EDMONTON - Dr. Janet Wright recalls a story told to her by a nurse about the dressing-down she received when she made a suggestion on patient care to a doctor.
"You're not paid to think," the doctor shot back. "I'm paid to think. Just keep your opinions to yourself."
"It's very cutting," Wright, the assistant registrar for the College of Physicians and Surgeons of Alberta, said in an interview Tuesday.
"Why is that physician saying that? Are they themselves really stressed and need some assistance?
"Or do they just need to be told, 'That's not an OK way to speak to someone else?"'
Rude or even abusive behaviour from doctors toward other health providers isn't rampant, but the body that regulates physicians in the province says it's time to clamp down with a new code of conduct.
The college has spent six months compiling a draft document to standardize how complaints are handled. It would replace patchwork rules that vary from region to region and even hospital to hospital. It would also enshrine a binding code of conduct on physicians.
The stakes are high, said Wright. When nurses and other health workers get intimidated and abused by doctors, workplaces become toxic. Sick leave goes up and staff quit or move on. Those who remain may be loath to step up to provide advice or prevent mistakes - and that can directly affect patients.
"Our primary responsibility is to the public - that's really what underlies this," said Wright. "Let's make sure people work together respectfully so we can provide good care to patients."
The college is now getting comments on the draft from stakeholders, including doctors and nurses.
Alberta is following a trail already blazed by other jurisdictions. There are codes of conduct in the United States and Quebec. Ontario is implementing a uniform way to report complaints.
While the bulk of concerns in Alberta relate to rude or belittling comments, there isn't much hard data on the problem.
Research by the college, however, notes that six per cent of the referrals to the Ontario Medical Association's physician-help program have been for disruptive behaviour. And a 2003 survey of medical residents in Alberta found that almost three in four experienced intimidation and harassment.
The code of conduct would take aim at all forms of unacceptable behaviour, including publicly berating and humiliating people, swearing, yelling, spreading malicious rumours, slamming doors, throwing objects, making racist jokes or comments or sexually intimidating others by leering, making suggestive comments or inappropriately touching.
Discussions and, if necessary, counselling would begin once a complaint was received. In extreme cases, a doctor's privileges could be suspended or the complaint could be referred to police.
Dr. Noel Grisdale, president of the Alberta Medical Association, said physicians welcome a code of conduct as long as it addresses larger issues and doesn't devolve into a witch hunt.
"It's not like we sort of said, 'Hey we think this needs to be done,' but the fact they are doing it and looking at it, we're supportive of the direction," said Grisdale in an interview from Calgary.
The focus, he said, should be to make sure the system isn't abused and that "the things that really need the attention get the attention, and the things that can be dealt with on a low level are dealt with and not turned into something more than they are and drain the time and resources of everyone involved."
Wright said critics who write off an angry doctor for a disruptive episode may be missing the big picture. Over the last few years, she said, doctors are struggling with stress, staff shortages, long hours and growing patient wait lists.
Calls to the Alberta Medical Association's support service group for doctors and their families have "mushroomed dramatically in the last couple of years."
Grisdale agreed.
"Is there some greater amount or huge problem with doctors being disruptive? No, not at all. I don't think it's any more than any other kind of similar situation where you're dealing with people all the time."
Heather Smith, president of the United Nurses of Alberta, said her members welcome the code of conduct, but added the problem isn't limited to doctors.
Staff shortages mean a nurse arriving on duty is now responsible for far more patients than a few years ago, she said. The cases they deal with are more complex and too often an eight-hour shift becomes a 16-hour marathon when a replacement doesn't arrive and there's no one else available.
So nurses are turning on other nurses, she said.
"That kind of stuff didn't happen two years ago. It's a growing concern - colleague-to-colleague harassment and abuse."
