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. Christine Davies, Saint John
Registrar - Dr. Ed Schollenberg
At its meeting on 6 April 2001, Council considered the following matters:
A patient underwent a minor procedure under sedation. She later complained that she had expected it to have been done under general anaesthesia. The physician asserted that this had been explained to the patient and appropriate consent had been obtained. On reviewing the matter, there appeared to be no evidence that the patient had been misled. The issue came down to one of communication. No fault was found with the care provided.
An elderly patient was diagnosed with tuberculosis based on positive skin test and a "density" on chest x-ray. There was a history of past exposure to tuberculosis and the x-ray findings were not typical. The patient was placed on antituberculosis therapy. Such resulted in extreme liver toxicity. Investigations continued to be negative and the chest x-ray remained non-specific, as did CT of the lungs. Nevertheless, treatment was continued. On reviewing the matter, the Committee had some concerns regarding the initial diagnosis and decision to treat, but felt that the decision to continue treatment, despite negative investigations and significant toxicity, was highly questionable. From the facts at hand, the Committee felt this represented an error in judgement on the part of the physicians involved. Never-theless, the Committee did not feel that it was of such a nature as to warrant further action. Physicians should note that new cases of tuberculosis continue to arise at a rate of approximately ten per year in New Brunswick. In such situations, physicians are encouraged to access the best possible expertise when managing such.
A family complained that an elderly patient's diagnosis was delayed. They allege that the patient's main complaint of fatigue had been ignored by the family physician. In response the physician states that it was the patient herself who wished minimal investigations. When such were eventually done, they revealed a terminal diagnosis for which appropriate support was provided. The Committee could find no fault with the care provided.
A patient had a skin lesion removed some years ago. The patient was never advised of the diagnosis, which turned out to be an unusual tumor, not malignant, but known to recur. The complaint was that the surgeon had failed to advise the patient of the diagnosis. In response the surgeon stated that repeated attempts to contact the patient over a number of years were unsuccessful. In reviewing the matter, the Committee noted that at the time in question, the efforts of the surgeon would have met the expected standard. However, recent court cases have now placed a greater onus on physicians to contact patients regarding results. Thus, when a physician sends a specimen to pathology, the physician is expected to make every effort to retrieve the results, contact the patient directly, and contact the referring physician. Thus, under these circumstances, where the patient has not returned for follow-up visits, physicians should consider both writing directly to the patient, as well as the referring physician.
A patient complained that the report of an independent medical examination was inaccurate. The physician was retained to review the patient's file following an accident and assess any ongoing disability. The patient complained that there were many inaccuracies in the report and that the physician had made reference to other extraneous factors. In response the physician noted that a large volume of documentation was reviewed and an extensive interview and examination was also undertaken. In reviewing the matter, it was the Committee's opinion that the physician had provided appropriate comment on all factors which may be relating to the patient's difficulties. Furthermore, any discrepancies in the report were of a minor nature and not relevant. The Committee felt that appropriate care had been provided.
A patient returned for a second visit to the Emergency Department complaining of abdominal pain. The patient was examined, but no investigation was done. In certain comments, the physician implied that the patient should not have attended. The patient was seen a day later and diagnosed with a ruptured appendix and abscess. In reviewing the matter, the Committee was uncertain whether the diagnosis could have been made on physical examination at the time in question. Some investigations may have been helpful and indicated, given that the patient was presenting for the second time. The Committee did feel that the physician's gratuitous remarks, which he did not deny making, contributed to the patient's impression that the assessment was inadequate. Beyond making that observation, the Committee did not feel that further investigation was necessary.
A patient was admitted with jaundice. An ultrasound examination suggested a strong possibility of a malignancy of the liver. Such was communicated to the patient and the family. This caused a great deal of distress. Subsequent investigation showed that it was not a malignancy. The patient was appropriately treated and recovered. The complaint was that unnecessary stress had been placed on the family based on the preliminary information. In response the physician stated that he had communicated what was the best information available at the time. On reviewing the matter, the Committee felt that the physician had acted quite appropriately. It was an ethical obligation to communicate such information as was available to the patient and family if requested. The fact that subsequent information may change this outlook does not alter this, except insofar as to encourage the physician to provide the appropriate context for any information which is communicated.
A patient complained regarding the treatment for a back injury several years ago. The allegations were that the treatment was inadequate, resulting in long-term problems. In response the physician noted that the patient was only seen very briefly and, in his opinion, he had acted appropriately. In reviewing the matter, the Committee could not determine why a complaint would arise at this point, over ten years after the physician's treatment had concluded. In any case, the Committee felt the physician had treated the matter appropriately and could find no fault with the care provided.
In addition, the Committee referred two complaints against a physician to the Review Committee.
By now, physicians should have received copies of the 2001 Medical Directory.
A searchable database of licensed physicians, updated weekly, is also available on the College web site at www.cpsnb.org.
Finally, the College is in the process of developing a searchable database for use with a personal digital assistant (Palm). Physicians who would like to assist this process by "beta testing" a version should contact the College's computer consultant, Mark Goldsmith, at firstname.lastname@example.org.