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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 September 24^th, 2021 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.

A consultant alleged that a physician was declining to see patients in person when such would have been appropriate.  This resulted, in her opinion, in an unnecessary referral.  In response, the physician stated that she was seeing a significant number of patients in person along with an even higher volume of virtual visits.   In reviewing the matter, the

Committee felt that the patient should have been referred regardless how he was seen.  Nevertheless, absent clear guidelines on when virtual care is appropriate, the Committee could find no fault with the care provided.

Following a knee replacement, a patient attended another surgeon due to excessive pain.  The physician forcefully flexed and extended the knee in a way which significantly increased the patient’s pain.  He asserted such was necessary to assess range of motion.  In the Committee’s view, there was a gap in the communication between the patient and the physician regarding the need for the visit.  In any case, the Committee could find no evidence that the examination itself caused any significant injury. 

A patient complained that she was unable to access care from her family physician.  The patient had recently moved farther away, but wished to continue to see the physician.  A series of telephone conversations followed which became increasingly difficult.  The physician suggested that the patient attend a physician closer to home, but the patient took this as an attempt at abandonment.  There was no

evidence that such was the case, but difficulties in communication, which seemed to result from a number of reasons, were noted. 

A patient had seen two family physicians regarding a “mole” on her ankle.  It was alleged by her husband that the “mole” was not examined.  He noted his wife, some seven years later, had developed a melanoma which proved fatal.  The husband now alleged inadequate care by the original physicians.  In response, both physicians claimed they had no record of the lesion as described, but the patient had other issues, such as planter warts, for which she had been seen.  The Committee noted that, while the course of a melanoma may be quite slow, there was still no objective evidence that any such lesion was present originally. 

An elderly patient attended Emergency with a sudden onset of abdominal pain.  After being examined, the patient alleged that the physician made inappropriate remarks suggesting that the visit to the Emergency Department had been wasted.  A heated discussion followed.

Two days later, the patient, through his family physician, had a CT scan which demonstrated a ruptured appendix.  It was uncertain when the rupture occurred.  In reviewing the matter, the Committee did note the difficulties with a diagnosis of acute abdominal pain in some patients.  The Committee believed that the physician had appropriately examined the patient and arranged for a further assessment if the symptoms persisted.  On that point, the Committee could find no fault.  Nevertheless, the Committee did feel it was appropriate to Counsel the physician regarding the alleged comments concerning the significance of the patient’s symptoms. 

Some few years ago, a seventeen-year-old patient became pregnant and was followed by her family physician who she asserts provided minimal, if any, prenatal care.  In response, the physician presented documentation of the patient being seen regularly and appropriately monitored.  It was unclear why the patient had a significantly different recollection.  It was likely that the patient was significantly stressed at the time in question, but there was no evidence that she did not have appropriate care. 

A patient was referred to a surgeon for recurrent abdominal pain.  Attending the appointment, the surgeon immediately commented on her excessive weight and began to lecture her on appropriate dietary changes.  The patient asserted that she had not attended the physician for that purpose.  She, consequently, resented the comments as raised.  In reviewing the matter, the Committee did note that such allegations have been recurrently made by several obese patients in the past.  The first issue is that their initial entrance complaint is often ignored.  Secondly, they can only feel that the physician is unnecessarily judgmental regarding a very difficult problem.  In this case, the Committee thought the physician could have approached the matter in a better way, recognizing the resistance such comments would likely face.

A patient alleged that he and his family had been discharged improperly from his physician’s practice.  The reasons were unclear.  The patient noted that there had been ongoing difficulties with the physician’s policies relating to using a particular hospital, as well as a particular blood clinic.  In addition, the physician required unnecessary repeated visits to reorder some medication.  In response, the physician denied all of the allegations.  He further denied that he had taken any action against the patient’s family.  The Committee could not explain the significantly different versions.

GUIDELINES
Council has been revisiting several guidelines in recent years.  The most recent one concerns Informed Consent.  The new guideline is available on our website.  It has not changed physicians’ obligations, but does provide guidance in a clearer format.

The College has also received a wide range of complaints which have been related to the pandemic.  In order to address some issues on which there may be some confusion, Council has adopted a guideline to address these.  Such is included with this mailing.

Finally, Council has decided to support the Regional Health Authorities, and others, to ensure that all health professionals are vaccinated against Covid-19.  Physicians should take appropriate measures to ensure such.  You will be obligated to provide proof of this status if requested.  It should also be clear that failure to be vaccinated could result in a complaint and, possibly, discipline.

REGISTRAR
Position available as Chief Executive Officer of the Medical Licensing and Regulatory Authority for New Brunswick. 

Candidate must be licensed, or eligible for licensure, in New Brunswick and must have some experience with the practice of clinical medicine.  Other qualifications would include experience with medical organizations, knowledge of medical practice in New Brunswick and reasonable fluency in English and French.

Salary will be based on scale of New Brunswick Department of Health, with final level determined by qualifications. 

Inquiries should be directed to the President, College of Physicians and Surgeons of New Brunswick, by email (This email address is being protected from spambots. You need JavaScript enabled to view it.) or by mail (1 Hampton Road, Suite 300, Rothesay NB   E2E 5K8).  Applications will be accepted until November 1^st, 2021.