In brief
- Informal peer support may be available from volunteer peer supporters in hospitals and healthcare institutions to help physicians learn and to alleviate anxiety after a patient safety incident. Physicians should be mindful of medico-legal risk if information they share at a peer support session is later disclosed during legal proceedings.
- Peer support programs can be structured in such a way that protects the information exchanged in a peer support session. To ensure confidentiality, the group should have terms of reference and policies that state how information is handled.
- Supporters in peer support programs can reduce their liability risk by being aware of their limited role and responsibilities in the context of peer support, and communicating these limitations at the outset to participants.
After a routine medical procedure had gone wrong and left the patient with permanent mobility challenges, the treating physician had difficulty coming to terms with what had happened. “I don’t feel I need a professional counsellor, but I am interested in connecting informally with my colleagues to share this experience with them and hopefully learn from their perspectives,” the physician explained during a call to CMPA.
“At CMPA, we see the toll that unexpected clinical outcomes can have on the physicians involved,” says Dr. Armand Aalamian, Executive Director of Safe Medical Care & Equity, Diversity, and Inclusion at CMPA. “We generally encourage our physician members to seek support from trusted colleagues. We believe that sharing experiences with peers is helpful in navigating challenging times and in alleviating anxiety. However, what many people may not realize is that even informal peer support should be guided by some rules to protect the confidentiality of the information that’s shared.”
The support that physicians receive can take different forms. Depending on the circumstances, such as when suffering from burnout, physicians may choose a formal approach, including professional counselling and therapy. The Canadian Medical Association’s “Physician wellness support services” page lists programs offered by provincial/territorial medical associations and other healthcare organizations.
Alternatively, informal peer support may be available in a hospital or other institution. Such peer support initiatives are informal owing to the fact that they are typically run by staff physicians who volunteer as peer supporters, apart from their medical professional work.
Informal peer support programs enable physicians to get the needed help and advice from other physicians who may have similar experiences, while strengthening a culture of trust among colleagues. So, what could go wrong?
“Confidential patient information may be ‘leaked’ and potentially used in subsequent legal or regulatory proceedings. This could spell trouble for the physicians involved, who seek to learn from their experiences and want to continue to deliver the best possible care for their patients. However, the possibility of a confidentiality breach should not deter physicians from participating in peer support, especially if the program is set up with clear terms of reference and policies for handling information,” adds Dr. Aalamian.
Protecting information exchanged
Participants in a peer support program sometimes worry that if they say “too much” or the “wrong thing” the information they share might be used as evidence in a subsequent legal proceeding. While those concerns are valid, the protection afforded to peer support discussions depends on how the support program is structured.
In civil litigation, all relevant information is generally admissible as evidence, but information shared during a peer support session may be protected from disclosure. This protection may be achieved depending on how the session is structured, what is discussed, and whether there is an understanding among participants and supporters that the session is to be kept confidential.
Peer support programs may be structured as part of quality improvement activities conducted according to legislation that protects information from disclosure in subsequent legal or other proceedings. For more information, see the handbook “Quality improvement and accountability reviews: Learning from patient safety incidents and near misses.”
If a peer support group is not conducted in a way that affords legislative protection of information, supporters and participants can still take steps to improve the likelihood that information may be protected from disclosure in subsequent legal proceedings:
- Develop terms of reference and other protocols that clearly state participants and supporters must keep all information discussed as confidential.
- Conduct sessions in a setting that allows all information to be kept confidential.
- If notes are being taken at a peer support session, these should be kept confidential, with access available only to those listed in the terms of reference and protocols for the peer support program.
Potential liability for supporters
Volunteer peer supporters may face a heightened liability risk if participants perceive there is a therapeutic relationship between supporters and participants. To avoid such a perception, the peer support program’s policies should clearly set out the limited parameters of the supporter’s role, specifying that the supporter’s services are not intended to be therapeutic in nature or to create a doctor-patient relationship. This information should be made available to participants prior to contacting supporters. Further, participants may be asked to acknowledge in writing that they have reviewed the supporter’s role description, are aware of the limited role of supporters, and will seek medical assistance from their treating physician or a formal support program if needed.
Despite the absence of a doctor-patient relationship, it is still possible for a court to find that a supporter owed a duty of care to the participant—if, for example, it is reasonably foreseeable that the participant would rely on the supporter’s advice. To help mitigate this possibility:
- Supporters should have a clear understanding of their limited role and responsibilities and ensure they act within those boundaries.
- Supporters should be familiar with available resources that provide additional, professional support for physicians.
- Supporters should receive relevant training pertaining to the peer support program.
Additional reading
