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Officers and Councillors 2021-2022

At its meetings on April 1^st, 2022 and June 24^th, 2022, Council considered the following matters. 

A patient underwent a procedure on his knee, which he subsequently felt was unsatisfactory.  He found it difficult to see the surgeon in follow-up, who eventually insisted that an appointment three months later would require a new referral from the family physician.  The Committee noted that surgeons are always responsible for any follow-up of a procedure they had performed.  It was, consequently, improper to require a further referral. The physician was Counselled.

A woman attended a physician for pregnancy.  At some point during the assessment, the physician asked the patient whether termination was something she had considered.  The patient loudly objected and suggested the physician should not have raised the issue at all.  The Committee disagreed.  The Committee noted that this is a difficult discussion for both patient and physician, but considering time constraints, it was appropriate for the physician to raise the issue at that time. 

A patient had recently been taken over by another physician.  She had numerous physical and mental issues requiring a range of medications.  She frequently did not take medication prescribed and insisted on access to the physician at times which were not appropriate.  The physician had actually interrupted his office to speak with her on one occasion.  The patient alleged inadequate care, but the Committee could find no evidence of such. 

A patient seeing a specialist had an appointment for follow-up.  When he was reminded of a missed appointment by the physician’s staff, he objected strongly.  Later, when he did come in, he, again, got into a dispute with the staff and then subsequently with the physician.  This became a tirade of obscenities.  The physician did not respond in any way.  The physician did not feel he could further look after the patient.  The patient objected to being discharged improperly.  The Committee felt that, when a physician does not feel objective care is possible, it is appropriate to discontinue caring for that patient. 

A patient had difficulty connecting with her physician for a virtual call.  The calls were missed for a number of reasons.  When she attempted to make another such appointment, she was advised there would be a charge for the previously missed calls.  She did not feel this was appropriate, as she had been available during the range of times that a call was expected.  In addition, she was advised that she would not be seen until she had paid the outstanding invoice.  She felt this was inappropriate.  In response, the physician asserted this was the office policy, which the patient had known.  In reviewing the matter, the Committee first noted that connecting on virtual calls has proven difficult. It is suggested that physicians be as accurate as possible as to when a patient might expect a call.  In addition, the Committee noted that it was improper to decline to provide care as a result of an outstanding invoice.  The physician agreed to modify his approach. 

A patient had contacted the College regarding a number of issues including completion of forms.  The Registrar then contacted the physician informally to suggest that the patient’s request be met.  Instead, the physician discharged the patient without further warning.  In the Committee’s view, it was improper to discharge him for simply contacting the College.  It was also improper to discharge a patient without previous warning.  The Committee felt a Censure was appropriate.

A patient with a significant heart condition was being followed by his family physician and an internist.  Over the course of several months, there appeared to be some confusion regarding follow-up of investigations or communication with the family.  There was no evidence of inappropriate clinical decisions, however.  The patient, while waiting for another referral, died suddenly.  In the Committee’s view, the physicians should have had better systems to follow-up missed reports, had a clearer picture of who was responsible for which part of the patient’s care, and should have had a regular process of communicating between them regarding the patient’s progress.  The Committee felt a Counsel was appropriate.

A physician was accused of improperly prescribing narcotics, as evidenced by late hour prescriptions for significant amounts, often to a range of individuals, and not always her patients.  The pharmacist raised the issue with the physician who did not accept the comments very well.  In reviewing the matter, the Committee felt it was appropriate for the pharmacist to raise questions regarding the appropriateness of the prescribing decisions. The Committee also wished to reinforce with the physician the importance of working with other professionals in a cooperative manner for the patient’s best interest.  A Counsel was considered appropriate.

In two unrelated complaints, different ophthalmologists were accused of recommending surgery for cataracts which were not evident on subsequent examinations by others.  There appeared to be no reasonable explanation for the original “findings”.  The Committee had at least some suspicions that the original examination was improperly performed or improperly reported.  In the end, the Committee felt it appropriate to Censure both physicians.

