This November, Respiratory Therapy will have been regulated in Ontario for 20 years. In that time, as well as all the years before the CRTO came into being, we have witnessed tremendous growth in our profession.  The most dramatic changes have occurred in the acute care setting, where RTs are now performing procedures and fulfilling roles that weren’t even conceived of 20 years ago.  We know that medical advances will continue, with every reason to believe that the RT role in acute care will evolve along with them.  There are many other ways RTs can make significant differences in the lives of their patients, however most opportunities to grow as a profession now exist outside the walls of a hospital.

Demographic and financial realities will cause a dramatic shift in how health care services are delivered in this province over the next several years. One of the principal goals in the Ministry of Health and Long Term Care’s (MOHLTC) Ontario’s Action Plan for Health Care is to find cost effective ways to provide timely and high quality health care closer to home. The “Right Care, Right Time, Right Place” initiative is aimed at expanding practitioners’ scope of practice so that patients can receive the care they need in the place they choose.  As patients with increasing complex respiratory needs are being discharged from hospitals, RTs are being asked to apply a broader range of acute care skills in a community setting. This presents a unique opportunity for RTs to use their specialized knowledge and have a tremendous impact by fulfilling a very real need.  But for many of us, it will require a significant shift in how we practice individually, as well as how we see ourselves as a profession collectively.

Traditionally we’ve tended to view respiratory therapy as technology-focused and acute care-centred. However, as the population ages and more Family Health Teams (FHTs), community-based specialty clinics and long-term care facilities require RT services, we must be willing to work and (to borrow from Apple’s advertising slogan…) “think differently”. For some RTs already out in practice, it may mean learning a new skill…or dusting off an old one.  For new grads, it means considering a much broader range of practice setting options than ever before.  For example, the trach we previously changed in the ICU will now, more than likely, be changed in the person’s home. 

No matter where we work – or how long we have been working – RTs need to be ready for what may be the biggest evolution in our profession yet. 

Recently, a Toronto anesthesiologist had his certificate of registration revoked by the College of Physicians and Surgeons of Ontario (CPSO) and was criminally sentenced to 10 years in prison for assaulting a number of female patients.  Most of the offenses allegedly occurred in a busy hospital operating room while the patients where under anesthetic. I have no first-hand knowledge of this particular case or of any of the circumstances that surrounded it.  I mention it merely as an example where a health care professional failed to uphold even the most basic standards of their profession – and of society.  When a transgression like this occurs in the midst of a team environment, we are all left to wonder “how could that happen” and “what could have been done to prevent or stop it?”

Dr. Patricia Houston, president of the Canadian Anesthesiologists’ Society, spoke recently about the case on CBC Radio’s Metro Morning.  She said that it illustrates the “collective responsibility » all health care professionals have to safeguard the patients in their care[1].  It is important to remember that it cannot be assumed that someone else will bring a concern forward to the appropriate people or agency.  Admittedly, it can be challenging to report a coworker, especially if there are suspicions that something is not quite right but there’s no clear cut evidence.  An RT may feel that voicing their concerns will invite retaliation and make them appear disloyal to the team. They may also worry about damaging a colleague’s reputation if their concerns turn out to be unfounded. However, an RT’s primary accountability is to the patients receiving services within their organization and all patients are entitled to receive safe, competent and ethical care.

Fortunately, there are several avenues that an RT can take if they feel another health care professional has behaved inappropriately or failed to provide the appropriate standard of care.  First, if the conduct of the individual places patients in imminent danger, then the RT must immediately alert the appropriate person or department within their organization.  If the colleague is a member of a regulated health care profession, the RT should also contact that person’s regulatory College.  It is each health regulatory college’s duty to investigate complaints and determine if the cases merit further action.  If an RT wishes to remain anonymous, it’s best to contact the relevant College and find out what options they have.  There are often ways that Colleges can investigate an individual’s concerns without revealing their identity.

Patients need our support and advocacy…not our silence.