To the Editor:
While medical doctors have a great deal to contribute to public policy debates, the systems that have developed within the profession and within government both stifle their participation and have created a phony unity that works against the public interest.
First, there is the problem of licensing bodies such as the College of Physicians and Surgeons of Alberta, which exist to protect the public interest by insuring that only those who meet the strictest qualifications and the highest standards of practice get to remain within the profession.
But, for historical reasons, such bodies also hinder members of the profession from engaging in public policy debates of relevance to the profession's effectiveness. In this sense, the bodies work against the public's right to know. A medical doctor is in the spotlight one day, explaining the problems with a current policy and proposing changes, and the next day seems to have vanished from the earth.
Consider the case of John O'Connor, the long-time doctor in Fort Chipewyan, who began making charges in 2003 and 2004 that Fort Chipewyan residents had unusually high rates of blood, colon, bile duct, and liver cancer. In 2007, when his claims began to receive media attention, Health Canada physicians complained to the College of Physicians that Dr. O'Connor was raising "undue public alarm." As a fellow Fort McMurray doctor, Michael Sauve, charged at the time, "This is very clearly to shut him up and shut him down."
How so? As another medical specialist who ran afoul of government - in his case provincial - medical officials explained to me: "The first thing you do when you receive a complaint is go to a lawyer. The first thing the lawyer tells you is not to speak to the media till the case is settled." So a doctor with a story to tell "drops out of the media and by the time (he is) cleared by the College, the story isn't a story anymore."
In Dr. O'Connor's case, it took over two years before the College cleared him. Unsurprisingly, by then the media had largely lost interest in him, and he was more concerned with just getting on with his life and not subjecting his family to any more disruption.
The impact of a case like Dr. O'Connor's on the medical profession as a whole is rather obvious. It is risk-free for any public official with a medical degree to go to the College and lay a vague complaint of "raising undue public alarm." That immediately shuts up the doctor who is irritating them and generally shuts down the media debate.
But for the doctor who is charged, regardless of how careful they have been with the facts, it means that a period of uncertainty immediately begins. It will be a period of legal bills, of watching one's every word, and of worry about being banished from the profession to which you have devoted your life. The College has a range of penalties that it can apply if it finds that a doctor has indeed raised undue public alarm or in other ways brought harm upon the medical profession. Losing one's medical license as a result of such complaint may be unlikely, but anyone who is being investigated by the College always has to fear that possibility. No wonder, then, that most doctors keep their heads low.
At least, with the College, the doctor faces a panel of peers. In the case of Dr. Ciaran McNamee, who was fired by Capital Health after he complained about the long wait times for thoracic surgery, it appears from his statement of claim that he was unceremoniously dumped. Indeed Dr. McNamee's lawyer, in his statement of claim, makes the interesting point that "It was a term of Dr. McNamee's employment contract, express or implied, that Dr. McNamee would be permitted to practice as a thoracic surgeon at the Hospital so long as he remained in good standing with the College of Physicians and Surgeons . . ."
What then is necessary to encourage members of the medical profession to bring their various insights about health policies into public debates? The answer likely lies in redefining the role of the College of Physicians and Surgeons, strengthening its powers in some areas and removing them in others.
The College, and along with it virtually all other self-governing professional bodies, should lose the right to punish people for expressing views publicly that might offend some members of the profession. Self-government should not mean the right to limit freedom of speech or present a false front of professional unity to the broad public.
At the same time, the College should become the sole body to determine whether a physician or surgeon is fit to carry on their role. An employer such as the Alberta Health Board or a particular hospital should never be in a position to muffle its doctors or other health professionals. But as long as it has the exclusive right to fire such professionals, it can suppress their right to speak publicly at will. Handing over the decision to determine whether a doctor remains physically and mentally able to conduct their duties to a depoliticized College of Physicians and Surgeons should help to get the balance we need in Alberta, but currently lack, between medical competence, on the one hand, and freedom of speech, on the other.
Alvin Finkel, co-chair of the Alberta Democratic Renewal Project, and professor of History, Athabasca University.
