Role of the College

Issue: BCMJ, vol. 45, No. 4, May 2003, Page 164 Editorials

During the dispute between the Vancouver Hospital and the surgeons concerning the lack of surgical resources to take care of even the most urgent patients, the surgeons felt obligated to close the emergency department until adequate resources were available to deal with the patients.

This prompted a response from the College of Physicians and Surgeons of British Columbia reminding these doctors about their responsibilities.

At the time I found this quite ironic since it, in fact, was the surgeons’ responsibility to the patients that forced them to take such drastic steps and forced the hospital and region into a more appropriate division of the resources.

This whole episode got me thinking about the relevance of the College of Physicians and Surgeons. Certainly, it must be a difficult job to act as the conscience for 8000 diverse and unruly doctors, and obviously one would not like the government to be the sole arbiter for what is appropriate ethical behavior for a doctor. However, I wonder if it strikes anyone else as odd that the College would criticize these physicians for potentially making patients wait an extra week for their surgery, but had no problem with the fact that many had already been waiting months! In other words, it seems to me that the College of Physicians and Surgeons may be missing the big picture. If the College wants to wade in with an opinion on the very serious dilemma of access to care, then perhaps they need to do a little more research and develop a better understanding of the situation. There are thousands of physicians, who every day in this province must prioritize critically ill patients to determine who will be treated with the limited resources. These physicians do this with a very deep understanding of clinical illnesses and social impact of these illnesses for the patient. These physicians do this with the highest ethical regard for all patients.

If the College of Physicians and Surgeons wants to be an ombudsman—where they have access to waiting list data, available operating time, and surgical and administrative budgets that force people to wait months or years for cancer surgery and then actually criminalizes them if they try to obtain more timely care by paying for it privately—then perhaps that would be a good idea.

I am sure the Registrar of the College would argue “that is not my job,” but since we cannot seem to trust the government or the Fraser Institute, or perhaps even the BCMA, then perhaps the College would like to assume that role when a patient has waited an unreasonable length of time for potential life- or limb-saving procedures. The CMPA tells us, and it has been proven time and again in court, that a lack of resources does not absolve physicians of their responsibility for timely treatment of their patients. Perhaps such an independent body could enlighten us as to the real waitlist times and how many patients have to go south or to private clinics to get timely care.

Most physicians would welcome an independent body to look at health care in BC with respect to resources, waitlists, and outcomes. Perhaps the College would like to be that body.


Anthony J. Salvian, MD. Role of the College. BCMJ, Vol. 45, No. 4, May, 2003, Page(s) 164 - Editorials.

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