Disclosure of Physician Health Information: Seeking the Right Balance between Confidentiality and Public Safety
The Alberta Medical Association (AMA) began this process with two problems relating to physician health. The first was a conviction that a newly proposed Standard of Practice from the College of Physicians & Surgeons of Alberta (CPSA) would contribute to inhibiting physicians with medical and emotional or mental health issues from seeking the help they need. The second was a disagreement with the CPSA on the best model for a physician health program and, in particular, with the governance of the biologic monitoring component of the program.
The great musician Duke Ellington once advised that a problem is a chance for you to do your best. It is our hope that the Health Law Institute report titled Physicians with Health Conditions: Law and Policy Reform to Protect the Public and Physician-Patients' will serve as the instrument for both the AMA and CPSA to do our best in serving the physicians of Alberta and the public, the patients of those same physicians.
The AMA appreciates the agreement by both the CPSA and AMA boards to pursue a common approach to these issues through engagement of the Health Law Institute.
The AMA presented evidence that fear of reprisals from regulatory authorities is a factor in preventing physicians from seeking care. This assertion is supported in current medical literature regarding physician health and in the policies of the Federation of State Physician Health Programs and the American Society of Addiction Medicine (ASAM). While recognizing the need for the CPSA to protect the public from unfit doctors, we feel this is counterbalanced by the need for physicians to be able to seek care in a confidential manner--allowing them to be patients with the rights of privacy and confidentiality afforded to all persons accessing the health care system in Alberta. In the broad perspective, this serves the public by allowing physicians to seek care early in the onset of their medical or mental health condition, secure in the knowledge that the CPSA will be informed only at the point that the condition affects the physician's ability to practice.
Another obstacle facing our physician patients is the current direct connection between the biologic monitoring program and the CPSA. Biologic monitoring of patients with addictions is a basic tenet of treatment programs. Yet, not every physician with addiction is at a stage in their disease process where reporting to the CPSA is either mandatory or recommended. The fact that all monitoring test results of the current program are currently reported to the CPSA is, in our view, a detrimental factor when the objective is ensuring that physicians seek assistance and treatment early on in their struggles with addiction. The earlier ill physicians enter into treatment, the better it is for them, their families and patients.
Health Law Institute Physician Health Report
The Health Law Institute review of physician health issues provided a legal perspective on the balance between the right of physicians for access to personal health care and the safety of the patients whom they treat. These items are not mutually exclusive goals and one profoundly impacts the other. The recommendations in the report pertained to three specific areas related to physician health and patient safety.
i) Disclosure of personal health issues that is required upon licensure
The HLI report reinforced many of the concerns expressed by the AMA. The conclusions and recommendations supported the need to remove the stigma that develops when specific health issues are always reportable. The report also acknowledged that there must be a connection between the condition and a negative impact on practice for a health issue to be reportable to the regulatory body.
The AMA would have preferred the report to acknowledge more specific benefits for physicians who take positive steps to address personal health issues. …