originally published September 2016 – in CMPA Perspective P1603-2-E
All physicians will admit that at some point in their careers they’ve failed at being collegial. And most would be embarrassed to recall those times they’ve been disrespectful and unsupportive of fellow physicians and other healthcare colleagues.
When physicians don’t behave collegially toward each other, the effects can be far-reaching. The behaviour can impact the quality of care provided to patients and cause unhealthy stress for physicians, both of which can potentially lead to medical-legal issues.
The CMPA has seen medical-legal cases where collegiality between physicians could have made a positive difference. “In these cases,” says the Association’s Executive Director and Chief Executive Officer, Dr. Hartley Stern, “a little collegiality could have gone a long way. It could have reduced the risk of harm to patients and the stress of physicians.”
WHAT IS COLLEGIALITY?
Physicians often use similar terms to describe collegiality — mutual trust; respect; knowledge of each other’s expertise, skills, and responsibilities;1 a sense of mutual collaboration; openness; transparency; a common focus on the patient; and compassion and support.2,3
How a lack of collegiality can lead to medical-legal difficulties
In some CMPA medical-legal cases, physicians’ disrespectful and unsupportive behaviour has directly interfered with patient care. In one such case, a surgeon wanted a locum to care for a frail patient immediately after surgery. The locum asked to also be involved in the care before and during the surgery. The surgeon denied the request and as a result, the locum refused to provide after surgery care. The disagreement meant that post-operative care for the patient was now unavailable at the hospital. The surgeon made other arrangements and 24 hours after the surgery, the patient was transferred to another hospital three hours away.
The care and transfer prompted the patient to complain to the medical regulatory authority (College). The final outcomes of this disagreement were an unnecessary transfer for the patient, a College investigation of the surgeon and locum, and College discipline of the locum.4
In other CMPA cases, a lack of collegiality has indirectly impacted patient care. In these cases, physicians have become so distressed or ill they cannot practise effectively or safely. As a result, patient care has suffered, and a complaint or legal action has followed. The Association often discovers that one of the contributors to these physicians’ distress has been disrespectful and unsupportive treatment from peers.
MEDICAL-LEGAL ISSUES AND STRESS
For many physicians, dealing with a College or hospital complaint, or a legal action can bring on anxiety and stress. Calling the Association and speaking to one of our physician advisors, licensed physicians with clinical experience, can help members reduce their stress. The physician advisors can provide helpful information and identify other resources. Members are encouraged to contact the CMPA whenever they are concerned with a medical-legal issue.
What can be done to encourage collegiality?
Many physicians do recognize the value of collegiality and are actively working through various organizations to enhance its role in medicine. For instance, in the CanMEDS 2015, Physician Competency Framework, collegiality has been given greater emphasis and is more explicit.5 Members of the Representative Assembly of the Saskatchewan Medical Association (SMA) have discussed collegiality and how to strengthen physician-to-physician relationships.6 And physicians attending a Canadian Medical Association forum on professionalism “…. identified the need to improve collegiality between family physicians and specialists, and also to focus on inter-generational collegiality.”3
Individually, physicians can take the opportunities offered in their daily work to practise collegially. For example, one area where physicians can build respectful and supportive relationships with fellow physicians is the referral-consultation process.
Referrals and consultations
Both referring and consulting physicians can practise collegially by keeping patient care as the focus of the working relationship.7
When making a request for a consultation or an investigation, referring physicians should ask themselves a number of questions. What is it I need answers to? Is the request urgent? What kind of help am I looking for: advice, a second opinion, or on-going care management? The consultation request itself should clearly state its purpose and include the relevant clinical information.7
Physicians being consulted should provide their report in a timely manner, making sure it is also clear and complete. Follow-up plans should state who is accountable for investigations and further care so everyone is clear on their responsibilities.7
On receiving a consultant’s report, physicians should review it and the recommendations. If anything is unclear, they should communicate directly with the consultant and document the responses for future reference. The follow-up plans and accountabilities for investigations and further care should be clear so both physicians understand their responsibilities.7
A more detailed discussion of this collaborative approach to referrals and consultations can be found in the CMPA Good Practices Guide.7
Resources on collegiality
Physicians wanting to enhance collegiality in their practice have a number of resources available to them. College guidelines, standards of practice, or recommendations can be helpful. Many Colleges, for instance, provide information on how to work collaboratively with other physicians in specific areas such as the referral process.8
The physician health programs in each province and territory are another source of guidance on practising collegially. For example, a 2014-15 series of articles by Dr. Michael Kaufman of the Ontario Physician Health Program discusses how to bring civility into medicine.9
Other medical organizations, such as the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians, and the Canadian Medical Association are also addressing various aspects of collegiality. A backgrounder commissioned by these three organizations, for example, looks at the factors in medicine that prevent doctors from practising better intra-professional behaviour and collegiality.10
The CMPA is another source of information on collegiality. The Association’s website (www.cmpa-acpm.ca) has a number of articles on working collaboratively and respectfully, and its Good Practices Guide7 offers specific advice for fostering collegiality.
Collegiality: Worth the effort
The Association has seen medical-legal cases where a lack of collegiality has negatively impacted the patient care and increased physician stress. And in some cases, patients have noticed the lack of collegiality among physicians, which can devalue the profession in patients’ eyes.
While many medical organizations, including the CMPA, are actively working to strengthen collegiality in the profession of medicine, <sup>3,5,6</sup>all practitioners can enhance it in their own practices. Physicians can commit to being mindful of how well they work with physicians and other healthcare team members, and make the effort to build respectful and collaborative relationships that focus on patient care.