The COVID-19 pandemic is giving rise to new types of complaints to regulatory authorities (Colleges). Since the start of the pandemic, patients have been lodging complaints to Colleges about issues such as:
- physicians closing their clinics out of safety concerns and failing to offer virtual care or referrals to other physicians
- inadequate infection prevention or inadequate use of PPE by physicians
- physicians continuing to work following a known COVID-19 exposure
- physicians declining to respond to patient requests for mask exemptions or work-related accommodations
- physicians insisting that patients wear masks during appointments
In response to the pressures physicians are facing, some Colleges have issued statements about their expectations of patient care during COVID-19, and confirmed they will consider the context of the pandemic when assessing complaints. As well, the CMPA has created an online COVID-19 Hub to provide guidance about emerging medico-legal issues.
If you find yourself facing a College complaint relating to your care or clinical practice during COVID-19, consider the following.
- Seek support from the CMPA
If the complaint is related to the practice of medicine, the CMPA is there to assist you. Our physician advisors will advise you about your individual situation, and help you deal with any stress and anxiety you may be feeling.
Our online wellness resources, especially the article “Coping with a College complaint” can help put the complaint in context. Most physicians face at least one complaint during their careers, and most complaints do not result in disciplinary action or are dismissed outright.
- Assess the complaint
Colleges typically notify physicians of a complaint by email, letter, or telephone. They may provide a copy of the complaint letter, or simply enumerate the complaint issues.
To assess the complaint, begin by determining who complained about what. Anyone—patients, family members, employers, or colleagues—can complain if dissatisfied with your care or conduct. Although most complaints stem from patient interactions, some may refer to activities outside your professional practice. This is especially the case during COVID-19, which has seen an increase in complaints filed against physicians for social media posts or other statements perceived as spreading disinformation. To learn more about engaging with the public during COVID-19, see the text box on “Advocating online and in the media”.
- Review the medical record
When the complaint is about a clinical event, review the patient’s medical record. If the record belongs to a hospital or other institution, contact the CMPA first, since there are steps you may need to take before accessing the record. If the College requests a copy of the patient’s record and it is under the custodianship of another organization or individual, contact the CMPA for more detailed advice.
After reviewing the record, you may find inaccuracies or omissions in your documentation. When you see information you think is incorrect, you may want to respond by providing additional information or attempting to clarify what happened. However, it is very important that you not alter the record. Instead, you should contact a CMPA physician advisor to help you decide on the best course of action. If you make changes without first speaking to the CMPA, those changes may impact your credibility and lead to a charge of unprofessional conduct.
Finally, confirm that you understand what the College is asking you to do. If asking you to respond, Colleges typically give directions on how and when, including deadlines. While Colleges expect a reply within a certain timeframe, extensions can be granted in certain circumstances.
- Write a response
Before writing your response, contact the CMPA and speak to a physician advisor for guidance.
Your initial response should be factual, and describe what happened with the patient or third party, as well as the rationale for your decisions. Include your recollections of the encounter and information from the medical record, clearly indicating the source of the information.
Use a respectful and professional tone. Avoid expressing anger, or being defensive or dismissive. Remain objective and avoid making subjective comments about others involved in the clinical situation.
It can be helpful if you can demonstrate to the College that you are able to assess your practice when an interaction with a patient was unsatisfactory. This means being able to consider the key issues in the complaint and determine if there are steps you could take to mitigate the risk of a recurrence.
What happens next?
Many Colleges will send a copy of your response to the complainant, asking for further comments. Occasionally, this satisfies the complainant. Frequently, however, the complainant will send a second letter to the College, which the College may send to you for further comments.
If there are new issues to be addressed or clarified, you should consult again with a CMPA physician advisor about whether to send an additional response to the College.
The College will consider the information from the complainant and the physician. If the medical issues are complex, the College might seek an expert peer opinion from an independent physician. On occasion, the College will seek information from witnesses such as office staff or hospital employees.
How does it get resolved?
In most cases, physicians successfully demonstrate their actions were appropriate medically and professionally, and the College takes no action on the complaint. In cases involving less serious complaints (e.g. minor communication concerns), an alternative dispute resolution process may be used to resolve the complaint in a mutually agreeable way.
Sometimes physicians are criticized for being unprofessional in their interaction with the patient, even though the medical advice was appropriate. In these cases, physicians may receive advice or a caution from the College. In some jurisdictions, the caution may appear on the public register. The College may also suggest remedial actions, such as targeted education or professional development, particularly where there has been a failure to adhere to College policies.
In more severe cases, where the physician’s actions lead the College to have concerns about conduct or competence, the matter may be referred to another College committee for a discipline hearing. Issues with physical or mental health may be referred to the committee responsible for assessing the physician’s fitness to practise.
Advocating online and in the media
The CMPA has seen College complaints recently about statements made by physicians during COVID-19 on platforms such as Twitter, Facebook, Instagram, and personal blogs. Media outlets are also asking physicians for their opinions during the pandemic. If you’re thinking of posting comments online or granting a media interview:
- The CMPA encourages physicians to speak out on issues in a professional and respectful manner, provide an informed perspective, and follow any applicable institutional or College policies to ensure appropriate channels are used.
- Take a pause before making any posts or comments live. With emotions running high during the pandemic, it can be easy to respond angrily if you read something you think is disinformation. Give your emotions time to cool before pressing send, and remember that social media posts are not private. Anything you post should be considered public and permanent.
- Be aware that some Colleges have issued guidance about online statements during the pandemic. For example, the College of Physicians and Surgeons of Ontario reminds physicians that their comments or actions may lead to public or patient harm if their opinion does not align with information from public health agencies or governments.1
CMPA assistance with College complaints
The CMPA will generally assist members with College complaints relating to the professional practice of medicine, but will generally not assist with complaints arising primarily from business or personal issues, such as matters relating to advertising, rental or leasing disputes, employment issues, or marital and family disputes.
The bottom line
If you are notified of a College complaint:
- Contact the CMPA. Speak with a physician advisor and visit our website to access helpful information on dealing with College complaints and maintaining physician wellness.
- Assess the complaint. Determine what the complaint is about and what the College is asking you to do. Do not alter the medical record in any way without first speaking to a CMPA physician advisor.
- Respond professionally. Write to the College and address the complaint in a respectful manner.
College of Physicians and Surgeons of Ontario [Internet]. Toronto: CPSO; 2021. COVID-19 FAQs for physicians. https://www.cpso.on.ca/Physicians/Your-Practice/Physician-Advisory-Services/COVID-19-FAQs-for-Physicians