Ontario docs are leaving – patients have trouble finding good doctors

From the Medical Post

I WRITE IN RESPONSE to your article “What happens when a surgeon gets infected” (April 10) to provide complete and accurate information about the College of Physicians and Surgeons of Ontario’s (CPSO) process to evaluate risk and protect the public when physicians are blood-borne pathogen positive. While we are legally bound to preserve the confidentiality and privacy of all information received or created in the course of fulfilling our regulatory functions, we did provide extensive information to inform your article, much of which was not included.

To provide context, the CPSO’s “Physicians with Blood-Borne Pathogens” policy applies only to physicians who perform exposure-prone procedures (EPPs). When a physician is seropositive for HBV, HCV or HIV, and wishes to continue performing EPPs, we take steps, as authorized by our legal authority, to gather relevant information about the physician’s health and practice. This information is provided to an expert panel, composed of experts in surgery, public health, infectious diseases, a chief of staff and other experts, including those from the member’s own specialty, as required.

As part of this process, the physician has an opportunity to make representations (as happened in Dr. Wayne Gregory’s case) and to provide his or her own experts’ opinions if available, and if different from that of the expert panel.

Any advice provided or, where necessary, restrictions imposed, are based on the recommendations of the expert panel, using the best available evidence. Restricting physicians from doing EPPs is resorted to when other options are not sufficient to safeguard patient health.

The process does take time to complete and, in the best interests of the physician and the public, we try to complete it as quickly as possible. The timeliness of the process is dependent on many factors, including the willingness of the physician to co-operate with the college.

You suggest that the Canadian Medical Protective Association “takes a softer stance when it comes to doctors who get infected.” Absent from your article is the fact that in numerous ways the college and the CMPA are in agreement with regard to managing the risk associated with the practices of physicians infected by a blood-borne virus, including that:

  • Physicians should disclose personal health information (including serologic status) to colleges where it is required by law, or where it is necessary to protect patient safety.
  • HCV-infected physicians (HCV RNA positive) should not perform EPPs, but they can perform other medical duties. They may resume EPPs while on anti-HCV therapy once HCV RNA is negative.
  • Colleges should adopt management approaches based on reasonable risk and avoid seeking an unattainable and potentially injurious goal of zero risk.
  • Physicians with blood-borne viral infections that may impair their ability to practise should be able to participate in the discussions regarding their practice and any health-related restrictions being considered.

Participation should include the right to make submissions, to respond to reports with expert opinion and to appeal decisions.

You note that the question of when colleges should intervene in a physician’s health is a “minefield and a key part of the delicate dance the regulatory bodies perform around protecting patients and the profession.” We agree and believe that we have developed a framework that takes necessary precautions to protect public safety while, at the same time, respects the individual privacy rights of physicians.—Dr. Robert Byrick, president, CPSO

A long-winded sermon signed by Dr. Robert Byrick –  almost certainly composed by a CPSO Staff Member –  avoiding the issue of surgeons losing their careers because they cannot insist on HIV testing.  
The fact remains that physicians are not allowed to protect themselves and Hospital Staff against HIV-Aids by ordering routine blood tests before an EPP.
The fact remains that physicians must continue to risk their health, welfare, livelihood, career and future of their families to protect  homosexuals infected with the HIV virus.
There is no restriction for a physician to test a patient for syphillis   –  increasingly diagnosed in the Rainbow District .
An interesting fact:  Dentists can continue to work regardlesss of being infected with the entire Hepatititis ABC.
The fact that Dr. Byrick’s surgical colleagues  –   who tend to regard anaesthetists like Dr. Byrick as Junior Partners when it comes to surgery   –   are forced to risk their health, welfare, livelihood, career and future of their families with each patient, must be a source of satisfaction to this soon-to-retire Gaspasser.

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