Doctors report being 'ostracized' for patient advocacy

Several doctors have been ostracized and found their careers suffered as a result of advocating for their patients, according to an interim report on the quality of health care in Alberta.

The Health Quality Council of Alberta (HQCA) also found emergency rooms in the province continue to be severely crowded, routinely forcing patients to wait an extremely long time for the care they need.

The council is part-way through its independent review of the quality of care and safety of patients in Alberta. It is examining three things: emergency care, cancer surgery and issues related to physician advocacy.

Doctors 'ostracized' for advocacy

"A number of physicians have described disturbing life- and career-changing outcomes that they attribute to their advocacy efforts," said Dr. John Cowell, CEO of the HQCA. 

Some doctors interviewed by the council said their hospital privileges were reduced and their contracts altered or cancelled, leading them to seek work in other provinces, the report said.

'A number of physicians have described disturbing ... outcomes that they attribute to their advocacy efforts.' —Dr. John Cowell, HQCA CEO

However the council also found no evidence that inappropriate financial payments were made to any doctor to muzzle their attempts to advocate on behalf of patients.

The report notes that, while doctors are expected and encouraged to advocate on behalf of patients, there seems to be no defined process to for them to follow.

"Physicians we have spoken with have had little, if any, coaching or education on how to advocate effectively," the report said. 

Every practicing physician in Alberta is being mailed a survey asking about their experiences with patient advocacy, the report said.

Culture change comes from the top: AHS boss

Dr. Chris Eagle, CEO of Alberta Health Services, said the findings in the interim report have left him "hungry" to see the final recommendations. 

Eagle says that the ability for physicians to advocate for their patients widely throughout the province under the old regional health board system and guidelines to protect staff were not written down.

"We need to set guidelines, not only for the staff, but for the administrators, so we know what are appropriate boundaries, that there aren't recriminations, intended or accidental, for physicians or other staff trying to advocate for the best care of patients," he said. "That should not take place."

AHS set up a working group after allegations of physician intimidation surfaced earlier this year. They propose AHS create a hotline that doctors can use to report intimidation or concerns with the system.

"That group has absolutely affirmed the fact that advocacy is not only a right and a responsibility but is incredibly beneficial to bringing improvement to the health system," said Dr. David Megran, the Chief Medical Officer for AHS.  

"It also clearly reaffirmed that intimidation is unacceptable, unacceptable and can't be tolerated."

Eagle said any change in the culture of AHS needs to start at the top.

"The tone set by the leadership of the organization is critical in making people comfortable with that advocacy role that they have," he said. "Advocacy is clearly a role that physicians have in the system."

Emergency care stretched

Examining data from 2008, the HQCA report found severe crowding and long wait times at the University of Alberta Hospital emergency department.

"What we have seen is that once patients received care, it was appropriate, but was often provided in challenging and very difficult conditions," said Dr. Cowell.

However, the report also concluded that there is no evidence lives were lost because of overcrowding.

While the report focused on emergency care at the U of A Hospital in Edmonton, it said there is no reason to think overcrowding is unique to that facility.

Cancer care data limited

Information about wait times for cancer surgery has been difficult to find, the report said.

Referring to a suggestion made in the Alberta Legislature in February that 250 patients died while they waited on a 1,200-person queue for lung operations, the report said "the HQCA has not seen evidence to date that a waitlist of this size exists or existed."

"… the review team has concluded that there likely have been issues with delays in accessing thoracic surgery at the University of Alberta Hospital," the report said.

The HQCA said a report will be released in mid-December with a full review of "effective intervention strategies" that address emergency room crowding and effective patient advocacy.