- Most provinces and territories have statutory provisions and/or College policies that make it mandatory for you to report a health professional whose health might compromise their ability to practise or put the public's health at risk.
- All jurisdictions have legislation that requires you to report patients with certain communicable diseases.
- In cases of unprofessional conduct by colleagues, you or your institution may have a statutory duty to report in some jurisdictions and a general duty to do so in other jurisdictions.
- It is important to inform a health professional-patient of your decision to report.
- Consider referring health professional colleagues to relevant health programs for the assessment and treatment of medical, mental, substance abuse, or behavioural problems.
A Manitoba physician suffers from alcohol dependence and occasionally has tremors and blackouts. They are being treated by their family physician. The family physician is becoming increasingly concerned about the physician-patient's ability to work, and suggests they stop seeing patients until getting the necessary treatment. Despite this, the physician-patient continues to practise, but says they do not drink or take drugs before working.
Manitoba's Regulated Health Professions Act requires a treating physician make a report to the College if a physician reasonably believes another physician is unfit to practise or suffers from a disorder or illness that may affect their ability to practise, and continues to practise despite having been counselled otherwise.
In this situation, the family physician should assess whether their physician-patient can properly perform their clinical duties, even if they do not drink or take drugs before seeing patients. If the risks of blackouts, tremors, or lapses in judgment remain, a duty to report exists. In that case, the family physician should advise the physician-patient that there is an obligation to make a report to the College, and this should be done as soon as possible.
You should become familiar with the legislation and/or College policies on reporting in your province or territory. The reporting requirements and expectations can generally be found on the relevant College website. You may want to contact a CMPA physician advisor for information and to review your obligations to report. Most statutes or policies require that you have reasonable grounds for reporting; however, the triggering criteria can vary considerably between Colleges. Terms such as incompetence, incapacity, or unfit are commonly used, but typically are not defined in the pertinent statute or policy document.
You may be required to report to health care institutions, hospitals, public health officials, or Colleges. A hospital or facility that limits, suspends, or revokes the practice privileges of a physician (or another health professional) may be required to report this to the College.
If you are uncertain about your reporting obligations, contact the CMPA for advice.
The CMPA encourages physicians to attend to their own personal health. This is especially important when facing stress from medico-legal difficulties.
Physician health and wellness programs (PHPs) are available across the country. Studies have shown that these programs can successfully help physicians and allow them to return to active practice. Physicians may contact a PHP directly for help or refer a colleague.
Generally, the confidentiality provisions associated with PHPs provide a safe haven to seek assistance and treatment in a manner that does not threaten professional standing. In specific situations, PHPs may have an obligation to report to the College. Physicians considering PHP treatment regimes are encouraged to review the reporting obligations of PHPs.
Concerns about a health professional who is your patient
Communicable diseases: All provinces and territories have public health laws requiring physicians to report patients with certain communicable diseases (e.g., HIV or hepatitis) to public health officials. If a health professional-patient is diagnosed with a reportable condition, you must report this to the individual or office designated in the legislation.
Health: As a treating physician, you may have a legal requirement or ethical duty to report a health professional-patient's health status to the relevant regulatory authority when the condition might reasonably impair their ability to practise or when the condition could threaten the safety of patients, staff, or others.
This can happen when the health professional-patient refuses to follow recommended and reasonable treatments such as taking medications, exercising safety precautions, or taking a necessary leave of absence. You may face a dilemma between your duty of confidentiality as a treating physician and the imperative to protect the public. Public safety must be the primary consideration.
Alleged sexual impropriety: Many provinces/territories have specific statutory provisions or College policies that require the reporting of conduct such as suspected sexual impropriety by a health professional toward a patient. This obligation most often arises when you have reasonable grounds, based on information you have obtained in your practice, to believe that another health professional (whether a patient or a colleague) has sexually abused a patient.
Concerns about a health professional colleague who is not your patient
Clinical competency: There may be uncommon circumstances in which you feel it is necessary – for reasons of patient safety – to bring forward your concerns about a colleague's pattern of care, health, or behaviour.
In a hospital or institution, you should voice your concerns through the proper administrative channel. In a just culture of safety, the leadership would fairly determine if the individual has a gap in knowledge or skills, or if a medical assessment is indicated. The preferred approach is to provide training and support.
Disruptive behaviour: Physicians may have a responsibility to report the unprofessional conduct and behaviour of other health professionals to an appropriate person in an institution or hospital, often the chief of the department.
Institutions and hospitals generally have a legislated obligation to address disruptive behaviour in the workplace. Referrals to a health program for assessment and treatment can often help resolve the disruptive behaviour. If disruptive behaviour negatively impacts patient safety or if the health professional is impaired, there may be an obligation for you or the institution to report the health professional to the College.
Making the report
When you determine you have a legal obligation or ethical duty to make a report to an institution, hospital, College, or public health official, in most cases it is best to first inform the health professional that you are obliged to make the report. The report should be made in a timely manner or immediately if patient safety is at risk. Although a health professional may wish to continue practising, the physician making a report must consider the safety of the community and the wellbeing of the health professional being reported. The health professional who is the subject of the report may require advice to stop practising in the interim.
Helping decrease the stress associated with reporting
The report itself and even your concerns about a colleague's fitness to practise or disruptive behaviour can be stressful for all involved. Recognizing that reporting is difficult, it is important to inform your colleague why you need to make the report. Generally, avoiding surprises and showing support or empathy will help ease the tension.
Being aware of a health professional who should be reported but failing to do so may result in disciplinary proceedings against you at your health care institution or hospital, or at the College. It could also result in a legal action, especially if someone is allegedly harmed because of an unreported health professional's incapacity, health status or behaviour.
Although a decision to report may cause you considerable stress, it may be reassuring to know that the statutory provisions and the civil/common law generally protect you against liability in such circumstances. This protection typically prohibits a legal action against reporting physicians when their report is made on reasonable grounds and in good faith.
Keeping records of relevant information
You should keep detailed records of any relevant information leading up to making a report. The records should include the outcome of discussions with the health professional-patient or colleague referred to in the report. Contemporaneous notes (i.e., notes made at the time of or as soon as practical after the actual encounter) may be helpful if it is alleged that the report was not made in good faith or on reasonable grounds. Any disclosure of patient information (even if it relates to another health professional) should be documented in the patient record.
Self-reporting by health professionals
If a health professional is being treated for serious health issues, they must also consider whether they are obligated to self-report in accordance with applicable legislation or College policies. On license applications or renewal forms, some regulatory authorities include questions about alcohol or drug dependence, infectious diseases, and physical or mental health conditions that might affect fitness to practise safely.