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 2012-2013
President - Dr. Mark Whalen, Campbellton
Registrar - Dr. Ed Schollenberg
Mr. Paul Leger, Rothesay
Mr. Edward L.D. McLean, Saint John
Dr. Mamoun Meddoun, Edmundston
Ms. Patricia l. O'Dell, Riverview
Dr. Stéphane Paulin, Fredericton
Dr. Susan E. Skanes, Dieppe
Dr. Lisa Sutherland, Rothesay
Dr. Julie Whalen, Moncton
At its meeting of 27 September, 2013, Council considered the following matters.
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.
At a previous meeting, the Committee considered the following matter:
A consultant examined a patient in the Emergency Room. The patient alleged that, during the examination, the physician pressed himself against her body in a manner which made her feel uncomfortable. The Committee could not be certain what had transpired, but Cautioned the physician to be more careful regarding his approach during the assessment of patients.
The physician requested that the Committee reconsider the matter. He argued that the Caution should be reserved for situations where there was no doubt that the behaviour had occurred. On further review, the Committee agreed and altered the comment to a Counsel.
A patient complained about excessive pain during an endoscopy procedure done under sedation. These procedures are commonly a source of a complaint, particularly as patients vary a great deal in their ability to tolerate such. There was no shortcoming in the care provided by the physician, but the expectation that some patients will have more difficulty than others should be considered.
A patient had seen a new physician on two occasions. Due to a conflict, the patient missed an appointment. The physician determined not to see the patient again. In reviewing the matter, the Committee noted that the physician had not followed the guidelines on appropriate warnings which should be given to patients who are at risk of being discharged from a practice. On that basis, a Counsel was issued.
A complainant alleged that her elderly parents were receiving deficient care from a physician. On reviewing the specifics of the allegations, the Committee could find no fault with the care. However, there clearly were communication issues, resulting from a number of factors. The best physicians can do in such circumstances is to make every effort possible to ensure that patients reasonably understand all aspects of their care. The fact that no questions were asked may not necessarily be reassuring in this context.
A patient injured his ankle playing hockey. At the Emergency Room he was treated and discharged without an x-ray. Months later he developed a significant complication which he blamed on an inadequate early assessment. The physician asserted that appropriate guidelines regarding investigations of ankle injuries were followed. Even an x-ray done several months later was negative. Based on the information available, it appeared that the complication arose, not from any lack of treatment, but rather from the unusual nature of the injury. The Committee could find no fault with the care provided.
A surgeon was about to commence a procedure when he became aware that a dispute had developed between a member of the patient’s family and his staff. On becoming aware of such, he became quite upset and declined to proceed further at that time. In response, the physician stated that the nature of the matter created so much personal distress he did not feel he could proceed. In reviewing the matter, the Committee had concerns that the patient was denied care in such a context. However, the College has always advised physicians who feel they cannot provide appropriate care to a patient, due to a personal distraction, that they should not proceed until they feel they can safely do so. In this case, other than the delay, the patient suffered no significant harm. The Committee did not feel it could take further action on the matter.
A patient saw a physician for the first time. She complained regarding comments the physician made relating to her gender and place of origin. The physician offered an alternative explanation including that the issues raised were clinically important. The Committee notes that communication difficulties, particularly including misinterpretation of such comments, are more likely when the physician and patient are new to each other. Physicians must be conscious of this and make every effort to clarify any comments which run the risk of being taken the wrong way. The Committee felt a Counsel was appropriate.
A patient was permanently disabled from an injury. By all accounts, he could not return to work. Nevertheless, there were concerns regarding his pain management and he was referred to a consultant regarding such. While the consultant was attempting to assess methods of improving the patient’s quality of life by adjusting his medication, the patient was convinced the entire process was aimed at discontinuing his disability coverage. Arguments ensued and words were exchanged. In reviewing the matter, it was clear that the relationship between the patient and the consultant was, through a misunderstanding, “poisoned” from the outset. The Committee could find no fault with the care provided.
Council has approved an increase in annual fees for licensure. Physicians who pay by cheque will pay $540 in 2014, those who pay by direct deposit will now pay $520. Please note that, for 2014, a single invoice will be issued for the physician and their professional corporation. When there is more than one physician involved with the corporation, only one physician will be invoiced for the latter.
Screening of Potential Patients
From time to time, Council receives information that some physicians are continuing to deny access to patients based on their age, clinical condition, or complexity. Denying access on such basis is considered improper. For that reason, Council is considering developing a guideline on this matter. Any comments from members, by any means, are welcome.
The Executive Committee of the College of Physicians and Surgeons for 2013-2014 is as follows.
Dr. Lachelle Noftall, President
Dr. Lisa Jean Sutherland, Vice-President
Mr. Paul Leger, Public Member
Dr. Eric Basque, Member at Large
Dr. Robert Fisher, Member at large