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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 October 2^nd, and November 27^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

Two hospital employees complained about a physician who had a long history of disruptive, and often aggressive, behaviour.  The employees were unsatisfied with the way the hospital had handled the matter and, consequently, complained to the College.  The Committee felt that the behaviour was clearly unacceptable and could potentially pose a risk to patients.  Nevertheless, as the physician was no longer practising, the Committee felt it appropriate to issue a Caution.

An elderly patient had been seeing a physician for a few years.  She repeatedly requested assessments and investigations appropriate to her age.  The physician repeatedly declined.  In response, he asserted that he was using investigations appropriately as currently recommended.  In reviewing the matter, the Committee did not feel the physician was meeting the minimum requirements for ongoing health maintenance of a patient of this age.  Absent a specific complaint, he would decline any annual blood work, for example.  The Committee felt such minimal assessment of patients of advanced age could pose a risk and, consequently, he was Cautioned to take a more thorough view of such patients.

A patient disputed a doctor’s approach when he presented to her with a loss of consciousness.  He alleged that she had immediately reported his condition to the Motor Vehicle Branch and he had his licence suspended.  He noted that further investigations suggested that he had not had a seizure, but had lost consciousness for another reason.  In reviewing the matter, the Committee felt that the physician had acted appropriately.  There are guidelines for the sort of issues which need to be reported and, once they are determined, the physician has no discretion. 

A couple complained when they were rejected by a family physician following a “meet and greet”.  They had understood from that meeting that he was willing to accept them and, in fact, he had made changes to their medication and ordered some investigations.  Nevertheless, a few weeks later, he advised them that he was now not accepting them.  At that point, the physician offered no explanation, but later implied that the patients were, perhaps, too independent in their views and approach.  The Committee noted that there are guidelines on accepting patients.  They state that if a “meet and greet” meeting is arranged, and the patients are not accepted, the physician must provide a direct reason.  The physician was Counselled on this point.  Nevertheless, the Committee also noted that the College was reviewing its guidelines on accepting new patients, which should help avoid such issues arising in the future.

A complaint arose regarding the care provided to an elderly patient.  It was alleged the physician had improperly completed an affidavit regarding the patient’s competence.  The patient’s son vigorously disagreed with the conclusion.  In the Committee’s view, the physician was obligated to provide observations and conclusions based on the information available, which was done in this case. 

A patient went repeatedly to an Emergency Department with shortness of breath and chest pain.  She was sent home each time.  On the last visit she saw the Emergency Physician who noted that she had recently had a CT scan for an unrelated reason.  The physician concluded that the CT scan did not show any significant abnormalities and sent the patient home again.  The report was later received stating that the patient had evidence of pulmonary edema, strongly pointing to congestive heart failure as her underlying problem.  The physician was Counselled to avoid “anchoring” to a previous diagnosis.

A hospital employee had to leave her shift because she was feeling unwell.  This was likely a recurrence of migraines from which she had suffered in the past.  She went to the Emergency Department and the physician there took minimal interest, telling her that there was nothing to be done and she should seek further care at a walk-in clinic.  Although the advice was reasonable, the Committee felt the care appeared to be disinterested and dismissive.  The physician was Counselled in this regard.

A physician chose to provide a virtual assessment as an opted-out service. However, contrary to Medicare requirements, the patient was not advised in advance, did not specifically consent, nor was there clear evidence that the service was otherwise available.  It appeared the physician had been warned about this in the past and, consequently, a Caution was considered appropriate.

There was a complaint about the care provided to the husband, both at home, and later in a personal care home.  The patient was demonstrating increasing dementia, along with aggressiveness.  Both the family physician and the physician looking after him in the facility tried different medications without clear success.  The complainant subsequently took the patient home on no medication.  Both physicians felt that this was a difficult problem and trial and error was often necessary to find the right solution.  The Committee agreed and found no fault with the care provided. 

A patient complained that a physician had failed to take appropriate precautions, including wearing a mask, during an assessment which involved fairly close contact.  The physician asserted that he had taken all of the measures necessary regarding distancing within his office, and all staff were wearing masks, but he had chosen not to do so because he felt it caused difficulty in patients understanding him.  It was noted that he had been warned about the same issue some months earlier.  Consequently, a Caution was considered appropriate.

A patient complained that a physician had failed to follow-up an abnormal blood test, specifically an elevated blood glucose.  She had only uncovered the information when she saw another physician a few months later.  In response, the physician noted that the result had been noted and the plan was to repeat the test at the next visit.  However, this was delayed by pandemic precautions and, before a follow-up visit could be arranged, the patient had relocated to another community.  The Committee did not feel the physician had acted improperly, but there was no evidence he had a system in place to make sure that important results are not missed.  The Committee felt that a Counsel was appropriate on this matter.

A dispute developed between a physician and a family who all attended his office at the same time.  The issue started with some alleged misbehaviour by the children, but when the physician asked questions about it, the family became very hostile and threatening.  The physician did not think he could continue with the visit.  In any case, the family left on their own volition.  The Committee was not quite sure what precisely happened here.  Such encounters can deteriorate quickly and any comments by a physician can be subject to misinterpretation.  The Committee was not convinced that misconduct had occurred and, consequently, recommended no further action.

College Guidelines 

It is necessary from time to time to review College guidelines to determine the currency of the advice they provide.  Such was recently done regarding a number of guidelines.  Full text is available on the College website (https://cpsnb.org/en/medical-act-regulations-and-guidelines/guidelines), but some of the highlights include:

Consultations and Referrals
The revision attempts to re-enforce the importance of communication among the referring physician, the consulting physician, and the patient.  Unacceptable gaps in these processes continue to be a problem.

One Problem Per Visit
Further language is included to clarify that physicians may “prioritize” problems and then work with the patient to develop an appropriate approach.

Potential Patients
This guideline previously referred to “screening” new patients.  The amendment clarifies the limited reasons that a patient may be refused.  It also clarifies the procedure for any introductory meeting. 

Preventing Follow-Up Care Failures
The amendment here obligates physicians to develop an effective test management system to avoid failing to notify a patient of significant results.  Such events continue to occur. 

Termination of Care
The amendment articulates, in a clearer form, situations under which a patient may, or may not, be terminated by a physician. 

Walk-in Clinics
The amendment confirms the obligation to complete necessary investigations and to have an appropriate approach for communicating results.

Physicians are expected to be familiar with these provisions.