Introduction

The purpose of this practice guide is to articulate the expectations of the medical profession for its members. The guide does not set out any new expectations for physicians, but is an articulation of existing values that provide the foundation for the practise of medicine. From these overarching values flow principles of practice and related duties. Together, the values, principles and duties of medical professionalism enable the profession to provide the best quality care.

Medical professionalism is the translation of the values of the profession — compassion, service, altruism, and trustworthiness — into action. Medical professionalism is demonstrated when these values are upheld in the everyday interactions that comprise each doctor’s own medical practice.

Professionalism also underpins the social contract between the medical profession and the public: in return for a monopoly over the practice of medicine, professional autonomy and the privilege of selfregulation, the profession has made a commitment to competence, integrity, altruism, and the promotion of the public good within its domain. This social contract is reflected in the ethical tenets of the profession, the legislation governing the profession, and the standards of practice for physicians.

The social contract is a covenant of the profession as a collective. Individual physicians are not expected to assume responsibility for society at large, but to uphold the social contract through their commitment to their profession, their medical practice, and their patients.

This practice guide is intended to:

  1. Articulate the profession’s values and the principles of medical practice;
  2. Provide assistance to the membership in determining its specific duties and the reasons for those duties; and
  3. Organize the existing policies of the College of Physicians and Surgeons of Ontario within a principled framework and provide a basis for new policy development. All College policies will be explicitly grounded in the values, principles and duties set out in this guide. Practical examples will illustrate how the policies apply in day-to-day medical practice.

The values, principles and duties are intended to provide broad guidance to the profession, rather than describe specific standards for practice or create legal obligations. Physicians are encouraged to refer to the relevant College policies for more specific guidance about their obligations, including those set out in legislation and by-law.

Assimilating into day-to-day practice the values, principles and duties set out in this guide is a high ideal that may seem to be overwhelming. However, it is worth striving for and is not unachievable. In fact, it is exhibited daily in physicians’ offices and hospitals across Ontario, reflecting the longstanding tradition of excellence in the medical profession.

The overarching values—compassion, service, altruism, and trustworthiness—and the principles of the profession will remain constant. The specific duties that flow from the values/principles, however, may change as the environment changes. This guide has been prepared with the recognition that change is inevitable and any guidance to the profession should be capable of responding to new issues. To remain responsive, the College welcomes your feedback on this guide and the policies it frames.

The Role of the College

The College is the embodiment in statute of the ethics of the profession. The College’s primary obligation to the public is to ensure that members of the profession are competent in the areas in which they practice. The College’s motto is ‘The best quality care for the people of Ontario by the doctors of Ontario’. Quality care involves more than clinical excellence—it is also safe, effective and compassionate practice.

Incorporating ethical principles of practice and existing legislation into College policies is one way for the College to fulfill its mandate of ensuring quality care for the people of Ontario. The College and, through the College, the profession, expect compliance with these policies.

Use of this Guide

The Practice Guide outlines to the profession and the public the expectations the medical profession holds for itself. It can not and is not intended to address every situation that may arise in the practice of medicine. For specific situations that are not covered here, physicians should rely on the values and principles articulated to guide their practice, and should not hesitate to seek advice.

This practice guide does not stand alone. There are many resources available, which through varying approaches, provide excellent guidance to physicians on how to practice well. These include the principles of bioethics, the Royal College of Physicians and Surgeons of Canada’s CanMEDS framework, the Canadian Medical Association’s Code of Ethics, and codes and guidelines from other medical leaders across Canada and internationally. The CPSO’s practice guide is not intended to replace these resources; rather, it is intended to organize the information in a way that will best guide Ontario physicians in how to meet the expectations of their profession. It should be used in companionship with other resources, rather than in isolation. A more complete list of helpful resources has been provided at the end of this document.

This guide is designed to be of use to multiple stakeholders, including: practising physicians; patients and the public; medical students and residents; educators and clinical teachers; other health care professionals; administrators; and government and public officials.