Physician codes of conduct becoming a norm.

Hospitals in North America and around the world are increasingly asking doctors to sign codes of conduct as a precondition of hospital privileges. Supporters of this trend say it will improve professionalism and reduce disruptive behaviour. Critics warn that it reeks of authoritarianism and is insulting to physicians. In some jurisdictions, codes of conduct are relatively new. The Ottawa Hospital in Ontario, for instance, has only recently drafted what it calls a " physician engagement agreement, " which includes such commitments as " Engage with others, actively listen to them, communicate respectively, and consider their ideas " and " Communicate with patients and families in a clear, timely, supportive, engaged and empathetic manner. " The Alberta College of Physicians and Surgeons drafted a code of conduct in 2009. " I think they are becoming more common, " says Dr. Janet Wright, assistant registrar of the College of Physicians and Surgeons of Alberta, citing the increased presence of such codes not only in Canada, but also in other countries, including the United States, New Zealand and Australia. The purpose of a physician code of conduct is to clearly establish the expectations of professional behaviour for doctors and to create a consistent process for handling complaints about disruptive behaviour. It is important that the codes are implemented properly and that breaches are handled fairly, says Wright. " There needs to be a fair process, " she adds. " The doctor should be notified and both sides of the story should be heard. " Then again, perhaps the very notion of fairness is impossible for codes of conduct that only apply to particular individuals in a workplace. " I'm not condoning bad behaviour, but putting these rules up there that are applied solely to physicians is demeaning. I wonder if it's more about control than about quashing bad behaviour, " says Dr. Lawrence Huntoon, a US neurologist and editor-in-chief of the Journal of American Physicians and Surgeons. " I think there is a bias regarding disruptive physicians. You rarely hear about disruptive nurses or disruptive hospital administrators. " Huntoon wrote in a 2008 editorial that codes of conducts are insulting to doctors and that their underlying purpose is to diminish " the professional standard of physicians on staff and in so doing increases the hospital's authority and control over physicians " (JPANDS 2008;13:2–4). They are sometimes put into effect without feedback from medical …