Thisis 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 2011-2012
President - Dr. Mark Whalen, Campbellton
Dr. Stephen R. Bent, Miramichi
Dr. Zeljko Bolesnikov, Fredericton
Dr. Santo Filice, Moncton
Dr. Robert J. Fisher, Hampton
Dr. Kathleen L. Keith, Saint John
Mr. Paul Leger, Rothesay
Registrar - Dr. Ed Schollenberg
Ms. Ruth Lyons, Tide Head
Dr. Mamound Meddoun,Edmudnston
Ms. Patricia I. O'Dell, Riverview
Dr. Teréz Rétfalvi (PhD), Moncton Dr. Susan E. Skanes, Dieppe
Dr. Lisa Sutherland, Rothesay
Dr. Juile Whalen, Moncton
At its meeting on 23 November, 2012, Council considered the following matter:
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 complained that her former physician refused to provide a copy of her chart to her new physician. Instead he only provided summaries of his own notes, along with other documentation. In response, the physician asserted that he provided all relevant information so that the patient could receive ongoing care. In that regard, the Committee agreed that he had met his ethical obligations. However, under provincial legislation, patients do have the right to review and, on request, have forwarded, actual copies of the physician’s own notes. When there is such a specific request, the physician should be prepared to do so. The physician was issued a Counsel in that regard.
A patient had seen a consultant and needed to be reassessed several years later. However, she now wanted to be referred to another physician in the same office. She was advised it was office policy to decline such and she had to continue to see the original specialist. The Committee noted that physicians are ethically obligated to respect the patient’s wishes regarding the choice of treatment and to not interfere with their access to another physician. In these particular circumstances, the Committee felt it appropriate to Caution the physician whose office had denied access solely because she was seen by a colleague several years earlier.
A patient was under investigation for a tumour. She was expecting results of a most recent test, but was advised that she would not receive such for several weeks as her physician was going to be away. She, nevertheless, understood that the result would be available and she attended his office in hopes of receiving some information. However, on seeing her, the physician reacted, in her view, inappropriately and remonstrated her for attending the office in this fashion. While the physician denied any adverse language, he acknowledged that he had approached the patient in a rather forceful manner. In reviewing this matter, the Committee noted the anxiety the situation had created for the patient and so far as possible, felt the physician might have anticipated such and perhaps responded in a different way to her attempt to receive results which she hoped would be reassuring. The physician was Counselled to avoid such circumstances in the future.
Several unrelated complaints dealt with complications arising from procedures. On reviewing the matters, the Committee could find no evidence of deficient care, nor any evidence that the physicians did not respond appropriately, from a clinical point of view, to the complication as it developed. The Committee notes that any procedure carries some risk. The best the physician can do is assure appropriate informed consent has been obtained. Furthermore, communication with a patient after the complication has developed can be critical in determining whether the matter might proceed to a complaint.
To correct a comment from the last newsletter, physicians will note the admonishment to avoid treatment of patients with Lyme disease based only on symptoms, and without appropriate serological confirmation. It should be noted that these comments referred to the diagnoses of the chronic condition. In acute situations, it can be quite appropriate to commence treatment based on the history of exposure, as well as symptoms, including the typical rash, erythema migrans. There are a number of resources available for physicians in this regard.
At the last meeting of Council, a general guideline was adopted based on those previously done in other provinces. This guideline is currently being amended to be more relevant to New Brunswick. It will be available through the website shortly. In addition, in keeping with practices elsewhere, Council has also determined that, at some point in the future, physicians who wish to receive a general exemption for methadone maintenance therapy will be required to have evidence of appropriate training in that regard through one of a number of resources that are available. This will not yet be strictly enforced immediately, but physicians are encouraged to take advantage of such programs. Discussions are also underway to have such a program provided directly within the province.
Preventing Follow-up Care Failures
Members were provided a draft copy of a proposed guideline on this matter and offered the opportunity to comment. Council has now adopted this guideline as a standard of care with the intent to encourage members to develop processes in their practices to minimize communication gaps that could adversely affect a patient’s care. Such initiatives can also help limit a physician’s potential legal liability.
To assist referring physicians with tracking consultation requests, consultants are reminded of the guideline on Consultations/Referrals which is available on the College website. It states, in part: “Upon receipt of the consultation request, the consultant should make every reasonable effort to acknowledge such with the referring physician”.
By now, all physicians should have received notification of renewal regarding their licences, as well as licenses of the Professional Corporation. Physicians who have not done so should contact the College office without delay. In addition, any changes in contact or banking information should be forwarded to the College by fax or email.