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. Rudolph Stocek, Hartland
Registrar - Dr. Ed Schollenberg
At its meeting on 2 April, 2004, Council considered the following matters:
Expectations of treatment
A patient suffered an injury which, after treatment, resulted in a minor, but in the patient's view, significant disability. It was alleged the initial treatment was inappropriate. In response the physician asserted that the treatment was appropriate, but, even with the best of care, the difficulties at issue could arise. On reviewing the matter, the Committee agreed with the physician that some level of minor disability could occur from such an injury. However, the Committee was concerned with the expectations of the patient during the course of treatment. It is possible, but far from certain, that better communication from the physician would have avoided the complaint.
A patient had been treated some years earlier by a family physician. The physician's approach was considered "alternative". The period of treatment was relatively brief, but the patient alleged that the physician's approach denied her access to appropriate care. As a result, her ultimate diagnosis and treatment were delayed significantly. In response the physician noted that he had not seen the patient for a number of years and had only treated her for a short period of time. Even during this period, the patient did see a number of consultants. He asserted that in no way was the patient's care inadequate. In reviewing the matter, the Committee noted that the complaint had arisen several years after the treatment and, on reviewing the records, the patient clearly had extensive access to specialists. The Committee did not find there was any clear merit to the complaint.
Accepting a new patient
A new patient attended a physician after an appointment was made by the physician's staff. The patient had an acute, but minor, problem. However, the physician stated that the patient was not yet accepted into the practice and, furthermore, declined to treat the entrance complaint. In response the physician acknowledged that there was some confusion regarding the patient's status with the physician. On reviewing the matter, the Committee felt the physician could still have treated the patient's acute problem. Whether the physician continued to care for the patient was a separate issue.
ECT and the elderly
The family of an elderly patient complained that she was improperly treated, specifically with electric convulsive therapy (ECT). It was alleged that treatment was unnecessary and that the patient's medical condition was a contraindication. In reviewing the matter, the Committee noted that the treatment appeared appropriate for the patient's state and was likely worth the risk, considering the potential benefit. Furthermore, the Committee accepted that the patient was competent to consent to the treatment, notwithstanding the wishes of the family.
A time to every purpose
A patient was about to undergo a procedure when the physician involved decided to make a series of pointed comments regarding the patient's lifestyle. The patient became very upset to the point where consideration was given to canceling the procedure. The patient alleged that the physician's timing was inappropriate. In response the physician stated that he felt it appropriate to address such issues with the patient, regardless of the circumstances. In reviewing the matter, the Committee noted the value to such discussion, but felt this was better left to the patient's own physician. Furthermore, the timing of the interaction evidently added considerable stress to the patient's situation.
There was a complaint that a physician had failed to retain records regarding the complainant's children. As a result, the children's immunization status was uncertain. After the complaint was lodged, the physician did locate the records, which had been transferred to another physician. As a result, the complaint was withdrawn, but it was felt useful to remind physicians of their obligation to retain records of children until the age of twenty-one. Although parents should be encouraged to retain their own copies of records, if these are lost, the only record of immunizations may be with the physician. These may be requested many years later. For that reason, every effort should be made to retain such information according to the guidelines.
Consent & the elderly
There was a complaint from a family regarding the care provided to a deceased elderly patient. They had appropriately requested the patient's records and, after a detailed review, raised many issues regarding the care provided by the patient's family physician over a lengthy period of time. The allegations included failure to appreciate certain clinical conditions, failure to access consultants, and a general disregard for the wishes of the family. In reviewing the matter, the Committee found that, in contrast, the physician's care had been beyond criticism. All difficulties were appropriately followed up. There was extensive use of consultants. Furthermore, it was clear that the patient was competent to make her own decisions, notwithstanding the wishes of the family. In short, the Committee could find no fault with the care provided.
The Committee dealt with a number of matters. One physician had been under investigation for inappropriate narcotic prescribing. The Committee had ordered an inspection of his practice, which was otherwise found to be satisfactory. The physician subsequently agreed to relinquish his narcotic privileges.
The Committee met with another physician concerning a complaint of excessive narcotic prescribing. After some discussion, it was agreed that further investigation was necessary and arrangements were made to obtain additional information on the physician's prescribing habits.
The Committee also rejected an appeal from a complainant unsatisfied with the Council's resolution of a matter.
Council reviewed certain licensing policies. One issue concerned the licensing of physicians with American qualifications. Council determined to broaden the requirements for full licensure for physicians with American licensing exams and specialty recognition. Regional Health Authorities and physicians potentially affected have been advised.
Council also gave tentative approval to accelerating the process for specialty recognition for those physicians practising on a restricted basis. Under the current policy, physicians who have practised here for three years, and who have the support of their medical colleagues, can have their practice directly assessed by a suitably qualified specialist. On that basis, the physician's status can be changed. Council is considering whether this could be accelerated to allow such assessment after one year of practice in this province.
YOUR OPINIONS PLEASE
Two issues regarding consultations were brought to Council by members. Any comments physicians would make on these would be very much appreciated.
One issue concerns the requirement of some specialists for multiple consultations during the initial assessment of a patient. In other words, in addition to the initial consultation, a further would be required to assess investigations recommended or ordered by the consultant. Council is concerned that this may result in unnecessary delay in the investigation and treatment of patients.
Another matter, which has arisen before, concerns the ability of patients to access consultants from another region. In other words, is it acceptable for a physician to deny care to a patient on the basis of the patient's location? Is it acceptable to give priority to patients from the physician's own region? This clearly involves many issues and there is no easy answer. Nevertheless, any comments from members would be of assistance to Council.
A recent coroner's inquest concerned the death of a child after an attack by dogs. After hearing opinions from a number of experts on the issue, the jury made several recommendations. Some may have relevance to physicians. For example, one recommendation wants to "actively discourage dog ownership in families with preschool children who do not already own a dog". Physicians who wish more information on the matter may obtain such from the College office.
As physicians are aware, there are several situations where there is an obligation to breech confidentiality. These involve matters such as child abuse, communicable diseases, and unfit drivers. These are defined by statutes, both federal and provincial. Over the last several years, some of these statutes have been amended. There are no major changes, but the revised information is available on the College website or by contacting the College office.
This is the time of year for elections to the College Council. There were potential vacancies in five regions. Several Council members have been re-elected by acclamation. They are Dr. John McCrea from Moncton, Dr. Douglas Brien from Saint John, Dr. Rudolph Stocek from Hartland, and Dr. Paula Keating from Miramichi. In addition, an election will take place in Region 5 (Restigouche) over the next several weeks.