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 2005-2006
President - Dr. Marc Bourcier, Moncton
Registrar - Dr. Ed Schollenberg
At its meetings on 24 March and 16 June, 2006, Council considered the following matters:
A patient suffered a rare, but catastrophic, complication to a procedure. There was no allegation or evidence of deficient care regarding the procedure itself. When patient's care was taken over by another physician, the family complained that the first physician had not been available to the family for further discussion. In response, the physician noted that he had made several attempts to meet with the family. In these circumstances, the Committee noted that, while the first physician was no longer involved in the care of the patient, there may have still have been some benefit to have remained in contact if the family wished.
A child was seen at an after hours clinic. On initial inquiry, it was suggested that the child's problem had been ongoing for some time. Without offering any treatment, the physician stated that the child should have been seen by their own physician. In reviewing the matter, the Committee noted that, in such circumstances, patients are often directed away from such clinics. Nevertheless, in these circumstances, once the physician had attended the patient, there was an obligation to provide care appropriate for the circumstances.
A consultant performed a procedure on a patient. Neither the consultant, nor the family physician, communicated the result to the patient. The patient discovered the result inadvertently while attending a third physician on another matter. The patient alleged that the physician performing the procedure had failed to provide appropriate information. In response, the physician noted that the test result was received and normally would have been communicated directly to the patient. However, there had been a breakdown in office procedures in this regard. The Committee noted that, while the test result was positive, it would not have required further treatment. More than likely, however, the patient would have had some questions. The Committee notes that physicians have previously been reminded of the importance of keeping track of results. In these circumstances, the ultimate responsibility for communicating results rests with the physician who performed or ordered a test. In this case, the physician acknowledged that and asserted that procedures had been modified to avoid a repeat occurrence.
There was an allegation from a family that a patient had been inappropriately been prescribed narcotics. It was alleged that the physician continued to prescribe narcotics despite strong evidence that the patient was abusing them. In response, the physician acknowledged that the situation had gotten out of control and admitted that some of the treatment decisions were inappropriate. The Committee felt the physician's approach in this matter, while well intended, was not in the best interest of the patient or her family. The physician acknowledged the error and agreed on remedial measures, as suggested by the Committee.
A patient was seen by a consultant who, among other things, was asked to provide a comment regarding a patient's claim of disability. The patient alleged that the physician made a remark that the patient's problems were relatively insignificant. As a consequence, the patient felt the physician's conclusions were tainted. In response, the physician denied the remarks in question. In reviewing the matter, the Committee could find no evidence that the physician had assessed the patient inappropriately. The Committee understood that, if certain remarks had been made, this might raise questions regarding the objectivity of the assessment. Whether such remarks were made or not, the Committee could not determine. However, there was no evidence that the assessment was compromised.
A physician alleged that a colleague had declined to provide weekend coverage unless a consultation was requested. The second physician denied this was done for billing purposes, but rather, was an administrative tool which was the prevailing policy in the hospital. On reviewing the matter, the Committee could not be certain of the physician's motivation. Ongoing coverage of patients should occur without impediment and with a free flow of necessary information. The use of a form for a consultation, when a consultation was not performed, could be misleading. The Committee recommended a larger review of the issue.
A patient was referred to a specialist for a second opinion. However, the patient also sought a report for employment purposes. This was not noted on the consultation request and, consequently, the patient did not obtain an appointment in the appropriate setting. The patient was unsatisfied with the care offered in that context. In the Committee's view, the consultant had an obligation to respond reasonably to the needs of the patient. However, the difficulty could have been avoided if appropriate information had been provided by the primary physician.
A patient was admitted with a significant infection. He complained that the hospital physician failed to provide a surgical consult when he requested it and that it was only when another physician was covering that such was done. In response the physician noted that a surgeon had been consulted early and that the patient's course significantly deteriorated on a weekend when another physician was covering. The Committee reviewed the hospital records, which consistently backed up the physician's response. The patient had been doing well until the time in question. At that point, with increasing pain and fever, appropriate surgical intervention was done. The Committee did not feel there was anything more the physician could have done over the course of these events.
A patient was seen by a consultant for a number of problems. The patient complained that the physician made comments about her body which she found offensive. He also made inquiries about her private life, which she did not feel were relevant. In response the physician asserted that any comments or inquiries were indicated by the clinical situation. On reviewing the matter, the Committee felt the physician's remarks could have been well intentioned, but could also have been misinterpreted. Physicians have to be as conscious as possible as to how certain things may be interpreted by a patient, especially one they are meeting for the first time.
A patient transferred to another physician who, in contrast to the patient's opinion, felt she was capable of working. An ongoing dispute resulted and continued to the point where the patient was discharged from the practice. The physician asserted that the patient's best interests were always met. In reviewing the matter, the Committee could find no fault with the care provided.
A patient alleged that he suffered a significant complication as a result of vitamin injections. The physician asserted that such were provided at the patient's request and there were a number of other risk factors for the patient's health problems. The Committee agreed. There was no reason to believe the injections had caused the patient's problems.
A patient suffered a surgical complication relating to the healing of the wound. He attempted to see the surgeon, but was advised by the staff that, since thirty days had passed, a new referral from the family physician was necessary. The patient's condition worsened, resulting in a prolonged course. In response, the surgeon stated that this was an error on the part of his staff. Accepting that explanation, the Committee recommended that no further action be taken on the matter. However, the Committee wished to reinforce that surgeons remain responsible for postoperative complications. Patients should be seen for such without impediment.
In other business, Council:
- Approved the draft budget of Atlantic Provinces Medical Peer Review, which was intended to increase the frequency of assessments and expand the number of specialties which could be assessed.
- Reviewed a report from the Department of Health regarding an injured patient who had difficulty accessing the services of consultants. It is noted that physicians have been reminded that it is improper to deny access for a patient solely because the patient is from another region.
- Noted that there were an increasing number of complaints regarding the process of consultations. There were concerns that there were situations where an unnecessary request for a consultation could impede patient care. Council decided to raise the matter with the Department of Health and the Medical Society to consider where changes may improve the situation.
There were recent elections in four regions. All results were by acclamation. Re-elected were Drs. Robert Rae of Saint John, François Guinard of Edmundston, and Malcolm Smith of Tracadie-Sheila. Newly elected from Moncton is Dr. Mary Mitton.
FROM THE ARCHIVES
100 years ago
In 1906, Council questioned whether it had the authority to prosecute illegal practitioners, and decided to revoke the license of several physicians who had left the province.
75 years ago
In 1931, Council again discussed using the exams of the Medical Council of Canada as the only route to practise and determined to leave the annual fee at $3.
50 years ago
In 1956, the Council discussed the registration of specialists and osteopaths, and discussed which hospitals would be allowed to train interns.
25 years ago
In 1981, the Council suspended the license of a physician for reasons of alcohol and drug abuse, but reinstated it after two months based on satisfactory reports on his progress. However, he was subsequently convicted of impaired driving and his license was then revoked. He relocated to another province. Council also discussed the potential harmonization of the rules for licensure across the country. There was also the first meeting of Council elected under the new Medical Act.