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This Bulletin is forwarded to every medical practitioner in the province.  Decisions of the College on matters of standards, amendments to Regulations, guidelines, etc., are published in Bulletins.  The College, therefore, assumes that a practitioner should be aware of these matters.

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Officers and Councillors 2011-2012

At its meeting of 23 March, 2012, Council considered the following matters.

Complaints

A Counsel is advice as to how to improve the physician’s conduct or practice.

 A Caution is intended to express the dissatisfaction of the Committee and to forewarn the physician that if the conduct recurs, more serious disciplinary action may be considered. 

 A Censure is the expression of strong disapproval or harsh criticism.                                                                                                                                                                                              

A complaint was received from Atlantic Provinces Medical Peer Review that a physician had improperly declined to accept an assessment.  The ostensible reason was that the physician felt the costs involved should be borne by the Peer Review office.  After several delays, and the threat of suspension, the assessment was completed without incident.  The physician never actually provided an explanation to the College.  As a consequence, the Committee issued a Censure for failing to do so. 

A patient saw a surgeon for a longstanding issue.  The surgeon did not feel any surgical intervention was necessary.  The patient had a number of questions which, she alleged, were unanswered.  She also requested completion of certain disability forms, which the surgeon suggested were of insufficient importance to deal with quickly.  The Committee felt there were a number of shortcomings in the communication provided by the surgeon.  Even if no specific therapy could be offered, the patient was entitled to a reasonable explanation.  As a consequence, the Committee issued a Caution regarding such. 

A patient was under treatment at a local hospital.  Due to a number of unsatisfactory aspects of her care there, she chose to discharge herself.  Without further discussion, her physician subsequently advised her that she was discharged from the practice.  The reason offered was that the patient had lost confidence in both the physician and the local hospital.  The Committee felt that this patient was improperly discharged from the practice and that the physician had failed to follow appropriate guidelines, generally requiring a discussion with the patient of any outstanding issues prior to taking action.  The Committee felt that a Counsel to the physician was an appropriate response.   

A patient complained that there had been an improperly delayed diagnosis of a significant skin lesion.  In response, the physician noted that the presentation of the lesion, which turned out to be a squamous cell carcinoma, was extremely unusual.  The Committee agreed and could find no fault with the care provided. 

A patient suffered a work injury and developed persistent pain.  She saw a number of specialists who could not determine a specific cause and felt no intervention was appropriate.  She subsequently saw another consultant and requested further investigation.  In denying such, the physician implied that it would be a waste of resources to investigate the patient further.  The patient subsequently underwent further investigation through another physician and was determined to have a significant injury for which surgery was possible. On reviewing the matter, the Committee could find no fault with the physician’s clinical approach, but felt that, in discussing the matter with the patient, he left the implication that he was not addressing her best interests, but rather economic factors.  While such can be considered, it would be inappropriate to imply that they were the paramount consideration.  The Committee issued a Caution on that aspect.

An adolescent patient was seen in the Emergency Room on several visits.  It was alleged that the physician was dismissive of the symptoms.  A diagnosis was later made and the family complained that the physician’s care was inappropriate.  In response, the physician acknowledged such and apologized for his approach.  The Committee felt this was an appropriate conclusion to the matter.

An adolescent patient presented to her family physician for follow-up to a vaginal irritation.  She was not sexually active and declined an internal examination, but he insisted.  An argument developed which eventually included the patient’s mother by telephone.  In response, the physician acknowledged that his behaviour had been inappropriate and he should not have let the situation deteriorate as it did.  The Committee acknowledged the apology, but felt, in considering the issue of the patient’s age and circumstance, that the physician’s actions warranted a Censure. 

A family complained that a physician had improperly reported them to Child and Family Services.  The physician responded that the second child of the family had rarely attended for any well baby care and had not received any immunizations.  While this, in itself, did not immediately suggest problems, the Committee did feel that the physician had sufficient information to have the matter investigated, as she had been unable to discuss the matter directly with the family.

A patient was involved in a lengthy and complicated insurance claim.  As part of the documentation required, he requested a report from his current physician who provided excerpts from the clinical records of the patient’s former physician.  The patient complained that these were taken out of context and compromised his claim.  On reviewing the matter, the Committee felt that the physician had acted appropriately and could find no fault with the approach taken. 

A family complained regarding the care provided to an elderly patient in a nursing home.  It was alleged the physician failed to properly treat the patient and failed to properly record findings in the chart.  On reviewing the matter, the Committee noted that the patient was admitted with an unusual form of dementia.  A review of the records showed that the patient received the appropriate care.  The physician was actively involved with the patient’s care although, as he acknowledged, he should have provided better information in the chart and he should have communicated more directly with the patient’s family.

A family alleged that a physician had made an inappropriate and angry response to comments made during a visit for a prescription renewal for a disabled adult.  In response, the physician asserts that it was the family member who had provoked the confrontation.  The Committee found it impossible to sort out what had occurred.  Any such discussion should be avoided.  It can only distract attention from the patient at hand. 

REVIEW COMMITEE

The Committee considered two appeals from decisions of Council rejecting a complaint.  The Committee did not feel that further consideration of the matters was necessary, but did offer further advice to one of the physicians regarding the importance of documentation of any patient assessment or any communication with the patient or family. 

The Committee considered two physicians who were under agreement to maintain ongoing contact with a psychiatrist.  The Committee requested follow-up from the physicians involved. 

Finally, the Committee reviewed the matter of a physician practising under supervision.  An assessment of the physician’s practice had been positive save for some issues relating to documentation.  The Committee felt that the level of supervision could be decreased, but restrictions on the physician’s practice should be continued.

GUIDELINES

The guidelines on Moral Factors and Medical Care, and Walk-in Clinics, have now been adopted by Council.