Webinar Summary Part 1: Truth: the medical profession’s first step toward reconciliation
NOTE: The public consultation for the draft Standard of Practice – Practicing Medicine to Eliminate Anti-Indigenous Racism is now closed.
This webinar, held on October 23 for CPSM registrants, provided background on the draft Standard of Practice—Practicing Medicine to Eliminate Anti-Indigenous Racism, which is currently out for public consultation.
Watch the webinar below or read the first of a two-part summary of the webinar Truth: The Medical Profession’s First Step Toward Reconciliation.
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The CPSM Indigenous Advisory Circle
How the Standard was developed
Key concepts of the Standard of Practice
The Restorative Practices Program
How do you know the Restorative Practices Program will work?
A call to action
The Standard of Practice states that racism in healthcare via personal interactions and in systemic contexts for Indigenous Peoples is a well-documented, researched, and reported issue.
Several federal and provincial commissions/inquests have identified the need to address anti-Indigenous racism that exists in the healthcare system. This list is non-exhaustive; three of the ones raised on the webinar were:
A summary of the events leading up to Brian Sinclair’s death, the inquest that examined it, and the Interim Recommendations of the Brian Sinclair Working Group.
The overall recommendation from the working group was:
We recommend that all stakeholders in the healthcare system (including the federal government, the provincial government, Regional Health Authorities, unions, professional organizations, and postsecondary institutions involved in the delivery of professional programs) adopt anti-racist policies and implementation strategies that include committing resources to providing anti-racist training and supporting independent investigations when complaints are filed.
- Joyce’s Principle
In Quebec, an inquiry into the death of Joyce Echaquan in 2020 resulted in the creation of Joyce’s Principle.
Joyce’s Principle is a call to action to guarantee all Indigenous people have the right to equitable access to all social and health services without discrimination and to recognize and respect the traditions and living knowledge of Indigenous people in all aspects of health: physical, mental, emotional, and spiritual.
In April 2024, a study published in the CMA Association journal found that First Nation patients in Alberta were more likely to leave emergency department visits without being seen or against medical advice than non-First Nations patients because of mistreatment. Leaving without care delays access to essential medical services and treatments, continuity of care, and increases health gaps and risk of death.
The CPSM Indigenous Advisory Circle
As a regulator, we can empower cultural changes required in the profession. We also recognized that this work must be Indigenous led. The Advisory Circle was established in 2021.
Dr. Lisa Monkman chairs the Indigenous Advisory Circle, which includes Indigenous physicians, scholars, elders, public representatives, knowledge keepers, and other CPSM registrants. The Advisory Circle operates in a spirit of inclusion and respect for diversity and helps guide the collective work CPSM is doing.
For the last few years, the Indigenous Advisory Circle has provided advice, guidance, and recommendations to help CPSM reflect on its processes, policies, and systems to understand and support Indigenous patients.
Collectively, as a group, seven key areas of work were identified. We recognize that we will not see change until all practitioners acknowledge how medical care is impacted by Indigenous-specific racism. CPSM is committed to these seven recommendations in our path to truth and reconciliation and is grateful for the work of the Advisory Circle as they continue to guide CPSM through these actions and try to develop meaningful actions for change.
How the Standard of Practice was developed
The Indigenous Advisory Circle was divided into smaller groups, and this standard is the result of one of those groups that started developing it in early 2023.
How it differs from other Standards of Practice
This Standard is unlike other Standards of Practice; the development and consultation phases were approached differently. Before the draft public consultation, the following steps were taken to prepare the document for consultation:
- An Indigenous consultant was hired to help navigate the many moving pieces of this work.
- The Standard of Practice and an accompanying contextual document were drafted to ensure that Indigenous voices and perspectives were involved right from the beginning, guiding and informing the process.
- Once drafted, pre-consultations of the Standard occurred, resulting in many individuals and organizations contributing to it by providing their perspectives, resources, and feedback. This allowed the initial principles to evolve into a more robust practice standard.
- After community involvement and consultations with First Nations and Inuit organizations and the Manitoba Métis Federation, consultations were held with physician organizations such as Doctors Manitoba and the Canadian Medical Protective Association.
- The standard and contextual document underwent more revisions before being launched for public consultation.
