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.
President - Dr. Marc Bourcier, Moncton
Registrar - Dr. Ed Schollenberg
At its meeting on 25 November, 2005, Council considered the following matters:
Following a diagnostic procedure, a patient did not see the physician until follow-up two weeks later. That visit was interrupted several times by staff and phone calls. The patient still had questions and raised the matter with administration. A further appointment was arranged at which the physician allegedly berated the patient for being unsatisfied. In his response, the physician stated that he rarely sees patients immediately postoperatively, asserted that he offered the best explanation he could despite the circumstances of the follow-up visit, and admitted he was upset that the patient had raised any questions regarding any care provided. In reviewing the matter, the Committee felt that the patient had been reasonable in his request. Given the fact that the physician had declined to see the patient immediately after the procedure, and then had another meeting which was frequently interrupted, it was not surprising that the patient would wish further clarification. The Committee felt the complaint had been instructive to the physician and recommended no further action on the matter.
After a lengthy delay, a patient saw a consultant. The patient was already convinced of a particular diagnosis, but the consultant did not feel the evidence supported such. As a consequence, the patient insisted on a referral out of province. On that visit, no further investigation was done, but the patient was treated empirically. The patient felt that the first consultant had not provided appropriate investigation. On reviewing the matter, and considering what was known at the time of the initial consultation, the Committee could find no fault with the care provided. By the time the patient was seen out of province, the symptoms had progressed somewhat and, on that basis, treatment was started.
A patient was seen for excision of a cancerous lesion. The patient felt the procedure done was not that which was consented to. When the patient was sent to a second consultant for further treatment, she insisted on further explanation of the original surgery, which the second consultant declined to provide. In response, the surgeon felt he had provided appropriate explanation, but there may have been some confusion regarding the terminology. The second consultant responded that he did not feel obliged to explain treatment that he himself had not provided. In reviewing the matter, the Committee felt the terminology involved could be confusing. The best physicians can do is to be mindful of such difficulties when discussing procedures with patients. The Committee also felt that a physician is obligated to respond to any questions that he is competent to answer. Even though the procedure was performed by another physician, an explanation should have been offered if it would assist the patient. In this case, a simple explanation of the terminology involved might have avoided complaints against both physicians.
A patient was awaiting transfer to another centre for definitive treatment when her condition worsened dramatically. Despite aggressive intervention, the patient died. An autopsy did not particularly clarify the matter. The family complained regarding the care provided. On reviewing the matter, based on the information it had, the Committee could find no evidence that the care was deficient in any way.
From time to time, either following a formal inquest or an informal investigation, the Chief Coroner requests the College's assistance in providing certain information to members. In this context, Council reviewed a number of recent cases and suggests the following issues on which members should take note:
- Following the death of an infant due to asphyxiation while sleeping, physicians are encouraged to review sleeping arrangements of infants at the earliest opportunity. This includes measures to prevent Sudden Infant Death Syndrome (SIDS), as well as asphyxiation due to smothering. The Canadian Paediatric Society recently produced a position statement on safe sleeping environments for children. They have also provided a parent information sheet. Members are encouraged to review both at www.cps.ca.
- Following the deaths of two adolescents in foster care, physicians are encouraged to determine appropriate consent arrangements for such patients. Depending on their legal status, the physician may need to obtain consent from the social worker, the foster parents, or the patient themselves if they have reached the age of sixteen.
The same considerations for consent to treatment apply to access to information and confidentiality. Given the special circumstances of these patients, physicians must balance privacy and confidentiality considerations against the general benefit that flows when all parties involved in a patient's care are appropriately informed.
- Following the death of an adolescent from a self-inflicted gun shot wound, physicians are encouraged to make inquiries regarding possible firearms access for any patient where suicide may be a risk.
- Following the death of a patient who had been followed by both his family physician and the Mental Health Clinic, with little communication between the two, Council noted the benefit of appropriate sharing of information in the patient's best interest. Council is encouraged by recent efforts to enhance such sharing of information.
The Review Committee, which provides more in-depth and ongoing analysis, dealt with several matters.
There had been concerns regarding the appropriateness of physician prescribing various narcotics. After extensive review, the Committee was satisfied that the physician had made significant efforts in education and in altering his practice.
In another case, there had been a number of complaints regarding a particular aspect of a physician's practice. After monitoring the situation for some time, the issues appear to have resolved and the Committee felt it appropriate to conclude its investigation.
In another case, the Committee agreed to a treatment agreement regarding a physician who had a number of personal difficulties which could increase the risk of complaints from patients.
By now, all physicians should have received notice regarding fees for their licenses for 2006, as well as that for their professional corporations. Physicians are reminded that all fees must be received in the College office by 1 January, 2006. Physicians who have not received such notices should contact the College office.
FROM THE ARCHIVES
75 years ago
In 1930, the Council agreed with the Canadian Medical Association to put restrictions on physicians who were importing drugs from the United States, and agreed to allow the Medical Council of Canada exams to be the sole portal for licensure, so long as the exams could be taken in New Brunswick.
50 years ago
In 1955, Council decided that there was still no need to require the registration of interns, considered the possibility of increasing the internship for "alien" doctors to two years, and considered changing auditors because it was felt that the audit fee of $100 was excessive.
25 years ago
In 1980, Council referred several complaints to the Ethics Committee of the Medical Society, considered a request by Medicare to become involved in reviewing physicians' billing practices, discussed the continued availability of ether without a prescription with the Pharmaceutical Society, and increased the annual fee to $60. There were seven hundred and sixty physicians registered.
The Executive Committee generally handles matters which arise between Council meetings. They also are responsible for reviewing the performance and the contract of the Registrar.
President: Dr. Marc Bourcier
Vice President: Dr. Malcolm Smith
Past President: Dr. Douglas Brien
Public Member: Mr. Eugene LeBlanc
Member at large: Dr. Robert Rae
The Complaints Committee is responsible for the initial investigation of complaints and making recommendations regarding disposition.
Dr. Douglas Brien
Ms. Ellen C. Desmond
Mr. Gordon Foster
Dr. Leonard Higgins
Dr. Douglas Keeling
Ms. Colleen Knudson
Dr. Perry Spencer
Matters may be referred to the Review Committee by the Complaints Committee or Council. They generally deal with issues requiring more extensive investigation or ongoing monitoring, including questions of physician performance and competence and incapacity due to illness or substance abuse. The Committee also handles appeals from decisions of Council.
Dr. Rudolph Stocek
Ms. Sarah Cummings
Dr. Gary Fecteau, PhD
Dr. Linda LeBlanc
Dr. Gordon Mockler
Dr. Beatriz Sainz
Dr. Patrick D. Sullivan
Dr. Georges Surette