Preventing the need for disciplinary actions against Canadian physicians

M edicine has been organized as a profession across the developed world for almost two centuries. 1 As part of belonging to a profession , physicians have developed and agreed to adhere to codes of ethics and/or standards of conduct. The use of professionalism to organize and deliver medical services is based on the understanding that medicine demands an expertise " not easily comprehensible to the average citizen, " 2 that becoming a physician requires significant periods of education and training, and that physicians must serve the common good. Professional status confers significant privileges on physicians, including autonomy of practice and the right to self-regulate—that is, to set and enforce standards of practice. The right to self-regulate is also a fundamental obligation for the profession as a whole. The professional licensing bodies, which in Canada are the provincial colleges of physicians and surgeons and equivalent territorial bodies, are an important part of this right and obligation. Ultimately, the disciplinary action carried out by these bodies is the final enforcement of the profession's standards. Disciplinary action by medicine's licensing organizations involving practising physicians receives relatively little attention in the medical literature. However, a growing body of published evidence supports the need to teach and evaluate professionalism in physician trainees. The article by Alam and colleagues published in this issue of Open Medicine describes the frequency and type of, as well as the specialty involved in, disciplinary actions against physicians in Canada over almost a decade. Although the authors found that no more than 1 in 1000 physicians in Canada had been subject to disciplinary action during that period, in order to protect patients it is important for the profession to understand the causes of disciplinary actions and to actively seek ways to reduce behaviours leading to disciplinary actions. Alam and colleagues report two particularly interesting findings on the characteristics of physicians involved in disciplinary action. Most of the current medical literature on efforts to teach, promote and evaluate professionalism focuses on medical students and trainees. Indeed, Alam and colleagues suggest a need for greater inclusion of education on sexual misconduct in medical training curricula. On average, the physicians who were disciplined had been in practice for approximately 29 years before the disciplinary action, which suggests that strategies for continuing medical education for physicians in practice are also critically important. However, there is a paucity of literature on teaching and enforcing professional …