A highway of paper crosses the desks of all physicians on a daily basis, but I recently received a document from my health authority (HA) that stood out. Perhaps you’ve received something similar—if so, I would encourage you to examine the wording closely.
At the end of September I received a glossy, full-color handout from my HA labeled “Statement of Expectations between Physicians and the HA.” Attached was a cover letter from the vice president of medicine at Fraser Health advising that this Statement of Expectations (SoE) was approved by the HAMAC, which is either a nice place to take a nap or the Medical Advisory Committee. The cover letter states that, “The SoE is an essential step in developing true partnership between physicians and the Health Authority.” It goes on, “I ask you to indicate, voluntarily, you have read and understood the Statement of Expectations in order to guide future developments in our partnership with you. I stress I cannot and do not want to mandate a response.” It then asks me to indicate my acknowledgment by sending a signed copy to the credentials office.
What kind of “true partnership” is fostered by not allowing a response? It seems a little like having the king’s proclamation nailed to the tree so they can hang you later if you don’t comply. Also, is there any other way to read something than “voluntarily”? If I am only acknowledging a document then why am I sending the response to the credentials office? What could this office have to do with a voluntary “true partnership”?
The document itself has many good things in it. Words such as support, encourage, collaborate, and share are used frequently. It is divided into two columns under a number of headings—“Fraser Health Responsibilities” in one column and “Physician Responsibilities” in the other. I notice that under the heading “Focus on Patients” the health authority is going to “Support effective and efficient care delivery within the available resources,” whereas the physicians are going to “Provide timely care coverage” and “Participate in an on-call coverage group.” It appears that the health authority can say it doesn’t have available resources but we must be on call. Also, who gets to decide what “timely care coverage” means?
Let’s read further. Under “Foster Excellence,” the health authority’s responsibilities are full of the words “support” and “encourage,” whereas the physician’s responsibilities start with words like “maintain,” “advise,” “remain current,” and “abide.” Seems like one group is doing all the work. Under “Listen and Communicate,” the health authority is going to “share information,” “offer opportunities,” and “provide performance appraisals” in which (you guessed it) physicians are responsible for participating. I am curious as to what type of performance is going to be appraised and who is going to be doing the appraising.
Moving on: under the heading “Collaborate on Care Delivery,” physicians are going to “attend necessary multidisciplinary meetings and behave in a manner that is supportive of program vision and goals.” Again, who decides which meetings are necessary? What programs are we talking about? Lastly, under “Leadership and Ownership,” the physicians are going to “implement the clinical standards of care adopted by the programs.” What programs and which clinical standards?
I am deeply concerned about signing a document and sending it to the credentials office without the opportunity to ask questions, especially a document containing so many items that require clarification. By signing I am only acknowledging that I have read it, but if this Statement of Expectations isn’t going to become some sort of contract down the road, why does it exist? Lastly, why does the health authority get to tell me what my responsibilities are when I can’t do the same for them?
I am curious whether other health authorities are already using or considering a similar document, as that could be a slippery slope indeed.
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
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