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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.

Officers and Councillors 2018-2019

At its meeting on 5 April, 2019, and 21 June, 2019, 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 patient with a number of mental health concerns presented to a walk-in clinic. She did not have a local family physician.  She alleged the physician was not helpful regarding her concerns and simply made some suggestions as to where she would be better treated.  The physician responded that, under the circumstances, he could not provide anything more than a very preliminary assessment.  He believed he provided the patient with appropriate advice.  The Committee noted that, even in walk-in clinics, physicians are expected to provide care appropriate to the entrance complaint.  However, in this case, the patient’s issues were clearly more complex than could be normally handled in such an environment.  The Committee felt that the physician had made a reasonable attempt to assist the patient in this case. 

There was a complaint that a family physician failed to respond appropriately to a patient with an enlarged tonsil. The patient was treated with antibiotics for several courses before being referred to an ENT surgeon.  Surgery revealed the presence of cancer.  The physician asserted that the care had been appropriate.  The Committee noted that, even on assessment by the surgeon, there was no sense of anything suspicious occurring other than persistent pain.  No action was recommended on the matter. 

The patient was seen by an occupational physician regarding a return for work plan following absence related to an extremely stressful work event. The employee complained that the physician denigrated her current therapists and pushed her to return to work before she was ready.  In response, the physician asserted that as an occupational physician, he had no role in treating patients, but only was concerned with her ability to return to work.  In that context, the Committee felt that, in fact, such a physician was providing some treatment advice by recommending returning to work and commenting negatively on her current therapy.  The Committee felt it appropriate to Caution the physician on his appropriate role.

Two incarcerated patients. alleged they had poor access to a physician.  In response, the physician noted that access to medical services in the institution is triaged through nurses.  The Committee could find no particular fault with the care provided by the physician, but was concerned that significant matters, such as a foot infection in a diabetic, may not be presented to the physician in a timely fashion. 

An Alzheimer’s patient began to complain of abdominal pain. His physician initially dismissed this as a manifestation of the disorder. Eventually, another physician arranged investigations which demonstrated that the patient had advanced liver cancer.  The complaint was that the patient was not properly assessed or followed up by the family physician.  The Committee was concerned at how the physician had responded to the initial situation and, consequently, recommended a Caution.

There was a complaint against a family physician regarding discharging a family from his practice. On review, it appeared to be a longstanding issue between one member of the family and a member of the physician’s staff.  The matter had escalated to include others without them having been involved in any way.  The Committee did not feel further action could follow on the matter.

There was a complaint from a patient who was the plaintiff in a lengthy lawsuit regarding injuries from a car accident. The complainant alleged that the expert witness for the insurer had made a number of errors in her assessment and testimony.  In reviewing the matter in detail, the Committee determined that none of the allegations made were supported.  The physician provided an appropriately comprehensive report in response to the questions which were asked. 

There was a complaint concerning an independent psychiatric examination. The patient complained that the physician was aggressive in his interview, causing her distress.  She also complained that the physician had improperly criticized her current therapy.  In response, the physician stated he felt obligated to accurately assess the patient’s underlying problem.  He further felt obligated to raise issues regarding her current therapy, as he did not feel such was in her best interest.  The Committee noted the general understanding that physicians acting for third parties should not otherwise be involved in recommendations in the patient’s treatment.  Nevertheless, the Committee agreed that, if the physician felt there were significant risks to the patient, he was obligated to raise these issues.

The patient was seen in the Emergency Department and diagnosed with possible pneumonia. He was advised to follow up with his family physician, which he did.  At that time, a possible return to work was discussed.  He alleged that the family physician failed to respect the recommendation of the physician he had initially seen.  In response, the physician noted that the patient, in fact, had only raised the issue several days after he was seen.  The Committee could find no fault with the approach taken by the family physician in this matter. 

A patient complained that a physician had not properly assessed him for chest pain and he subsequently had a severe heart attack. The physician responded that, based on the information available, he did not suspect a significant cardiac issue in the patient when first seen.  The Committee wondered whether there were other clues, from the patient’s past history, and current symptoms, which could have focused the physician a little more on the issue.  The Committee recommended a Counsel to the physician in that regard.

A physician was subject to a complaint from Atlantic Provinces Medical Peer Review for inadequate records and questionable management of several chronic conditions. The physician responded that he had developed his own way of dealing with issues such as hypertension and diabetes, which he felt was successful.  He further asserted that his records were solely for his own purpose.  As a consequence, the Committee ordered a follow up assessment of the physician’s practice.

A “Choosing Wisely” guideline on antibiotic use is enclosed for interest and guidance

http://cpsnb.org/en/medical-act-regulations-and-guidelines/guidelines/862-choosing-wisely-antbiotics?highlight=WyJjaG9vc2luZyIsIndpc2VseSIsImNob29zaW5nIHdpc2VseSJd