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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 its meeting on November 26^th, 2021, Council considered the following matters.

An elderly patient had been causing difficulties in a physician’s office.  Consequently, the physician advised him that he would have to leave the practice.  Nevertheless, she continued to look after him for some months.  He then complained when she eventually determined she could not see him anymore.  It seemed likely that continuing to see the patient caused some confusion about his status with the physician. 

A patient with a range of mental health issues was discharged by a psychiatrist.  The patient had become upset because the psychiatrist had been receiving information from the patient’s wife.  This resulted in the patient becoming very angry and very threatening.  The physician felt he could no longer provide objective care.  Under the circumstances, the Committee felt that the physician had acted appropriately. 

A complainant claimed that her adult daughter, suffering from a significant dental infection, was treated poorly by an Emergency physician.  The physician was dismissive of the patient’s complaints and ridiculed them for attending the Emergency Department.  The physician denied such behaviour and noted that the patient had not been taking the medication previously prescribed by a dentist.  The Committee could find no clear fault with the care provided, but noted an increasing irritability among patients and physicians in recent months.

A patient had determined, several years after an injury, that such was the result of employment and, consequently, wanted to pursue a claim.  There was no contemporary evidence of the injury and the physician did not feel he could support this.  The patient objected that the physician was not providing the information that he should.  On reviewing the matter, the Committee felt that the physician had provided an appropriate response. 

There was a complaint that a physician had improperly accessed the electronic medical record of a child.  An investigation by the hospital had determined that the physician’s access code was used.  The physician denied that he was personally involved as he was not at that computer at the time.  He did acknowledge that he had shared his access code with his staff for several reasons.  The staff denied that they had been involved.  The physician was reminded of patient privacy and the improper sharing of access information.  The Committee felt that this warranted a Caution.

A patient in labor began to progress poorly.  Consequently, the obstetrician on call was consulted.  He felt that she could be observed for a bit longer.  There was some confusion regarding the intent to proceed to a caesarean section.  In addition, the patient complained that she was improperly examined and attended by a resident and a medical student.  She had not consented to such.  The delivery resulted in a large, but healthy baby.  The baby required observation and the mother was not told anything for several hours.  The Committee confirmed that the obstetrician was not directly responsible. The behaviour by the trainees may have occurred prior to his assuming care. There was also some unfortunate confusion around the decision to proceed to an operative delivery.  The Committee noted that, in such circumstances, emotions might be high, communication can be difficult and, consequently, extra effort must be made to be satisfied the patient is as aware as possible of what she needs to know.  There must also be consent to involve trainees.  For all of these reasons, the physician was given a Counsel regarding communication difficulties.

A patient complained regarding a telephone visit with a physician.  The connection had been somewhat delayed and, consequently, the physician limited the call to a few minutes.  She also asserted that only one problem could be dealt with.  The patient had a number of issues and, consequently, felt that the physician was not meeting her needs in a proper fashion.  The Committee noted that the process of arranging timely connections for virtual visits can be difficult.  Consequently, the physician may feel some time pressure.  Nevertheless, it was improper to have an absolute policy of only one problem per visit and she was, consequently, Counselled.

A patient with significant chronic issues had moved into the area and was referred by her family physician to the appropriate specialist.  The patient complained that the assessment by the latter had been difficult and inadequate.  She felt that there was poor history taking, minimal examination, and little guidance offered.  The patient subsequently complained to the hospital.  At that point, the specialist had contacted the family physician to discuss the patient.  As a result, the family physician discharged the patient from her practice.  The Committee felt that this consultant may have improperly discussed the patient after she was no longer in his care and, consequently, felt a Counsel was appropriate.  It was also alleged that she had been discussed with other consultants, and as a consequence, was unable to access them and left the province.

With minimal warning, a consultant had decided to take a vacation, notwithstanding that there were many patients booked during the subsequent weeks.  Some were contacted directly by telephone.  Other patients were mailed a letter.  In this case the patient, who was supposedly mailed a letter, arrived to find the office closed.  For a range of reasons, she had not checked her community mail box frequently.  As a consequence, she did not receive the letter until after the attempted visit.  The Committee felt that the physician had generally acted appropriately, but wondered if difficulties with surface mail, for example, might have been anticipated.  The Committee did not feel that attempting a telephone call would be any more a burden on the staff than addressing and mailing a letter. 

Two adult patients attended a specialist to request an exemption from the Covid vaccination.  It was alleged the physician became immediately confrontational and unnecessarily rude to them for making this request.  The Committee noted that the issue can become highly charged and, despite the physician’s initial attitude, such assessment and discussion should take place in as professional a manner as possible.  This has been shown to significantly increase the possibility that advice the physician chooses to provide would be more readily accepted.