- The working group will review all feedback. The group will determine what changes will be made to the standard before it goes to CPSM’s Council for final approval and implementation.
Key concepts of the Standard of Practice
Defining Anti-Indigenous Racism
Step one is defining what Anti-Indigenous racism means. What does it look like and what does it feel like in the health system?
It’s easy to define stereotyping and discrimination and action on the part of an individual, but we know that racism is far beyond that.
Racism is a structure and a system of inequity. Racism is more than individually mediated behaviours. The Standard is structured into three main principles:
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Understanding what anti-Indigenous racism is, acknowledging it exists, and its negative impacts on the health of Indigenous people.
Racism doesn't just hurt people's feelings… it can end people's lives; it results in delays to medical care that is essential for Indigenous people to be healthy and well.
- Dr. Lisa Monkman, Chair, CPSM Indigenous Advisory Circle
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Identifying anti-Indigenous racism, not just acts but also omissions —you need to be able to engage in a process of deep self-reflection.
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Taking action to address acts or omissions of anti-Indigenous racism. This aligns with the Code of Ethics and Professionalism
This principle aligns with the Code of Ethics and Professionalism we abide by as doctors in Canada. Specifically, the fundamental commitments of the medical profession to:
1) advocate
2) the essential need to have difficult conversations
3) reporting things when you see them occur
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Following their apology to Indigenous people and as part of their ReconciliACTION plan, the Canadian Medical Association has committed to reviewing the Code of Ethics and Professionalism — a foundational document for ethical medical practice in Canada — with the goal of strengthening provisions related to racism and discrimination. |
The Restorative Practices Program
The Restorative Practices Program is an important piece of the standard and its implementation.
We want to acknowledge that the restorative justice working group includes members from The Rady Faculty of Health Sciences, CPSM, and worked with Knowledge Keeper Leslie Spillett, who helps ensure our work is rooted in local teachings about restorative justice.
Restorative justice emphasizes repairing or restoring relationships, fixing harm, and preventing further harm from occurring. It is collaborative and requires engagement from all people involved. Using human-first principles, it is intended to be positive and restorative. Using this kind of approach is crucial for the successful implementation of the standard.
Ultimately, we aim to change human behaviour and gain insights into things many haven't seen or experienced themselves. The process is intended to empower individuals to do better and to alleviate the fear that engaging with CPSM will automatically and immediately lead to discipline.
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Restorative justice is a way of conflict resolution that is deeply rooted in Indigenous worldviews and knowledge systems. It follows a framework that seeks to restore the integrity and the humanity of both the perpetrators of harm and the recipients of harm. - Dr. Lisa Monkman |
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Concerns about complaints
We have heard concerns from registrants that the Standard will increase complaints because their actions could be misinterpreted, misunderstood, or otherwise result in a complaint.
When harm happens, sometimes some cases must go to the Complaints & Investigations department, Still, the foundation we are trying to achieve is a safe space for education, discussing behavioural changes, and making a meaningful impact on patient care for Indigenous patients.
This program will focus on healing harm through a quality-focused approach separate from the complaints and investigation process. It is intended to address anti-Indigenous racism concerns that may arise in the practice of medicine by prioritizing education and support.
The Restorative Practices Program will be led by someone with expertise in anti-Indigenous health-related racism and restorative practices, ideally, a CPSM registrant.
The rollout of this program would be aligned with the launch of the standard of practice as early as 2025.
We operate a similar program in the Quality department called the Prescribing Practices Program. It is a program that educates and supports registrants to enhance prescribing practices and was developed to support the implementation of the standards for prescribing opioids and prescribing benzodiazepines.
How do you know this program will work?
In the Prescribing Practices Program, this educational and supportive approach allows registrants, whether self-identified or referred by colleagues or health professionals, to start with a conversation with a medical consultant and CPSM staff to enhance their understanding and application of the standards.
Instead of directing concerns to complaints and investigations, the focus is on education and constructive feedback.
Last year, 85% of the 400 calls related to prescribing advice resulted in educational interventions or advice to enhance competency and safety, with only 1% leading to disciplinary referrals. This initiative aims to improve the profession through support and education rather than “shaming and blaming.”
Collectively, we can make meaningful strides toward reconciliation and ensure that all Indigenous patients receive equitable medical care.
Watch for part 2 of the summary of the webinar.