety in their practice environment. The best way to do this is to take stock of risks and dangers that may surround one's work. Here are some of these considerations:
1. Personal safety
Physicians should review their kind of practice to see if and how the patients for whom they care could be a threat to their safety. The issues of transference, threats of violence, history of violence and above all, a physician's instinct should alert them to take extra personal safety measures.
Physicians should take a common sense approach to personal safety, e.g. park the car in a lighted place, avoid being alone in the office, employ home security measures. If the situation warrants, when a physician/patient relationship has deteriorated or there is a threat of violence, the physician/patient relationship should be terminated in accordance with the provincial/territorial regulatory authority's (College's) guidelines.
- Are you dealing with difficult patients, e.g. patients with transference who are violent or potentially violent, angry or dissatisfied?
- Does your schedule of calls, house calls or routine at the office increase the threat to your personal safety?
- Do you screen your house calls, park your car in a well-lighted place, avoid being alone in the office? Do you have adequate locks and security for your office?
2. Safety of the staff
A physician's office should be a safe environment to work in.
- Is the space and physical set-up such that risk of injury is minimized?
- Is help available if a situation arises where the staff members need help dealing with violence or injury?
- Are garbage and sharps disposals safe for both staff and patients?
- If you are working with hazardous material, what safeguards are in place? Are you complying with legislation and regulations regarding use, storage and disposal of such products? Are you prepared to deal with a hazardous spill?
- Does the location and type of practice increase the risk of violence? If so, what measures are in place to minimize the risk?
3. Safety of the medical records
Physicians are required to ensure that the clinical records of their patients are safe and secure and that the information in them is kept confidential.
- Is the physical set-up for record keeping safe from fire, theft, water damage or, in case of electronic records, a malfunction, e.g. back-up records?
- Is your computer system compliant with relevant federal and/or provincial laws?
- Is the access to medical information in the records secure?
- Is confidentiality of medical information protected, i.e. is information released only when patients authorize it or when required by law?
- Do you know who handles the records and who has access to your records?
4. Safety of the patients
The physician's office environment should be safe for patients and the risk of injury should be at a minimum.
- Does the physical set-up of the examination rooms and office minimize the risk of injury? Does it allow for privacy for patients to dress and undress?
- Is your office child-proof?
- Are instruments and equipment appropriately maintained and sterilized?
- If drugs are kept in your office, are measures in place so that only authorized persons access them? Are records kept of the drugs and to whom they are dispensed? Are prescription pads secure?
5. Safety of others
From time-to-time, a situation may arise in which information regarding a patient or the information received from a patient may have to be released in order to safeguard others. For example, mandatory reporting to the public health authorities and the driver licensing authorities are two of many examples of legislated requirements intended to provide for public safety. However, sometimes the issue is that information received from a patient may raise the concern that there is an identifiable third person at risk of violence. In such a situation, there may be a duty to warn that person at risk even though the information was gained in the context of a patient-physician relationship. If faced with a situation where a patient reveals information which raises concern about the safety of another person, you should obtain legal advice promptly. CMPA members should contact their Association.
These are only some of the safety issues for the medical profession. Depending on your type of practice there may be other hazards or risk factors. Physicians should evaluate their own practices and identify potential risks and assess what course of action should be taken to minimize these risks.
Many situations are unique. Medical and ethical obligations to patients may conflict with societal or personal expectations or beliefs. If you find yourself in this dilemma, seek assistance. The Canadian Medical Protective Association provides its members with advice in circumstances such as this. Members should contact the Association and speak to one of our dedicated and knowledgeable physicians.
Physicians must take the initiative in caring for their own personal safety so that when they are doing their professional work, they can feel safe and secure.