A patient, who had just finished Suboxone therapy, was prescribed a narcotic by his family physician.  The pharmacist objected and contacted the physician who berated her for raising the issue as, in his view, it was only he that could make such a judgement.  The Committee felt that the physician’s response was inappropriate.  Physicians are expected to act cooperatively with all professionals.  The Committee also noted that pharmacists have a professional obligation to assess the value of a prescription, as well as complete discretion as to whether the medication will be dispensed. The Committee felt a Counsel was appropriate.

A patient suffered a significant long splinter through the palm of her hand.  Emergency physicians were reluctant to attempt removal and, consequently, contacted the surgeon who advised that he would not come in, but would see the patient in his clinic in six days.  Subsequently, another Emergency Room physician removed the splinter.  The Committee felt that the surgeon’s response was not appropriate.  The patient was in a great deal of pain which would continue unnecessarily for several days.  Furthermore, there was always the risk of infection.  The Committee felt a Counsel was appropriate. 

A patient with chronic pain attended a walk-in-clinic in an attempt to get his pain medications altered.  The physician refused, asserting that he was not familiar with the patient’s treatment plan.  The Committee felt this this response was appropriate. 

A mother attended a physician’s office to obtain a routine immunization for her child.  Prior to doing so, the physician inquired regarding the mother’s Covid vaccine status and, when told she was refusing such, a heated discussion occurred.  The mother alleged that, when the physician injected the child with the vaccine, she was frustrated and rushed, causing unnecessary and unusual injury at the injection site.  The physician denied the sequence of events.  Absent of any certainty regarding that, the Committee did not feel further action was necessary.  However, the Committee did feel it appropriate to remind the physician to be careful under similar circumstances in the future.

Virtual Care

Council has been reviewing recent developments in the regulation of Virtual Care.  Several provinces have placed restrictions on its use.  Some have limited the percentage of visits which can be done virtually (between 20% - 40 %)  They have also made it clear that no physician is permitted to have an exclusively “virtual” practice.  Finally, it is expected that physicians who practise virtually will be able to see the patient in person when such is necessary.  (The only alternative is to have a specific colleague who is willing to accept such responsibility). 

Looking at New Brunswick, the numbers on virtual and in-person visits were reviewed from the beginning of the pandemic.  The range in usage is significant.  A small number of physicians made no claims form virtual care.  On average, physicians claimed for 2000 virtual visits.  At one extreme was a physician who had claimed for 22,000 virtual visits since the beginning of the pandemic.

It should be noted that there have been no specific complaints regarding care provided virtually.  Rather, issues are related to more procedural matters, such as arranging appointments.  Some physicians have no difficulty in connecting with a patient at a specific time while, in other cases, this becomes a common problem.  Finally, physicians have not always respected the patient’s choice as to how they wish to be attended. 

In any case, at this point, there is little evidence that access to virtual care is being misused or abused.  In that context, it seems reasonable to wait until the pandemic situation is more settled before advancing any particular structure on an ongoing basis. 

Covid Vaccination

As physicians have been advised, appropriate immunization against Covid-19 is now a condition of practice.  When the College becomes aware of a physician who is unable to confirm their vaccination status, that physician will be suspended.

At this point, only a small number of physicians have been so affected.  They have many reasons for declining to be vaccinated.

Nevertheless, physicians are not the “general public” as they are frequently exposing patients with a range of susceptibilities to Covid and other infections.  In that regard, this can be simply seen as a question of public safety. 

At the same time, there are expectations of a reasonably equivalent approach for all professionals.  Thus, while hospitals have suspended many other employees who have not been vaccinated, up to this point, physicians have been relatively unaffected.  The approach should be reasonably similar.

In addition, there are intraprofessional issues which cannot be ignored.  Since the beginning of the pandemic, much praise and adulation has gone to physicians and other health professional for their efforts in dealing with these unprecedented events.  Those professionals had presented a true picture of altruism including making personal sacrifices.

Nevertheless, at this point, it is clear that some individuals, including a small number of physicians, wish to abandon that role, by declining the vaccination and, consequently, putting the needs of their patients is secondary to their own.  Physicians are as free as any other patient to decline any particular intervention.  Nevertheless, as with other situations, there are consequences to such decisions.

Search for Registrar

As members were advised earlier, the College is in the process of seeking a replacement for the current Registrar.  A number of suitable candidates have applied, but the Search Committee wishes to broaden the field as much as possible.  As a consequence, they will continue to accept applications and CVs at This email address is being protected from spambots. You need JavaScript enabled to view it..