Some common complaints we hear in Patient Relations include complaints from patients about doctors declining a referral sent by their family physician for specialist treatment at one of our hospitals; patients requesting to be referred to another physician for care because they disagree with or feel they “don’t get along” with their current physician; and patients who want hospital administration to tell a doctor to perform a procedure or test the doctor has said he or she will not perform. When speaking with patients about these types of concerns, I have realized that patients are not often aware of the position of doctors in relation to the hospital and in relation to patients. I must admit that I wasn’t either, before I started working for UHN!
Patients are often surprised to learn that a doctor is allowed to decline a referral and not see a person who would like to be a patient. Common and permissible reasons for this include that the physician or surgeon has a full patient load and cannot accommodate more patients; the treatment the person needs is outside of the doctor’s “scope of practice” or “clinical competence” (i.e. the doctor does not practice the particular kind of medicine the person needs or isn’t an expert in the area); the person lives outside of Toronto and can receive equivalent care at a hospital or healthcare centre closer to their home; and, the person is already being treated by a competent doctor in the area of practice. While patients do have a right to request a referral to another physician or surgeon if they are unhappy with their care, there is no guarantee that another physician or surgeon will agree to accept the person as a patient, and no guarantee that there is another physician or surgeon who is appropriate to take over a patient’s care.
Patients are also often surprised to learn that most doctors are independent professional staff who are appointed to work in our hospitals. What this means is that most of our doctors are not employees, and don’t have a “boss” at the hospital who can direct their activities. Most are paid directly by the Ministry of Health, not by the hospital. If a patient claims that a doctor did something that caused them harm, the hospital generally does not have legal responsibility – it is the doctor him or herself. All doctors are ultimately accountable to their governing body, The College of Physicians and Surgeons, which has policies doctors are expected to comply with.
That being said, the hospital does have a number of processes in place to make sure our physicians and surgeons are practicing according to standards of accepted safe practice. Each doctor reports to a Chief, and each Chief reports to the Physician in Chief or the Surgeon in Chief, depending on the specialty, as well as the VP of Medical Affairs. Patient safety is very important, and if a serious incident occurs, a review must take place.
If a patient has a complaint about their physician or surgeon that the patient is not able to resolve directly with the physician or surgeon, we in Patient Relations welcome you to speak with us. Sometimes we can assist with sorting out the issue a patient has with their doctor, and maintaining the patient’s relationship with the doctor. We can also promote education or remediation as needed, as the hospital does have responsibility for patient safety.