Bulletins

April 2000

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 1999-2000

President - Dr. Beatriz Sainz, Oromocto
Vice-President - Dr. Christine Davies, Saint John

Dr. Pamela Walsh, Riverview
Dr. Bill Martin, Miramichi
Dr. Ludger Blier, Edmundston
Dr. Marc Panneton, Campbellton
Dr. Marc Bourcier, Moncton
Dr. Gordon Mockler, Westfield
Dr. Zeljko Bolesnikov, Fredericton
Registrar - Dr. Ed Schollenberg


Dr. Nataraj Chettiar, Beresford
Dr. Rudolph Stocek, Hartland
Dr. Douglas Brien, Saint John
Mr. Eugene LeBlanc, Dalhousie
Mr. Fernand Rioux, Caraquet
Dr. Claudia Whalen (PhD), Fredericton
Ms Janet McIntosh, Moncton




At its meetings on 7 April 2000, Council considered the following matters:

Complaints:
An elderly patient was to undergo an operative procedure. Just before beginning, a dispute arose between the physician and the hospital staff, thus creating a great deal of anxiety on the part of the patient. The Committee felt that such a discussion should be avoided in any case, and even more so in the presence of the patient. Such can only lead to the concern that the physician may be somewhat distracted from the task at hand. In the same complaint, there were also concerns regarding the physician bringing his child along when assessing the patient the next day. While the Committee accepts that there are situations where it can be difficult to avoid parental obligations, the Committee noted safety concerns for both the child and the patient, as well as, as alleged here, the impression that the physician's full attention was not being paid to the patient.

At the conclusion of a surgical procedure, a patient suffered a cautery burn. In reviewing the matter, the Committee accepted that such incidents could occur. There was no evidence of undue carelessness.

There was a complaint that a physician had inappropriately prescribed a sedative for a small child. The Committee felt that alternative interventions, including support for the single mother in this case, as well as appropriate referrals, would have been a better alternative. A patient underwent a procedure under local anaesthesia. She was both unhappy with the result and claimed she had not consented in any case. On reviewing the matter, the Committee felt there was evidence that the patient had indeed consented to the procedure and had cooperated throughout. In such circumstances, the Committee still feels that every effort should be made to document consent. On the other hand, even such documentation may not be firm evidence that the patient had understood what they were agreeing to.

Two physicians provided coverage at a small clinic. They shared the office and the records, but did not normally see each other's patients. However, when a child's regular physician was unavailable, the staff had her see the other one. On entering the room, he initially objected to seeing the child. He subsequently provided a very minimal assessment. While the Committee accepted that further follow-up should be done by the regular family physician, the Committee felt it was inappropriate for the physician to raise any objection to seeing the child. Based on the appointment made by the office staff, the mother would not have been in any way aware that it was unusual for this physician to see the other's patients. In all such circumstances, the best interest of the patient must come first. The proper course would have been an appropriate assessment, such reassurance as necessary and further follow-up with the regular physician.

There was a complaint that a family physician had failed to reach a timely diagnosis on a 60-year old patient who subsequently died. The patient had seen the physician over the course of several years, but was subsequently found to have an uncommon illness, specifically a variant of scleroderma. Furthermore, her specific manifestations were unusual. On reviewing the matter, the Committee noted that the patient had been seen infrequently. Still, appropriate investigations had been ordered which had not suggested the progressive nature of the problem. The condition was clearly rare. The Committee could find no evidence that the diagnosis was unnecessarily delayed.

A patient complained that a physician had inappropriately asked her to leave his practice. Both parties agreed that there had been a gradually increasing breakdown in communication. The patient felt that the physician failed to appropriately respond to her questions. The physician noted that the patient continually questioned his judgement. The Committee notes that patients' increasing access to information, both valid and otherwise, may contribute to circumstances where the more traditional interaction between physician and patient may no longer occur. Inevitably, this still comes down to individual personalities and compatibilities. Physicians can only be cognisant of these issues and attempt to adjust their practice accordingly. Nevertheless, there may still come a point where the physician/patient relationship cannot continue.

A patient attended a physician for an assessment regarding a disability claim. A dispute arose as to the nature of the assessment and as to the kind of information which was available to the physician. The patient claimed that the physician subsequently provided correspondence which resulted in the termination of his disability claim. On reviewing the matter, the Committee noted that the physician had appropriately recommended the patient be seen by another physician who had completed the assessment. There was no evidence that this had resulted in undue hardship to the patient nor any evidence that the first physician had compromised the patient's claim.

A patient was seen by a physician who had his office staff provide various preliminary assessment procedures. When the patient subsequently attended the physician, a dispute arose evidently based on the patient's confusion regarding office procedures. Furthermore, the patient, having seen another physician who had provided a somewhat controversial diagnosis, complained that this physician had failed to accept that conclusion. On reviewing the matter, the Committee did note that the office practices may create some confusion for patients. To that end, efforts to make it clear as to the nature of these procedures may have helped. The Committee also noted the problems which arise when an earlier physician has provided a diagnosis without an accepted scientific basis. Under the circumstances, this can create difficulties for the second physician. Nevertheless, a clear explanation to the patient of the issues and concerns may be all that can be offered.

A child attended a clinic. She was not seen by her regular physician. The child was upset and the examination went poorly. The mother complained regarding the physician's attitude. The Committee noted that examinations of unwell, and often unhappy children, can be difficult. It is furthermore aggravated when done by an unfamiliar physician. The best that can be done is to anticipate such difficulties and to make an effort to proceed in a patient and reassuring manner.

A child was seen in an emergency department. After examining the child, the physician raised questions regarding the family's Medicare coverage and suggested that no prescription would be provided without a cash payment. In his response, the physician stated that there were questions regarding the patient's coverage which was from out of province and, in any case, the treatment was only marginally indicated. The Committee found the approach taken by this physician to be unacceptable. In no circumstance should it even be suggested that an assessment or treatment is conditional on payment in advance. The Committee reminded the physician of these obligations, but chose to recommend no further action.

Review Committee
Council endorsed the report of the Review Committee which:

Other Business

Council dealt with several other matters, specific information on which is available from the College office:

Elections
Election to Council will take place on May 15th. Elected by acclamation were:
Dr. Marc Bourcier from Moncton for Region 1;
Dr. Ludger Blier,from Edmundston for Region 4. Elections will take place in Regions 2 & 6. Ballots for these have been mailed.

From the Archives
90 years ago
In 1910, Council decided to mandate that five years of undergraduate studies be required for licensure, including 18 months in a clinical setting. Council also determined to reject proposed reciprocity with Québec.


60 years ago
In 1940, Council reviewed several points of difficulty with the Minister of Health, including the failure of government employed physicians to pay annual fees, as well as the employment of certain "alien" physicians in provincial hospitals.


30 years ago
In 1970, Council considered a report on medical manpower, particularly focussing on the shortage of general practitioners in certain areas. Measures considered included an aggressive recruitment program, as well as certain financial incentives

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