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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 will be aware of these matters.

Officers and Councillors 2020-2021

At it's meeting on February 26^th, and April 16^th, 2020, Council considered the following:

Complaints

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.

There was a complaint that a physician had been improperly treating her former husband.  The allegation came from another family member.  In response, the physician asserted that she had played no role at all in her husband’s care.  The Committee could find no evidence that she had and dismissed the complaint.

A consultant had seen a patient on a few occasions without reaching a satisfactory diagnosis.  The physician did not feel he could offer the patient anything further but did offer to see her again if a new referral came from the family physician.  The patient objected to that requirement.  In reviewing the matter, the Committee did note that the consultant was free to advise the patient’s physician that he doubted a further assessment would be of value.  At the same time, the Committee is also aware that it had become a pattern among some specialists to insist on repeat referrals in order to follow a chronic patient.  Such is not strictly prohibited. In any case, the Committee could find no fault with the care provided.

A patient was admitted involuntarily and stated that his treating psychiatrist had been spreading rumors about him in the hospital and in the community.  In response, the physician noted that the patient had a number of issues, but the specific incident in question simply had never happened.  With the hospital records revealing nothing unusual, the Committee felt no further action need be taken.

A patient was pressing her family physician for medication relating to ADHD.  The physician insisted on appropriate testing, but the patient delayed such repeatedly.  Finally, she was seen by a psychologist who recommended that the patient had the diagnosis and needed treatment.  The physician remained skeptical, as the intensity of the assessment seemed lacking.  To complicate things, there were also issues regarding the physician and members of the patient’s family.  In the end, the Committee could find no fault with the care provided. 

A patient had seen a physician once.  She had presented a significant range of chronic issues.  The physician hesitated to address all of them at once, but arranged some investigations, as well as referrals.  The patient alleged that the physician’s response was inadequate.  In considering the entire circumstances, the Committee could find no fault with the care provided.  There was some reason to question some of the diagnoses and, absent any urgency, a measured approached seemed best.

A physician performed a procedure on a patient.  The patient complained that there was excessive pain.  In response, the physician noted that a large amount of local anesthetic was used, and also, that the patient expressed no discomfort at the time of the procedure or in later follow-up.  In the end, the Committee could find no fault with the care provided. 

A patient had many past issues.  She was attempting to access her family physician to arrange investigations and referrals.  However, reaching her family physician was very difficult.  (The patient eventually found another physician and received the services she required).  In response, the first physician acknowledged that there had been considerable difficulty in accessing her office due to the volume created by calls relating to the pandemic.  She, in the past, provided requested referrals and believed she met the patient’s needs.  In reviewing the matter, the Committee noted that the fact of the pandemic and the various systems physicians have in place for dealing with phone access can create difficulties for some patients.  Physicians are urged to consider how best to facilitate access for their patients. 

An adolescent child of a physician was admitted at the hospital with behavior issues.  The hospital staff alleged that the father improperly interfered with the care they provided, thus creating a risk for the patient.  In response, the physician denied any such activity.  The Committee did not feel it could access sufficient evidence to verify the facts. Other than reminding the physician of the inappropriateness of certain behavior, the Committee did not feel further action was necessary. 

A patient suffered significant pain and neurological deficit following a pain injection.  This persisted for a great deal of time, but no specific diagnosis was reached.  In response, the physician denied that anything unusual had occurred and did not believe that he had caused the injury alleged.  The Committee was, consequently, unclear as to exactly what had happened.  Nevertheless, it did seem clear that the patient did suffer an adverse event at the time of the procedure.  Without knowing precisely what was going on, the Committee could not be critical of the physician’s technique or any clinical matters.  On the other hand, there was questionable informed consent, and the physician did not provide very intense follow-up once the patient began complaining.  The Committee felt this warranted a Counsel.

There were two unrelated complaints regarding deliveries of babies that did not do well.  The specifics of each were complicated.  In one case, a vaginal delivery became unexpectedly difficult.  In the other, a Cesarean section was delayed for staffing reasons.  In reviewing the matters, the Committee could not find that either physician was at fault and, consequently, determined no further action was necessary. 

A patient underwent surgery on her knee.  Because of past difficulties, she initially declined spinal or epidural anesthesia.  Nevertheless, the physician attempted such three times, but eventually proceeded to general anesthesia.  The patient complains regarding the general approach of the physician in this situation.  In response, the physician acknowledged that he had not handled this properly.  He apologized, unequivocally, for his approach.  He noted, at the time in question, there was pressure, due to the pandemic, to avoid general anesthesia if possible.

A patient was involved in a longstanding liability claim regarding a car accident.  She had submitted to a number of assessments regarding her ability to work and was, again, sent for another independent medical examination, as requested by the defence lawyer.  She had a wide-range of complaints regarding the assessment, including that she was forced to do things she could not do, was otherwise uncomfortable, and generally did not agree with the conclusions.  In response, the physician stated that he had followed all prevailing protocols.  He noted that the patient had, in fact, returned to work for a long period since the original claim.  On reviewing the matter, the Committee found that the assessment was thorough and complete and could find no fault with the care provided.

A patient underwent breast reduction surgery.  Her husband complained regarding the result.  The surgeon stated that he had provided an appropriate explanation, in advance, as to what the expectations might be.  On reviewing the details of the surgery, the Committee could find no fault with the surgeon’s approach.  It was noted that, ideally, patients will have realistic expectations regarding results.  In this case, it appeared the surgeon had made a reasonable effort to make sure of that.

A patient attended a family physician for insertion of an IUD.  She alleged that the physician’s approach was abrupt, hurried, and dismissive.  The physician countered that she approached the patient professionally and, at the time, there was no evidence of dissatisfaction or discomfort. On reviewing the matter, it was noted that this was the first encounter between this patient and this physician.  As a consequence, her reaction could be somewhat different from what it would be if she was more familiar with the physician.  The Committee believed the physician should be cognizant of that and, perhaps, make a greater effort with such a patient.  The Committee felt a Caution was appropriate.

An employee attended an occupational physician regarding a prolonged absence from work.  She had been pursuing her own treatment for some time, but the physician was concerned that there had been little progress.  He suggested the possibility of attending a more formal program.  The patient claimed that she attempted to do so, but was denied access.  She felt that the physician should not have insisted on that approach if it was not possible.  An ongoing discussion between the occupational physician, as well as the patient’s other therapists, eventually suggested that her return to work was unlikely.  The Committee could find no fault with the approach taken.

Guidelines

The Council is continuing to review the guidelines of the College.  Small changes have been made to the guidelines on Consultations/Referrals, as well as the guideline on Charging for Uninsured Services.  These are available, and changes highlighted, on the College website.

Medical Directory

For over a hundred years, the College has produced an annual printed directory of members.  The value of this has come into question, especially as updated information is available on the College’s website.  Nevertheless, some members do continue to feel that a paper directory has some value.  Before deciding to discontinue this publication, the College would appreciate hearing from members, by whatever means, regarding their wishes on this.