Advice to the Profession: Professional Behaviour

Approved by the Board: September 2024

In order to create an atmosphere of trust and to ensure good patient outcomes, it is important that physicians maintain professional behaviour. The Professional Behaviour policy sets out CPSO’s expectations of physician behaviour and identifies behaviour that is considered unprofessional. This document is intended to provide guidance for how the expectations set out in the Professional Behaviour policy can be met.

What are some of the potential factors that may contribute to unprofessional behaviour, and how can these be addressed?

Physicians are subject to many factors that can impact their health and behaviour, including mental health concerns, stress, burnout, and moral distress. These same factors can potentially contribute to unprofessional behaviour, however, physicians are still responsible for meeting the expectations set out in the policy and maintaining professional behaviour.

While there can be stigma related to substance use and mental illness, it is important that physicians are able to seek help regarding their health and well-being. Physicians are encouraged to engage in ongoing self-reflection regarding their ability to manage their stress and mental health and to seek support as soon as possible.

What resources are available to support physicians in managing their health and wellbeing?

In addition to any resources available through their local setting (e.g., university, hospital, or other work environment), physicians are encouraged to contact the Ontario Medical Association’s Physician Health Program (PHP) to explore available support resources.

Physicians can visit the Physician Wellness page on CPSO’s website for more information on programs and resources available to support their health and well-being. Physicians are also encouraged to contact their specialty societies if they have a specialty-specific wellness issue.

How can I ensure I remain professional while engaging in advocacy as a physician?

CPSO recognizes that advocacy for patients and an improved health care system is a key component of a physician’s role. Physicians may also care deeply about and wish to advocate for causes or issues unrelated to health care.

Physicians are entitled to speak out about issues important to them and exercise their rights of freedom of expression under the Canadian Charter of Rights and Freedoms (“Charter”). Charter rights are, however, subject to reasonable limits, which for physicians can include balancing regulatory concerns, including CPSO expectations around public communications (e.g., opinions shared on social media). 

When engaging in advocacy, physicians need to always consider the potential impact of this advocacy on patients’ best interest, the public, and the profession. For example, any advocacy that negatively affects a physician’s ability to deliver quality care, collaborate with others, or maintain a culture of safety in their practice may be considered unprofessional under the policy.

The public gives significant weight to physicians’ opinions. Accordingly, any opinions that a physician shares publicly, particularly when identifying themselves as a physician, need to be offered responsibly and professionally. For more information on engaging in advocacy, see the Canadian Medical Protective Association (CMPA) resource Advocacy for Change: An important role to undertake with care.

How can I engage in advocacy professionally when using social media?

For more information on engaging in advocacy using social media specifically, see CPSO’s Social Media policy and the companion Advice to the Profession: Social Media document. The Canadian Medical Protective Association (CMPA) also has a number of resources for physicians who engage in advocacy and use social media, including:

• Social media: The opportunities, the realities – Guidance for Physicians who use social media in their personal or professional lives, and
• 10 tips for using social media in professional practice.

What appropriate action can physicians take to address unprofessional behaviour demonstrated by colleagues, including their own staff members?

There are a range of “appropriate actions” depending on the specific circumstances. Where the unprofessional behaviour demonstrated by a colleague is relatively minor, an appropriate first step may be to have a conversation with the person about their behaviour. Where the colleague’s behaviour continues to be unprofessional or is particularly offensive, a more formal intervention may be required.

While it is important that physicians take action when they see unprofessional behaviour by a colleague or their own staff member to prevent it from occurring in the future, this action may look different, depending on the setting and the physician’s role.

For example, where a physician is the employer or supervisor of staff, such as in a solo practice, they would be expected to take specific action themselves to address a staff member’s behaviour. In a setting where the physician may not be the employer or supervisor of staff, such as in a team-based group setting or a hospital, appropriate action may include speaking directly with the colleague about their behaviour, if they feel safe to do so, and/or escalating concerns to the colleague’s immediate supervisor or another leader in the setting. 

How can I contribute to providing a safe and supportive environment?

There are significant challenges impacting the health-care system broadly, and physicians are subject to many competing demands. In this context, creating safe and supportive environments for physicians to work within is particularly important, and can help prevent unprofessional behaviour in the workplace. Recognizing that the actions a physician can take will depend on their role or workplace, the following non-exhaustive list of examples is provided for consideration:

• making staff aware of existing policies and procedures that outline clear mechanisms and pathways for reporting unprofessional behaviour;
• ensuring that staff meet regularly so that issues can be raised and addressed;
• offering conflict management, de-escalation, and cultural safety training;
• regularly giving and receiving feedback from colleagues, including normalizing positive feedback and behaviours; and
• being willing to engage meaningfully and transparently to understand the cause(s) of unprofessional behaviour(s), including prompt intervention and follow-up.

In addition to their advice on Addressing disruptive behaviour from other physicians for physicians in leadership positions, CMPA also offers practice guidance related to building a culture of psychological safety, situational awareness, and conflict resolution for all physicians.

CPSO’s Professional Responsibilities in Medical Education policy and the accompanying Advice to the Profession: Professional Responsibilities in Medical Education document include additional expectations and guidance for physicians involved in medical education and training of medical learners, including how to provide support and direction regarding unprofessional behaviour.

When might the policy be applied to situations outside the strictly professional context?

Physicians need to ensure that their behaviour, even in their personal lives, does not impair their ability to function in a professional capacity or negatively impact the profession as a whole.

The policy identifies several factors that can impact whether behaviour in a physician’s personal life would be considered unprofessional under the policy, including whether the behaviour:

• may bring the profession into disrepute (i.e., could cause people to lose respect for, and trust in, the profession), and/or
• raises concerns about the physician’s competence, integrity, and/or suitability to practise.

Additional factors that may be considered when determining whether a physician’s conduct outside the professional context may be considered unprofessional can include, but are not limited to:

• the nature and seriousness of the behaviour, 
• whether there is a pattern of similar behaviour, 
• the context in which the behaviour took place, and
• the consequences that resulted from the behaviour.