Bulletins

May 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 12 April, 2002, Council considered the following matters:

COMPLAINTS
For the second time in as many years, there was a complaint regarding the impact of a negative stress test on a patient with chest pain. In the first case, the patient suffered a sudden death, presumed to be cardiac in origin. In the more recent case, the patient subsequently underwent an angiogram, which showed significant disease. It could be argued that both cases did have additional factors which could raise questions as to whether heart disease had been completely ruled out. In the most recent case, the Committee felt that the physician had followed appropriate published guidelines. Nevertheless, situations may be more complex than such guidelines imply.

There was a complaint from parents that a physician failed to provide reasonably urgent access to an appointment. The earliest offered was one week later. The case illustrates the demands placed on physician time, both to provide ongoing care to all patients, and be reasonably responsive to acute, but not emergent, situations. Under these circumstances, no fault was found with the care provided.

The patient suffered a significant complication following an endoscopic procedure. The complication is a known one which can occur despite the best of care. Hence, the Committee did not feel that the complication itself suggested inadequate care. There was, however, some suggestion that the physician had not appropriately assessed the patient afterward. It is uncertain whether this would have allowed the complication to be recognized sooner.

A patient saw a physician for several years for a variety of complaints. The patient alleged a number of shortcomings in the care provided. He had come to this conclusion after seeing another physician. On reviewing the matter, the Committee felt that the original physician had responded appropriately to each situation as it had arisen. The Committee felt no further action was necessary.
A patient new to the area presented her family to a physician for a "screening" interview. This was to determine whether the family would be accepted into the physician's practice. After the visit, nothing was said, but the next day, the patient was contacted and advised that the physician would not accept the family. The patient felt this was inappropriate denial of care. In response the physician stated that the patient was advised of the "screening" process and clearly warned that the physician would not necessarily accept them as patients. In reviewing the matter, the Committee and Council noted that some years ago, Council had stated its opposition to such an approach to accepting new patients. This approach creates a risk that the physician will be accused of denying access for an improper purpose. For that reason, screening interviews might only be acceptable if the patient was advised what the criteria are going to be. It remains, however, acceptable to agree to see a patient for a single visit without making a specific commitment to ongoing care.

There was a complaint that a physician had inappropriately denied a patient access to narcotic analgesia. The patient had a known chronic condition for which such treatment could be appropriate. Nevertheless, the physician did have reason to believe that the patient was attempting to access narcotics from other sources. For this reason, the Committee agreed that the physician had acted appropriately.

Some weeks after a surgical procedure, a patient requested an analgesic from a family physician, who she had only been seeing for a short time. She requested such only for a short time. The physician's immediate response was to both deny the patient's request and ask the patient to leave the practice. It was the Committee's view that the physician's response in discharging the patient was not appropriate. There was no attempt to discuss alternatives, nor, as it turned out, any real attempt by the physician to review the patient's previous history.

NARCOTIC PRESCRIBING
In the last newsletter, there was a complaint report which included a comment regarding the frequency with which patients receiving narcotic analgesics should be assessed. In those circumstances, a patient evidently overdosed due to misuse. In response to several inquiries from members, Council has determined to clarify this comment. First of all, the most widely published guidelines on this issue, adopted by Council in 1995, include the following section:

The patient should be seen and assessed at least every 9 weeks and more frequently if needed (e.g. if there is a history of previous substance abuse). The clinician should specifically evaluate the patient for several distinct aspects of therapy at each visit, including:

- analgesic efficacy
- adverse pharmacologic events,
- function (physical and psychological), and
- the occurrence of apparent drug abuse related behaviours

It is Council's view that such advice remains appropriate. When circumstances warrant, physicians can consider more frequent assessments or, when such may not be necessary, but there remain concerns, "part-fills" of prescriptions.

PUBLIC COMMENTS BY PHYSICIANS
Over the last year, in the course of various disputes, some physicians may have made comments which, while advancing their own concerns, may have the effect of impugning the reputation of other physicians. It should be noted that the Code of Ethics advises that such is inappropriate whether regarding a specific physician, or a group of physicians. While members are entitled to take positions of advocacy, they must also consider any potential imputations which may be drawn from any public remarks.

OTHER BUSINESS
In other business Council:


¨ Approved an evaluation process to allow certain physicians currently practising on a restricted basis to upgrade the status of their license.

¨ Reviewed feedback from members regarding items noted in the last newsletter. (Members should note that the items were raised for the purpose of generating comment. There has been no change in College policy on the issues discussed.)

¨ Approved the elimination of the $10. annual fee charged to residents on the Medical Education Register.

¨ Approved an approach for temporarily licensing physicians who will be providing assistance at the Canada Winter Games in 2003.

¨ Approved the interim suspension of a physician practising out of province who was allegedly using his New Brunswick license solely to cosign American prescriptions to be filled by an internet pharmacy.

ELECTIONS
The following new members of Council were recently elected:

Dr. Jean-Marie Auffrey, Moncton
Dr. Mary E. Goodfellow, Saint John
Dr. Terrence E. Brennan, Fredericton