An employer questioned the validity of a vaccine exemption note from a physician.  The patient then presented a sick note from the physician seeking several weeks off work.  The employer questioned the validity of this in light of the earlier event.  The Committee could not be certain on that point, but did understand how the timing of the situation could raise significant questions regarding the physician’s approach. 

A patient presented to the Emergency Department with burning pain in her skin.  There was no rash, but the patient asked the physician if shingles was possible.  The physician asserted that it was not.  Nevertheless, over the next few days, the patient did, in fact, develop shingles.  The Committee appreciated that, earlier on, the diagnosis may not be certain, but such could have been better expressed to the patient with advice as to next steps. 

A patient who had been suspected of epilepsy was involved in a traffic accident resulting in significant injuries.  The patient did have investigations pending regarding the cause of the episodes, but those had not yet been completed.  It was alleged that the physician should have considered the patient’s driving privileges.  The physician declined to respond to the complaint.  In reviewing the matter, the Committee noted  that there are fairly specific guidelines as to what should be reported in the case of possible seizures.  Reporting is mandatory in New Brunswick.  The patient likely should not have been allowed to drive until the diagnosis was more certain.  In any case, the failure of the physician to respond to the complaint warranted a Censure.

A patient needed a sick note for work.  Her family physician was unavailable and no walk-in clinic was open.  She attended the Emergency Department for twelve hours to be then interviewed by the physician in the hallway.  She stated that the “sick note” was necessary for her to maintain enough income to survive for the next while.  The physician objected to her using the Emergency Department for that purpose.  The physician did acknowledge that she was not familiar with the resources available for such individuals and, on further investigation, believes she could still have provided some assistance.  In reviewing the matter, the Committee noted that, in many communities, patients who need even minimal care, have no option except the Emergency Department.  Family physicians may not be easily available, and walk-in clinics, during the pandemic, by and large, had significantly reduced many services.  Until this situation improves, patients may have little option. 

A patient had a broken shoulder, which was dealt with by an orthopedic surgeon.  The patient was to be followed up later in the fracture clinic.  By that time, the patient had become increasingly unwell according to the family and such was mentioned to the physician.  He advised that the fracture clinic was not the appropriate place to have this dealt with and, if they needed assistance, they should go to Emergency.  The patient died that evening, likely of a pulmonary embolus.  In reviewing the matter, the Committee noted that circumstances of this assessment were likely not ideal for any further investigation of the patient.  Nor could the Committee be certain if the patient was in significant enough distress to suggest a systemic issue.  If the latter was the case, the Committee believes the surgeon could have been more forceful in recommending further assessment.  The fact that this patient was seen in a fracture clinic should not automatically mean the patient symptoms are simply ignored.

Council Elections

Elections for members of Council, from several areas, were recently completed.  Newly elected are Dr. Arif Bungash, Saint John, Dr. Janik Côté-Bérubé, Edmundston, and Dr. Grant Oyeye, Campbellton, all by acclamation.  Also by acclamation, Dr. Hanif Chatur was re-elected from Region 3.

Virtual Care

The practice of virtual care continues to evolve.  While many of the principles were outlined in the College’s recent guideline, there still remains occasional issues with arranging appointments, and the correct balance of virtual vs in-person visits.  Some physicians are not agreeing to in-person visits when the patient expresses a wish for such.  Unless there is an overwhelming reason to avoid such, the patient is entitled to make the choice.

One issue which is often raised concerns the types of issues which can be properly managed virtually.  There are a number of statements on this.  The best one appears to come from the Canadian Medical Association and their Virtual Care Playbook.  Excerpts from that document are provided in this newsletter.  It is hoped this is of some value.

https://www.cma.ca/sites/default/files/pdf/Virtual-Care-Playbook_mar2020_E.pdf