Bulletins

August 2002

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 2001-2002

President - Dr. Ludger Blier, Edmundston
Vice-President - Dr. Marc Panneton, Campbellton

Ms. Barbara Bender, Saint John
Dr. Zeljko Bolesnikov, Fredericton
Dr. Marc Bourcier, Moncton
Dr. Douglas Brien, Saint John
Dr. Christine Davies, Saint John
Dr. Paula M. Keating, Miramichi
Mr. Stanley Knowles, Miramichi
Mr. Eugene LeBlanc, Dalhousie

Registrar - Dr. Ed Schollenberg


Dr. John McCrea, Moncton
Dr. Robert E. Rae, Saint John
Dr. Beatriz Sainz, Oromocto
Dr. Malcolm Smith, Tracadie-Sheila
Dr. Rudolph Stocek
Dr. Pamela Walsh, Riverview
Dr. Claudia Whalen (PhD), Fredericton




At its meeting on 7 June, 2002, Council considered the following matters:

COMPLAINTS
A patient was being followed by a specialist. The patient and his family became unsatisfied with the care provided and, at their request, the family physician consulted another specialist in the same clinic. This physician refused to see the patient, but a meeting was set up with the family, and other individuals, to discuss their concerns. It was the clinic's policy to resist patients changing physicians within the group. The patient complained both regarding the care provided by the first physician, as well as the family's difficulty in changing physicians. In reviewing the matter, the Committee noted that it is generally improper to interfere with a patient's choice of a physician. However, in the very particular circumstances here, the Committee agreed with the attempt to resolve the situation, but was concerned that the patient and his family were not clearly advised as to what was going on. They did not seem to clearly understand the evidently honest attempt to resolve the dispute. As a consequence, they felt they were being intimidated. The Committee felt that such might have been avoided with better communication.

A patient attended a new physician after relocating from elsewhere. She had an extensive past history, but complained that the physician refused to review such. A number of other disputes involving her care developed over the ensuing months. These included disputes regarding requests for referrals to specialists, fees for completing forms, and renewals of prescriptions. In response the physician stated that the patient's past history was extensively reviewed and all appropriate care had been provided. In reviewing the matter, the Committee could find no evidence that the physician had failed to provide appropriate care.

A lawyer requested medical records from a physician who had left the province. All requests for such had been unanswered. Eventually, after six months, the records were forwarded. At that point, the physician also advised the College as to the location of his former records. In reviewing the matter, the Committee noted that this issue had resolved itself. The Committee also noted that guidelines had been published which require physicians to, at the least, acknowledge receipt of such a request within forty-five days and, further, to advise lawyers as to when their requests will be met.

A patient claimed that she had visited an Emergency Department and was forced to submit to an internal examination to which she had not consented. In response the physician stated that the patient did not have an internal examination, but only an examination of the genitalia in response to a specific concern. He asserted that the complainant had consented to such. In reviewing the matter, and the relevant records, the Committee could find no evidence that the physician had acted improperly under the circumstances.

A patient was discharged home following the delivery of her baby, but soon developed a significant rash. She became extremely concerned that this rash may be contagious to the baby. She attended the Emergency Department and was unsatisfied with the response of the physician there. She requested that her own physician be called, which was refused. She eventually reattended the hospital the next day, was seen by her own physician, and a significant infectious rash was diagnosed. In reviewing the matter, the Committee felt that the Emergency Room physician had provided the appropriate clinical care. Nevertheless, given the anxiety of the patient under the circumstances, the Committee felt the matter could have been handled in a way which better allayed the patient's anxiety.

A patient claimed that she was discharged from a physician's practice for missing appointments. She stated that the physician had a policy that, after missing three appointments, the patient was automatically discharged from the practice. The patient complained that she had only missed one appointment on herself. One appointment for her son was missed, and in another circumstance, she was unable to contact the physician's office to determine the time. In reviewing the matter, the Committee had several concerns. First of all, appointments cannot be considered as "missed" unless the patient has a means to cancel them. This requires at least an answering service or answering machine which allows messages to be left at any time. Furthermore, the Committee is concerned about any "automatic" policy. Under the circumstances, the Committee felt that if the physician did have legitimate concerns, the appropriate approach would have been to discuss the matter with the patient with a clear understanding that future difficulties could result in the patient being discharged from the practice.

A patient had a lengthy wait at a specialist's office. On first seeing the physician, she made a brief comment regarding the wait. She alleged that the physician responded in an angry, hostile manner. In his response to the complaint, the physician stated that he did not recall the specific comments. He did acknowledge that the "tone" may not have been appropriate. He expressed his regret to the patient regarding the matter. The Committee felt this was an appropriate resolution to the issue.

A patient underwent a surgical procedure and suffered a complication. She alleged that the complication was avoidable, that the surgeon had not appropriately informed her of the difficulties, and failed to provide appropriate follow-up. In response, the surgeon denied any inappropriate care. In reviewing the matter, the Committee noted that the complication was known and not uncommon. Such can occur despite the best of care. Furthermore, the Committee felt that the follow-up care by the surgeon was appropriate. The one issue in which the Committee was uncertain was the information passed to the patient when the complication was discovered. It was impossible for the Committee to determine what exactly the surgeon had said to the patient. Physicians are reminded that it is their ethical obligation to disclose any complications or other adverse events to a patient. Such discussions should be documented.

NARCOTIC PRESCRIBING
A recent coroner's inquest has made several recommendations to the College, and others, regarding prescribing and misuse of narcotics. As a preliminary response to these recommendations, Council has authorized a republishing of existing guidelines on "The Management of Chronic Non-malignant Pain" and the regulation on "The Patient Medical Record". These are enclosed with this mailing.

In addition, the College will be working with the New Brunswick Medical Society in developing certain educational initiatives which will be of benefit to physicians regarding these issues.

The inquest also recommended the establishment of a comprehensive prescription monitoring scheme. The College has collected considerable information on such schemes in other provinces and will be working with other interested parties regarding the best approach to take.


VENTOLIN AND FLOVENT
As a result of the removal of chloroflorocarbons from these inhalers, the manufacturer has created two new preparations called Ventolin HFA and Flovent HFA. As only the modified products will be available, it will be necessary for pharmacists to replace these when refilling any prescriptions over the next several months. To avoid the necessity for physicians issuing new prescriptions for the new products, Council has approved that pharmacists can make the change without contacting the physician. This should reduce the burden of this process for pharmacists and physicians. This follows the approach taken in other provinces.