The failings of Jocelyne Genest, a family doctor and surgeon in Sainte-Agathe-des-Monts, Que., are eye-popping.
According to testimony before a disciplinary panel of the Collège des médecins du Québec, among other things, she:
Performed a sigmoidectomy (a removal of part of the colon) though she was not qualified to do so. Before the operation, Dr. Genest looked up the procedure on the Internet. Not surprisingly, surgery went badly and dragged on for 12 hours, putting the patient at risk for brain damage;
Failed to install a chest drain in a patient suffering from emphysema who was being transferred to another hospital, even though she was told to do so by an emergency room doctor, again putting a life at risk;
Administered "massive, unprecedented and unjustified" doses of morphine to a terminally ill patient - at the request of a family member, not the patient himself - until he died.
Dr. Genest had previously - in 1998, 2004 and 2005 - been reprimanded by the regulatory body for similar violations of professional ethics, but continued to work at the local hospital and in private practice.
This time around, the Collège des médecins finally stripped the physician of her licence to practise both surgery and family medicine, saying the risk of her repeating this type of act was "very real" and that, as such, Dr. Genest was a "danger to the public."
Amazingly, however, the collège ruled that Dr. Genest could still practice as a surgical assistant because oversight by another doctor would "ensure adequate protection for the public."
While this is just one example, and an extreme one at that, the question the public should be asking itself is this: Should the medical profession be self-regulated?
Do these regulatory and disciplinary bodies really serve the public interest?
While this is a bit of a generalization, medical disciplinary bodies tend to be secretive (or, at the very least, not enthusiastically transparent), bureaucratic, slow-moving and excessively forgiving.
Even these most grievous of offences are, all too often, punished with little more than a slap on the wrist. The ultimate sanction, loss of licence to practice, is a rarity and the case of Dr. Genest illustrates just how egregious violations must be before the hammer comes down.
It needs to be said that the vast majority of Canada's 62,000 doctors are ethical and professional and deliver a high standard of care. But that is not the issue.
Mandatory recertification - the need for doctors to renew their licences every five years or so - is ever-so-slowly becoming the norm in Canada. This necessary reform will ensure licensed physicians are keeping pace with the dizzying number of advances and stay fit to practise.
But the issue will remain: What is to be done with the small minority of practitioners who are unethical, incompetent or outright dangerous?
There are an estimated 24,000 deaths each year in Canada due to "adverse events" (medical errors). Again, only a small proportion may be caused by professional failings. Nonetheless, it is not a negligible number.
Anyone with a family member who has ever been on the receiving end of one of these "adverse events" and tried to seek answers - let alone justice - knows how frustrating and maddening the process can be.
When complaints do wend their way to provincial colleges, all too often the disciplinary process seems self-serving - by doctors and for doctors.
Patients and the public seem to be ancillary, whereas they should be front and centre.
If we are going to create a culture of patient safety - the fashionable term in medical circles these days - then we need to back up the grand talk with good incident reporting and even better investigation and discipline.
Why should investigations of problems - adverse events, sexual misconduct, contempt for patients - be confined strictly to self-regulated professional bodies? Should the public not have a say in such proceedings? Should the rules not be more clear? The penalties for transgressions less arbitrary?
While most provinces have non-physician representatives on their disciplinary bodies, these appointments reek of tokenism because the panels themselves lack the appearance of independence. The process is simply not credible in this day and age.
Worse yet, cases of professional misconduct are dealt with in isolation. There are cases where physicians, stripped of their licence in one province, simply set up shop in another jurisdiction.
Insisting that physicians be held to a high standard and that violations be severely punished is not vengeful, it is necessary.
Right now, we have an inappropriate tolerance for aberrant conduct and deviant practice, and a culture of deference for doctors that serves us poorly.
Good doctors make for safer patients. And that is why we must spare no effort in weeding out the bad doctors.
