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A Message from the Registrar and CPSA Council President: Practising up to standard during a pandemic

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Council, From the Registrar, October Messenger 2021, Physician Assistants, Physicians | Posted October 14, 2021
Read time: 3 minutes

By CPSA Council President Dr. Louis Hugo Francescutti and CPSA Registrar Dr. Scott McLeod

Without question, these are some of the most challenging times physicians have experienced in decades, if not our lifetime. At times, it feels virtually impossible to keep up with the ever-changing personal and professional demands on Alberta’s physicians and other members of the healthcare team. Now, as our ICUs are reaching capacity and our healthcare system as a whole is strained and overloaded, there is an increasing concern amongst our profession about what accountability individual doctors carry when they know they can’t provide the level and quality of care they normally would. This can cause moral distress, a term first coined in 1984 by Andrew Jameton. He wrote, “Moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.”

As a result, a number of physicians have reached out asking about CPSA’s expectations during this very challenging time with questions like, “Should the AHS Triage Protocols be activated, what would the medico-legal risk be for a physician?” and, “How do physicians continue to meet their professional requirements under the current situation?” These are all good and valid questions, and we feel it is important to share this guidance with everyone instead of just those who have asked.

Early in the pandemic, CPSA issued the following statement:

“Physicians should not be reluctant to provide care, even when it may be extremely difficult to follow some components of CPSA’s Standards of Practice. CPSA will always consider the individual circumstances and context if a complaint arises during the COVID-19 pandemic. In an emergency situation, failure to meet standards is not considered unprofessional conduct if a physician can demonstrate they took all reasonable actions in their service to patients.”

Our statement still holds true today, but it’s important to note that it doesn’t mean you can blatantly ignore CPSA’s standards. CPSA’s Standards of Practice exist to help guide physicians, and when you’re having a difficult time trying to make the best possible decisions, we hope you’ll use them to guide your practice. As we continue providing care in the face of the pandemic, it may not always be possible to meet the full requirements, but we recommend you focus on meeting the standard’s intent. Do you have the patient’s best interest at heart when you’re providing care? Are you doing the best you can?

When it comes to the AHS Triage Protocols, we’ve heard many concerns about the personal risk a physician would assume when following the protocols. CPSA has been working closely with Alberta Health Services and recently shared a message outlining that there is very little to worry about if you follow the protocols, doing so in the most professional manner you can.

Here are a few things to keep in mind as we continue into the upcoming weeks and months, and when managing difficult situations:

  1. Document, document, document. This is not the time to cut corners in your documentation. In fact, we highly recommend documenting more rather than less.
  2. Communicate clearly and professionally. Engage the patient’s family, friends and caregivers very early on and keep them apprised of the evolving situation.
  3. Consult with your colleagues and CPSA. Never hesitate to reach out to a colleague or CPSA if you have questions or need clarification.
  4. Provide the best care you can with the resources you have.
  5. Support each other and the rest of the healthcare team. This is not a time for arguments and dissention, it’s a time for teammates to support one another and function together at a high level. Being compassionate can go a very long way—don’t forget to show that compassion to yourself as well!

These are not easy times and we recognize physicians are having to make difficult decisions on a daily basis. There is no expectation for you to be perfect. CPSA will always take the circumstances into account, and if you’re doing the best you can, then you shouldn’t be worried.

Have questions or want to connect with CPSA?

Join CPSA Council President Dr. Louis Hugo Francescutti along with Dr. Scott McLeod, CPSA Registrar, on Thursday, Oct. 21 at noon for a 45-minute virtual Q&A session!

2 Responses

  1. Borys Hoshowsky says:

    I find it troubling that the CPSA has not looked at physicians who offer mostly virtual care. Perhaps it is time to explore the ethics of this practice and I believe Ontario is addressing this concern. At this point in the pandemic virtual visits should be few. Is it mostly non FFS physicians involved?

  2. Scott McLeod says:

    Hi Borys, thanks for reading Messenger and writing in. I’ll start by saying that CPSA views virtual care as simply a tool for the provision of high quality care. As such, when it’s used properly, it can be a very valuable tool. When used inappropriately, it can be very dangerous. At the end of the day good care is good care, whether that is provided in-person or virtually. We currently have three standards of practice relating to virtual care out for consultation if you wish to review and provide your feedback.

    We are aware of the position of CPSO and would agree that, for some patients, virtual visits may not offer the appropriate standard of care. Alberta remains under a state of public health emergency at this time—infection rates, hospitalizations and ICU capacity remain high, while vaccination rates lag behind provinces like Ontario. CPSA supports clinics in exploring the use of virtual care, scheduled appointments and the donning of PPE as strategies to help keep physicians and patients safe. CPSA is also supportive of the use of virtual care as a strategy to de-escalate situations where safety may be in question, such as when patients exhibit abusive or threatening behaviour when seeking out unproven therapies, such as ivermectin, or a mask or vaccination exemption letter.

    As for your question about whether these are mostly non-FFS physicians, there does not seem to be a clear pattern that would support that. We are seeing many FFS doctors looking at virtual care only models.

    Thanks again for taking the time to share your thoughts—please take care.