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 2011-2012
President - Dr. Jean-Marie Auffrey, Shediac
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. Lachelle V. Noftall, Fredericton
Ms. Patricia I. O'Dell, Riverview
Dr. Teréz Rétfalvi (PhD), Moncton
Dr. Susan E. Skanes, Dieppe
Dr. Lisa Sutherland, Rothesay
Dr. Mark Whalen, Campbellton
At its meeting on 28 September, 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.
Two separate complaints concerned patients unsatisfied with the results of cosmetic procedures. There was no evidence of any improper care in the procedures themselves. However, in one case, the patient had unrealistic expectations of the results of surgery, which resulted in the complaint. In the other case, there had been some antipathy between the patient and the surgeon from the outset. Ideally, in such situations, either the patient or the surgeon will determine it best not to proceed in the first place.
There were three separate complaints regarding methadone prescribing. Absent any formalized guidelines, the Committee did not feel it could be critical of the care provided. However, a general guideline is being adopted by the College.
A patient complained that a physician refused to make a diagnosis of Lyme disease, which she was convinced she had. The physician asserted that the patient had another explanation for her symptoms and, in any case, she failed to meet the diagnostic criteria. Physicians are aware of the controversy regarding this condition. Many patients will present expecting the diagnosis to be made and will be frustrated when such is not possible. Unfortunately, a small number of physicians have chosen to practise outside of recommended guidelines and begun treatment on the basis of symptoms alone. There is strong evidence that such an approach is both fruitless and potentially dangerous.
A patient was being followed by a family physician for a chronic condition. In an attempt to provide some comfort to the situation, the physician provided information regarding another patient who had been treated. Inadvertently or not, the physician did disclose the other patient’s name. At a subsequent visit, the patient, now increasingly frustrated with her problem, became involved in an argument with the physician. He subsequently discharged her from his practice without notice. The Committee was concerned about both the unnecessary breech of confidentiality and the inappropriate discharge of the patient from the practice without adequate warning. On that basis, the Committee felt it appropriate to issue a Censure to express its disapproval.
A patient underwent a routine surgical procedure and had a preoperative chest x-ray in advance. The patient later discovered that the x-ray had actually shown a tumour. She complained that the surgeon had failed to provide her this information when he received it. The surgeon acknowledged that the report had been received, but, for reasons unexplained, had been filed by his staff without his review. He accepted responsibility for the error. He advised of initiatives he would undertake to avoid difficulties arising in the future. The Committee felt, all considered, that the physician had responded appropriately to the complaint matter.
The Committee dealt with a number of separate allegations of missed diagnoses. Three were acute situations. These involved two cases of missed appendicitis and one case of a missed dissecting aneurysm. In reviewing these matters, the Committee is limited to the available information on the record and does not have the benefit of the appearance and other factors apparent to the physician assessing the patient. In such cases, accurate diagnosis can be confounded by a variety of factors, including an intervening unrelated diagnosis, unusual symptoms, and sometimes the very nature of the disease itself. Sometimes there are factors, such as repeated visits for the same issue, which may suggest to many physicians that a more complete reassessment of the patient is necessary. Similarly, physicians can sometimes be misdirected by an earlier assessment by a colleague. The best advice, as always, is to keep an open mind and avoid jumping to conclusions and other evidence of “tunnel vision” when pursuing a diagnostic answer.
Sexual Boundary Violations
In order to provide more concise and up to date advice, Council has repealed the guidelines on Sexuality in the Physician-Patient Relationship, Patient Privacy, and Breast Examination and replaced them with a guideline on Sexuality Boundary Violations, as developed by the College of Physicians and Surgeons of Alberta. A copy is enclosed with this Bulletin.
Preventing Follow-up Care Failures
Recent complaints have suggested the need for a specific guideline to encourage physicians to develop systems to follow up on consultation requests and test results. A draft of the guideline is enclosed for review and comment.
As a result of acknowledgement of some recent complaints, the College has adopted guidelines on methadone therapy based on those from the College of Physicians and Surgeons of Nova Scotia. These guidelines will eventually be posted on the College website.
Council has approved an increase of $40 in the annual fees to $500, or $480 for those who pay by direct deposit. In addition, Council has determined to increase the initial registration fee by $50 to $150.
As a result of amendments to the Medical Act in 2009, and Regulation No. 2 in 2010, several physicians had the terminology of their licence altered. As a result of a recent Court ruling, Council has determined to revert all such physicians to their original licence status. Those affected have been advised directly.
Interviewing Prospective Patients
Council has previously commented on the practice of some physicians interviewing prospective patients before determining whether or not they will be accepted into the practice. Such is not specifically prohibited, but there are areas for concern. Firstly, physicians should be prepared to respond to any inquiry regarding the criteria which they are applying to any decision regarding accepting a patient as a result of an interview. Furthermore, physicians who have determined not to accept a patient should make clear the reasons for such at the end of the interview. It should also be remembered that any interview process which results in a patient being denied access for any reason which would be considered discrimination, such as age, socioeconomic status or medical condition, could result in a formal complaint.