Originally published October 2012
As healthcare delivery relies increasingly on integrated or collaborative care, a growing number of physicians are working in teams composed of physicians and other healthcare professionals.
It is understood that in the context of collaborative care, the attributes which define professionalism become even more relevant. A respectful and collaborative approach to healthcare delivery requires a shared understanding of what is expected of each other and defining how team members interact. Teams are effective when there is a culture of professional respect and understanding, and clear and open communication among team members.
Recognizing that teamwork is an important component of professional conduct, some provincial and territorial regulatory authorities have outlined the responsibilities expected of physicians as they interact in a team environment. For example, the College of Physicians and Surgeons of Ontario states the following: "To promote the safe and efficient delivery of healthcare to all, physicians are expected to work respectfully and collaboratively with other members of the healthcare team. This includes other physicians, hospital staff, volunteers, students, and all other individuals who contribute to healthcare delivery."1
The Canadian Medical Association policy also outlines the accountabilities of physicians when interacting with providers: "While maintaining responsibility for care of the patient as a whole, physicians must be able to interact constructively with other healthcare providers within an interdisciplinary team setting. The relationship of physicians with their colleagues must be strengthened and reinforced. Patient care benefits when all healthcare practitioners work together towards a common goal, in an atmosphere of support and collegiality."2
Roles and accountabilities
When roles and accountabilities of members within a healthcare team are clearly defined, patient safety is enhanced and medico-legal risk for physicians is reduced. Achieving this clarity requires a policy and procedural framework that is specific to teams. Ideally, this framework is developed when a team becomes established and is revised over time or when new team members join.
Since a physician's role in healthcare delivery can vary depending on the care setting, clinical situation, and patient preference, policies and procedures should allow for flexibility. Professionalism requires physicians to acknowledge that their role can vary and to recognize the roles of other healthcare professionals.3
As the lines of communication and accountability are clarified for each care provider, professionalism also implies respecting the unique obligations imposed on physicians. Recognizing the fiduciary duty of physicians to patients, the collaborative care model should reflect the accountabilities expected of physicians. As roles and responsibilities of each member reflect their inherent accountabilities, the likelihood of confusion or ambiguity is further reduced. Such effort will lead to safer medical care.
Effective team communication
Physicians demonstrate professionalism when they listen to team members, consider different points of view, openly share information, and communicate clearly and respectfully. Just as the collaborative team should expect physicians to act professionally, physicians also have reasonable expectations that other team members will act in the same manner.
At times, interactions within and between healthcare teams may be strained owing to status, hierarchy, and professional identity of the team members.4 This can occur whether the physician or another team member is the primary care provider. Regardless, hierarchy and status should not alter a physician's communication style. Medical professionalism demands polite and courteous communication with all team members, at all times.
The CMPA's analysis of recently closed legal and medical regulatory authority (College) cases identified specific issues associated with physician-to-nurse communication that led to poor patient outcomes. These included the failure to alert the care team of key clinical management issues, to order necessary assessments, and to monitor and read nurses' notes. From a physician's perspective, the cases reveal that communication problems in teams may be avoided when physicians:
- inform other team members of the patient's management plan and identify the main concerns about a patient's care
- order the necessary assessments and monitoring to enable team members to observe any changes in the patient's condition
- read the patient's record to be up-to-date about the patient's current status
- attend to the patient's changing or deteriorating condition in a timely manner
- instruct office staff to document all telephone communications with patients
Differences of opinion
There may be times when a physician team member is concerned about the care being provided by another team member. There may be questions about an investigation, diagnosis, or treatment. When differences of opinion arise, physicians should avoid jumping to conclusions or making insulting or disparaging remarks about other healthcare professionals. Physicians should also refrain from questioning the treatment plan in front of patients or their families. These issues are best addressed in private where a thoughtful discussion can take place, and may require the input of other staff.
Collaboration and conflict resolution
Conflict in healthcare organizations has been described as a leading cause of unsafe cultures and a serious threat to patient safety.5 To address conflict issues, physicians should seek to develop skills in collaboration, as well as in conflict prevention and management. Workplace collaboration may be improved when, on an individual level, healthcare practitioners display emotional maturity and self-confidence, seek to understand the perspectives of others, communicate clearly, and avoid blaming others when something goes wrong.
When physicians encounter colleagues in conflict or who are displaying unprofessional behaviour, they should attempt to address the issue and recommend resources that can help. Early intervention and remediation have been shown to be very effective in correcting disruptive and other inappropriate behaviours.
Healthcare organizations, for their part, should support conflict resolution by offering appropriate training and implementing processes to resolve disputes. When necessary, the use of healthcare mediators should also be considered.6
For physicians working in smaller organizations, such as clinics and private practices, creating an environment of mutual respect is the best way to encourage a positive workplace that supports the well-being of physicians and portrays the professional image that is expected of them.
Collaborative care is transforming healthcare delivery in Canada. Teamwork is an important component of professional conduct. Clear roles and accountabilities, solid communication skills, and strong collaboration and conflict resolution will help doctors demonstrate their professionalism to their fellow team members and their patients. This commitment to professionalism should set an example for others to emulate.
- College of Physicians and Surgeons of Ontario. "Physician Behaviour in the Professional Environment." Policy #4-07. Retrieved on August 30, 2010 from: http://www.cpso.on.ca/ policies/policies/default.aspx?ID=1602
- Canadian Medical Association. "Medical Professionalism." Revised 2005. Retrieved on June 14, 2012 from: http://www.cpso.on.ca/ policies/policies/default.aspx?ID=1602
- Royal College of Physicians (U.K.), "Medical professionalism and leadership." Retrieved on February 17, 2012 from: http://www.rcplondon.ac.uk/policy/physician-development/medical-professionalism-and-leadership
- Apker, J., Propp, K., Ford, Z., "Negotiating status and identity tensions in healthcare team interactions: An exploration of nurse role dialectics," Journal of Applied Communication Research (2005) Vol. 33, no.2 p.93
- Marshall, P., Robson, R., "Preventing and managing conflict: Vital pieces in the patient safety puzzle," Healthcare Quarterly (2005) Vol. 8 (sp) p.39
- Ibid, 43