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Patient Compass

January 2017

The Opioid Crisis and You

If you’re in medical school, you should already be thinking about your future role in the safe prescribing of these powerful narcotics

If you were anywhere near a newspaper this past fall, you know that Canada, Ontario, and indeed much of the developed world is in the midst of an opioid crisis. Our country is the second largest per capita prescriber of these narcotics (after the US), and while our national and provincial guidelines have evolved to address the demand, professional practice among physicians has not followed. Without a doubt, opioids have a role in clinical practice and they should be used appropriately. The role of a doctor is to help patients manage their pain safely without contributing to addiction. As this crisis has unfolded, we here at the CPSO have been reminded just how important it is to keep our patients’ best interests at the centre of any strategy to deal with the problem of overprescribing.

There is also a role for you, as Ontario’s medical students and the future of this profession, to play in helping reduce the harm that opioids are causing. That role involves you developing good prescribing habits today that will benefit the patients you will help with their pain management tomorrow. There are a lot of elements to treating pain effectively: these include being cautious around dosages (“Start low and go slow,” as the saying goes), showing compassion towards your patients’ unique situations and needs, and staying mindful of the real risks of overprescribing.

Beyond familiarizing yourself with our Prescribing Drugs policy (which you should be doing anyway), you can also glean a lot of specific information about opioids by reading issue three of Dialogue 2016 and the most recent issue. In these issues, we’ve run a series of articles on opioids, covering topics like opioid use and abuse, new legislation around fentanyl patches, and the serious risks involved in abrupt opioid cessation. We encourage you all to read these articles closely.

And as always, if you have any questions around our prescribing policy, you can always call our physician advisors at 1-800-268-7096 Ext. 606 and they would be happy to help you out.

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Free Speech vs. Professionalism

In all medical interactions, it’s about upholding the standards of the profession.

At a recent talk on professionalism we delivered at an Ontario medical school, a student approached us afterward and started a conversation about free speech and professionalism. This medical student felt that, in certain hypothetical scenarios, professionalism standards might limit his ability to freely express his views.

It was a fascinating chat about the confluence of opinion, professional conduct, and free speech in medical or even non-medical situations. We reminded this student that doctors do enjoy the same rights as all Canadians when it comes to matters of free speech. But we also reminded him that there can be serious consequences to expressing any opinion – especially one that could be interpreted as insensitive or disrespectful – and that physicians are held to very high standards when it comes to interactions with their patients, colleagues and the public more broadly. These standards, captured in our Practice Guide, are built around the principles of compassion, service, altruism, and trustworthiness.

Even something as simple as expressing a political opinion, making a joke, or commenting on a person’s dress could be interpreted as falling short of these standards and be offensive to your patient. Remember: building rapport and trust is key to good clinical care, and expressing personal (and especially non-medical) opinions could undermine that effort.

But if you have concerns about whether opinions you want to express could cross a line in terms of your professionalism as a future doctor, we do have a number of other CPSO documents that can help guide you. These include our Physician Behaviour in the Professional Environment policy, which lays out our expectations around physicians acting in a respectful, courteous and civil manner towards their patients, colleagues, and others in the health care profession. We also have our Guidebook for Managing Disruptive Physician Behaviour, our Professional Obligations and Human Rights policy, and our position paper on the appropriate use of social media by physicians. Each of these documents can help you apply the principles of professional behaviour, both today as medical students and tomorrow as future doctors.

Remember: there can be a big difference between merely expressing an opinion and behaving in ways that do not uphold the standards of the medical profession. But if you have concerns, we encourage you to discuss these issues with your classmates and professors, consult your school or training hospital’s codes of conduct, or reach out to our physician advisors here at the CPSO at 1-800-268-7096 Ext. 606.

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Future Leaders’ Day – Nominate your Prof!

Do you know a professor who shows clinical leadership, shares knowledge and inspires you? If so, consider nominating him or her for our Future Leaders’ Day on May 12, 2017.

Each year at the College, we host Future Leaders’ Day, an event where we invite peer-nominated physicians from around the province to learn about the nuanced world of medical regulation. Future Leaders’ Day is our chance to show Ontario physicians how they can get involved in the work of the College. These opportunities include becoming a peer assessor, joining the College part-time as a medical advisor, participating in policy working groups or even running in their district election to join our Council.

If, during your journey through medical school, you’ve come across an inspiring professor, someone who displays excellence in leadership, nominate them to become a Future Leader! You can do so by contacting Nawaz Pirani. The deadline for nominations is March 3, 2017.

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Open consultations

We are conducting two policy consultations that deal with the beginning and end of a physician’s relationship with his or her patients. The draft Accepting New Patients policy sets out physicians’ professional and legal obligations, emphasizing they must accept new patients in a manner that’s fair, transparent and respectful of their rights, autonomy, dignity and diversity. At the other end of the spectrum, the draft Ending the Physician-Patient Relationship policy articulates the College’s expectations of all physicians when ending the physician-patient relationship for any reason other than the physician’s retirement, relocation, leave of absence, or as a result of disciplinary action by the College.

We encourage all medical students to participate in the open consultations the College is currently running. Your perspectives are just as important as the feedback we receive from our membership, other health care professionals and the general public. These consultations close on February 10, 2017.

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We want to hear from you!

Do you have an idea for the next issue of Medical Student Update?

Are you looking for a CPSO policy expert or medical advisor to provide a guest lecture at your school? Let us be a resource for you. Contact us to arrange a presentation, or get more information about our range of seminars.

Contact our Outreach Team:
80 College Street
Toronto, Ontario
M5G 2E2
416-967-2600, Ext. 552

Our quarterly magazine contains important updates on policies, topics of interest, as well as a summary of recent disciplinary findings.
Read the latest issue here.
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