The College of Physicians and Surgeons of Ontario defines a profession as follows:
“Medicine is about compassion, service, altruism, and trustworthiness, values that have always and will continue to guide the profession. These values are the basis for the principles, duties and policies that follow.
Individual doctors serve their patients by assessing, diagnosing and treating patients, and through rehabilitation and habilitation, palliation, health promotion, and disease prevention. However, medicine is more than procedures and physicians are more than purveyors of technology. Compassion is fundamental to the relationship between the patient and the doctor. Compassion is defined as a deep awareness of the suffering of another coupled with the wish to relieve it.
Service means working for the benefit of another. Doctors in Ontario are dedicated to serving their patients.
To serve their patients, physicians must be competent in the medical areas in which they practice. Competence requires the application of current knowledge with requisite skill and judgment needed to meet the patient’s medical needs. In this, physicians should strive for excellence.
Service is not only competence; it is also putting the patient first. A physician has professional responsibility to their patients, individually and collectively; their patients’ families; their own practice; and the health care system. However, at any given time a physician’s primary responsibility is to the individual patient before them.
Physicians, as a profession, also have a collective responsibility to the public, which is demonstrated by collaborating with and supporting colleagues and other health professionals, and participating in self-regulation in the public interest. The profession has a critical responsibility to the public as a whole via its responsibility to regulate. Just as doctors serve patients, the College, as the representative of the profession in self-regulation, has the ethical and statutory responsibility to serve the public by regulating physicians in the public interest.
Altruism, as a principle of action, is the highest commitment to service. Altruism in medicine is defined as practicing unselfishly and with a regard for others.
Patients’ needs are paramount and must be considered before the individual physician’s needs, the needs of physicians as a group, or the public as a whole. This is not to say that physicians must sacrifice their health or other important aspects of their life for their patients. Rather, it means that when providing care to a patient, a physician should always put that patient first.
Trustworthiness is the cornerstone of the practice of medicine. It is the demonstration of compassion, service and altruism that earns the medical profession the trust of the public. This trust manifests itself in the social contract between the profession and the public, as well as the relationship an individual patient has with his or her doctor.
Maintaining trust is an important aspect of medical professionalism. Patients must be able to trust that the physician will always uphold the values of the profession; in the absence of the trusting relationship the physician cannot help the patient and the patient cannot benefit from the relationship.”
The family physician is a skilled clinician.
Family physicians demonstrate competence in the patient-centred clinical method; they integrate a sensitive, skillful, and appropriate search for disease. They demonstrate an understanding of patients’ experience of illness (particularly their ideas, feelings, and expectations) and of the impact of illness on patients’ lives.
Family physicians use their understanding of human development and family and other social systems to develop a comprehensive approach to the management of disease and illness in patients and their families.
Family physicians are also adept at working with patients to reach common ground on the definition of problems, goals of treatment, and roles of physician and patient in management. They are skilled at providing information to patients in a manner that respects their autonomy and empowers them to “take charge” of their own health care and make decisions in their best interests.
Family physicians have an expert knowledge of the wide range of common problems of patients in the community, and of less common, but life threatening and treatable emergencies in patients in all age groups. Their approach to health care is based on the best scientific evidence available.
Family medicine is a community-based discipline.
Family practice is based in the community and is significantly influenced by community factors. As a member of the community, the family physician is able to respond to people’s changing needs, to adapt quickly to changing circumstances, and to mobilize appropriate resources to address patients’ needs.
Clinical problems presenting to a community-based family physician are not pre-selected and are commonly encountered at an undifferentiated stage. Family physicians are skilled at dealing with ambiguity and uncertainty. They will see patients with chronic diseases, emotional problems, acute disorders (ranging from those that are minor and self-limiting to those that are life-threatening), and complex biopsychosocial problems. Finally, the family physician may provide palliative care to people with terminal diseases.
The family physician may care for patients in the office, the hospital (including the emergency department), other health care facilities, or the home. Family physicians see themselves as part of a community network of health care providers and are skilled at collaborating as team members or team leaders. They use referral to specialists and community resources judiciously.
The family physician is a resource to a defined practice population.
The family physician views his or her practice as a “population at risk,” and organizes the practice to ensure that patients’ health is maintained whether or not they are visiting the office. Such organization requires the ability to evaluate new information and its relevance to the practice, knowledge and skills to assess the effectiveness of care provided by the practice, the appropriate use of medical records and/or other information systems, and the ability to plan and implement policies that will enhance patients’ health.
- Family physicians have effective strategies for self-directed, lifelong learning.
- Family physicians have the responsibility to advocate public policy that promotes their patients’ health.
- Family physicians accept their responsibility in the health care system for wise stewardship of scarce resources.
- They consider the needs of both the individual and the community.
The patient-physician relationship is central to the role of the family physician.
Family physicians have an understanding and appreciation of the human condition, especially the nature of suffering and patients’ response to sickness. They are aware of their strengths and limitations and recognize when their own personal issues interfere with effective care.
Family physicians respect the privacy of the person. The patient-physician relationship has the qualities of a covenant – a promise, by physicians, to be faithful to their commitment to patients’ well-being, whether or not patients are able to follow through on their commitments. Family physicians are cognizant of the power imbalance between doctors and patients and the potential for abuse of this power.
Family physicians provide continuing care to their patients. They use repeated contacts with patients to build on the patient-physician relationship and to promote the healing power of interactions. Over time, the relationship takes on special importance to patients, their families, and the physician. As a result, the family physician becomes an advocate for the patient.
|Continuity||Sees patient regularly over time for a large proportion of the patient’s health encounters (providing longitudinal rather than cross-sectional care).|
|Comprehensiveness||Cares for most of the patient’s health problems; capable of dealing with substantial comorbidity in those with multiple chronic problems.|
|Coordination||For the minority of problems that require services from other providers, arranges the referral, test, or procedure and collates the results.|
|Contact—first||Whenever possible, is willing to be the first provider the patient contacts for episodes of illness or health concerns.|
|Competence||Practices evidence-based medicine; participates in continuing education; enhances practice through continuous quality improvement.|
|Cost-effectiveness||Weighs benefits versus costs of care; sensitive to “economic C’s” such as capitation, copayments, carve-outs, and conflicts of interest.|
|Communication||Communicates effectively with patients and other health care workers; uses computers skillfully for accessing literature and providing care.|
|Collaboration||Comfortably works in teams involving specialty physicians and other health care workers; partners with patients by educating them, eliciting their preferences for care, and engaging in shared decision making.|
|Compliance||Monitors and enhances patient compliance with medical advice; personally complies with practice guidelines, regulations, etc.|
|Competing demands||Prioritizes within the brief time allocated for clinic visits a patient’s acute problems, chronic conditions, health maintenance, documentation, etc.|