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Professional Behaviour

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Approved by the Board: November 2007
Reviewed and Updated: May 2016, September 2024

Companion Resource: Advice to the Profession

 

Policies of the College of Physicians and Surgeons of Ontario (“CPSO”) set out expectations for the professional conduct of physicians practising in Ontario. Together with the Essentials of Medical Professionalism and relevant legislation and case law, they will be used by CPSO and its Committees when considering physician practice or conduct. 

Within policies, the terms ‘must’ and ‘advised’ are used to articulate CPSO’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.

Additional information, general advice, and/or best practices can be found in companion resources, such as Advice to the Profession documents.

 

Definitions

Professionalism: the words and actions of physicians that foster trust and respect with patients1, colleagues, and the public.

Unprofessional behaviour: words, actions, or inactions by a physician that interfere with (or may interfere with) the delivery of quality care, public trust in the profession, the safety or perceived safety of others, or the physician’s ability to collaborate. Unprofessional behaviour may be demonstrated through a single act, a pattern of events, or a number of separate events.

Colleague: physicians; other health care professionals; hospital or clinic administrative, ancillary, and support staff; medical students, interns, residents; and anyone involved in the provision of health care.

 

Policy

General

Physicians have been given the privilege and responsibility of profession-led regulation. This policy primarily focuses on physicians’ behaviour in the professional context. 

“Professional context” is a broad term that refers to any environment where a physician interacts with patients, colleagues, learners, and others in the workplace (whether in person or virtually). The professional context also includes any situation where a physician actively identifies themselves as a physician and/or represents the profession (e.g., public appearances, printed media, and social media).

Although the expectations set out in this policy primarily apply to physicians’ behaviour in the professional context, they may also apply to behaviour that takes place outside of the professional context. Physician behaviour outside of a professional context may be considered unprofessional under this policy where the behaviour:

  • may bring the profession into disrepute, and/or
  • raises concerns about the physician’s competence, integrity, and/or suitability to practise.2
  1. Physicians must uphold the standards of medical professionalism and conduct themselves in a professional manner.
    1. Physicians must act in a respectful and civil manner towards patients and colleagues.
  2. Physicians must meet the expectations set out in this policy, other CPSO policies3 , and applicable legislation4 , along with the expectations set out in any applicable institutional codes of conduct, policies, or by-laws.
  3. Physicians must meet the expectations for professionalism set out in CPSO’s Essentials of Medical Professionalism, including:
    1. considering each patient’s well-being and acting in their best interests;
    2. working respectfully and collaboratively with other members of the health-care team, even when their personal beliefs and/or professional opinions differ; and 
    3. modelling respect, appropriate conduct, and healthy collegial relationships in the workplace.

Advocacy

  1. Advocacy for patients and an improved health care system is an important component of the physician’s role, and while it may sometimes lead to disagreement or conflict with others, physicians must meet the expectation for professional behaviour even in these contexts.5

Unprofessional Behaviour

Unprofessional behaviour impacts patient care and outcomes through the negative effects it can have on the physician-patient relationship, teamwork, a safe working environment, communication, public trust, and morale. 

  1. Physicians must not engage in unprofessional behaviours including, but not limited to, the following:
    1. Acting or speaking in a disrespectful, insulting, demeaning, threatening, bullying, or abusive manner;
    2. Engaging in prejudiced or discriminatory behaviour (e.g., racist or sexist comments or actions);
    3. Exhibiting aggressive or hostile outbursts of anger (e.g., throwing or breaking things);
    4. Using, attempting to use, or threatening violence or physical force towards others6;
    5. Commenting or acting in a way that may contribute to a negative working environment (e.g., disrespecting boundaries, repeated unwanted communication, or sexual harassment)7;
    6. Mocking, shaming, or disparaging others; 
    7. Repeatedly failing to respond in a timely manner to calls or requests for information or assistance when on call or when expected to be available; and
    8. Intentionally delaying or disrupting patient access to care. 

Unprofessional Behaviour of Colleagues or Staff

  1. Physicians must take appropriate action when colleagues or staff demonstrate unprofessional behaviour in the workplace.8

Reporting Unprofessional Behaviour

  1. It is important that unprofessional behaviour can be reported without fear of retaliation. Physicians, especially those in leadership positions, must contribute to providing a safe and supportive environment that allows for reporting of unprofessional behaviour.9
  2. Where a colleague, in good faith, reports or acts as a witness to a physician’s unprofessional behaviour, that physician must not penalize, punish, or retaliate against the colleague (e.g., through unwarranted dismissal of a reporter or witness; demotion, transfer, or denial of opportunities for advancement).

Endnotes

1The term “patient” is used to refer to patients and their loved ones, including but not limited to caregivers, family members, friends, and substitute decision-makers.

2For more information on the scope of this policy, please see the Advice to the Profession: Professional Behaviour document.

3These include Boundary Violations (regarding sexual abuse and misconduct), Social Media (regarding avoiding unprofessional behaviour in the context of social media), Professional Responsibilities in Medical Education (regarding professional behaviour when involved in medical education and working with students or trainees), and Human Rights in the Provision of Health Services (regarding discriminatory behaviour).

4For example, the obligations set out in the Occupational Health and Safety Act, R.S.O. 1990, c.0.1.

5For more information on physician advocacy, please see the Advice to the Profession: Professional Behaviour document.

6The policy does not intend to capture circumstances where, for instance, force may be necessary to restrain a patient who poses a threat to themselves or those providing them with care.

7An example of behaviour that is not likely to be considered unprofessional behaviour includes constructive criticism offered in good faith with the intention of improving patient care or the health-care system.

8"Appropriate action” is context-dependent and allows physicians to use their professional judgment to determine possible next steps. Please see the Advice to the Profession: Professional Behaviour document for more information.

9Please see the Advice to the Profession: Professional Behaviour document for additional guidance on contributing to a safe and supportive environment that allows reporting of unprofessional behaviour.