In pursuit of the public interest

Hey there, time traveller!
This article was published 16/11/2022 (1417 days ago), so information in it may no longer be current.

SIX years ago, an infection in my finger got out of control and almost killed me. It was a nightmarish and life-changing experience.

A few months ago, I complained about the first of four doctors I saw in an 11-day period leading up to this near-fatal event. I indicated to the College of Physicians and Surgeons of Manitoba (CPSM) that this very experienced physician misdiagnosed my finger infection and prescribed the wrong medication.

The college’s complaints committee agreed with my complaint, diplomatically stating the physician “should be provided with advice in this situation, including that systemic treatment would have been appropriate in accordance with (medical) guidelines.”

It was a crucial mistake, given the importance of treating infections early and appropriately. Eleven days after seeing this physician, I collapsed with septic complications and was rushed to the hospital, where I was operated on and spent a week in a coma and three weeks in intensive care.

As a sepsis survivor, I know sepsis is the most preventable and lethal killer of people. It is estimated that sepsis causes at least 11 million deaths per year and is the No. 1 cause of death in hospitals.

That this physician could make such significant mistakes concerns me. How many other physicians are misdiagnosing cellulitis infections, with serious consequences for their patients?

The complaints committee disagreed, however, stating that “no further statements regarding … the management of cellulitis were required to protect the public interest.”

The complaints committee statement did not indicate how it had arrived at this conclusion, nor did it reference the criteria and standards used to make such a determination.

What is “the public interest,” and how is it protected? The Regulated Health Professions Act (RHPA) states the college must function in a way “that serves and protects the public interest.” But nowhere in the RHPA’s or the college’s literature is the public interest defined.

So how do we know the people who make these decisions — in this case, the complaints committee — are making decisions in the public interest, and not in their own personal or professional interests?

The key to assessing any public-interest decision is the transparency of the decision-making process and a consideration of what the competing interests are. In the case of the CPSM, it is obvious what the competing interests are.

No one likes to be criticized; physicians are no exception to this rule. A CPSM investigation is no doubt upsetting for a physician and their family.

These investigations threaten a physician’s livelihood and reputation. The adversarial nature of this process mitigates against the full disclosure of physician errors.

The CPSM complaints system considers 200 to 300 complaints a year. The few cases that get to the level of an inquiry become public knowledge. However, in cases in which the college “advises” or “criticizes” physicians, it rarely comments publicly.

There is no transparency regarding how the college makes public-interest decisions, and no identifiable process for it to do so.

But there are compelling reasons for the CPSM to consider the public interest when it assesses patient complaints about physicians. Physicians need to learn from the mistakes of other physicians.

As well, we need to have an informed patient population capable of working in partnership with their physicians to create best practices, favourable outcomes and the avoidance of harm.

The paternalism inherent in this system must end. It is time to create transparency regarding what the public interest is, what guidelines need to be followed and how relevant findings can be communicated to physicians and the public.

In this recent decision, it was stated that the physician “will reflect on his participation in this process.” In reality, we all need to reflect on processes such as this in order to determine what is in the public interest.

Mac Horsburgh lives in Winnipeg, where he is a parent council member for Sepsis Canada and a patient partner for a number of sepsis-related medical research projects.