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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 should be aware of these matters.

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Officers and Councillors 2006-2007

Council Update
At its meeting on 22 June and 7 September, 2007, Council considered the following matters:

COMPLAINTS
Following a procedure, a patient required ongoing follow-up of laboratory values over the course of several weeks.  However, both the physician and the office staff went on vacation and critical values were not noted.  As a consequence, significant treatment was delayed.  The physician acknowledged the responsibility to make arrangements for such circumstances when critical to a patient’s well being.  As a consequence, office procedures have been changed.  The Committee felt the fact of the complaint had been educational to the physician and, by reporting it in this newsletter, to other members as well. 

An elderly patient complained that a physician had declined to deal with several minor issues which she wished to discuss during the course of an appointment.  The physician asserted that a return visit would be necessary.  The Committee noted that the issue of limiting the matters which could be discussed at a single appointment has been an ongoing difficulty.  It is hoped that physicians and patients will balance their respective interests.  The Committee does note the special circumstances regarding elderly patients and the fact that there is commonly more than one matter of concern.  In addition, the difficulties in attending an office should be recognized when physicians request return appointments. 

There were two separate complaints against physicians concerning information which was provided regarding a disability claim.  The patients complained that the physicians had provided inaccurate information and offered an inappropriate opinion, consequently denying the patients’ claims.  In reviewing these matters, the Committee felt the physicians had provided accurate information and honest opinions.  Any conclusions regarding such claims were ultimately made by the agency in question.

A patient complained that a physician had improperly denied care because the patient had missed several appointments.  In response, the physician noted that, while the patient had failed to keep two appointments at the physician’s office, the greater difficulty was the fact that the patient had failed to keep many other appointments for investigations, various therapy, as well as several consultants.  In this context, the Committee felt the physician’s actions were appropriate in insisting that the physician could not properly care for a patient who accepted appointments, but failed to keep them.  

A patient had an ongoing problem which was causing a great deal of stress.  On a fairly urgent basis, she was seen by her physician.  However, this was not in his office, but in a busy outpatient setting.  As a result, it was alleged that the physician was brusque and insensitive.  The physician acknowledged that the context in which the patient was seen was not ideal.  He also acknowledged that some of his remarks may have been inappropriate.  The Committee accepted this version, noting that the physician had been well intentioned in seeing the patient earlier than he might otherwise have been able to, but unfortunately, such did not prove ideal in considering the bigger picture. 

A patient with a chronic condition had been referred to a consultant by his family physician for ongoing care in that regard.  The patient subsequently requested being referred to a different consultant.  He alleged that this annoyed the family physician who then improperly discharged him from his practice.  In response the physician asserted that the patient was discharged, not for any matter related to the consultant, but rather because the patient had been rude to the physician’s staff.  The Committee noted that physicians are free to discharge patients, but, in this case, the physician had not provided the patient with any warning or any information regarding the reasons for such.  If there are issues with staff, for example, physicians are expected to address this issue with the patient first in order to advise them of the potential risk to their ongoing care. 

It was alleged that a physician made an inappropriate remark to a patient.  In response, the physician noted that he had cared for the patient since she was a child.  He felt he made the remark in a joking manner to a patient whom he felt he knew very well.  He acknowledged that it could be misinterpreted.  The Committee felt it appropriate to remind him that comments can be misinterpreted, or taken out of context, especially when the patient is stressed from illness and other factors.  

A family complained that a consultant had improperly interfered with the care of a patient who was admitted under the family physician.  In response, the physician noted that the responsibility of patient care was shared in the local hospital.  He asserted that he had only acted in the patient’s best interest.  While the Committee notes that varying arrangements can exist within local hospitals regarding the shared management of patients, the Committee felt difficulties such as this could be avoided with good communication with the patient or family, as well as the admitting physician, and appropriate charting of all clinical decisions. 

An elderly patient suffered a long and protracted course following a complication of surgery.  Correction of the matter was only achieved when the patient was seen by a surgeon at another centre.  The family alleges that the initial complication arose as a result of the patient being treated with a narcotic to which she was allergic.  They also alleged that the original surgeon had failed to arrange for appropriate second opinions.  In reviewing the matter, the Committee could find no evidence that the administration of any specific medication had any impact on the patient’s course.  In contrast to the family’s assertion, the Committee also felt that the physician had made timely referrals to other consultants in hopes of achieving some benefit for the patient.  It was unfortunate that it required several such consultations before corrective treatment could be offered.

 The departure of a physician from a clinic had created some difficulties for patients.  The Committee noted that this was normally not an area which would be dealt with by the College.  The Committee did feel that some problems could be avoided if the arrangements for joining or leaving a group or clinic were subject to a written agreement.  Such an agreement could outline appropriate interventions if a disagreement occurs between the parties.  While physicians have traditionally avoided formalizing such arrangements, this may not be the best way to avoid legal disputes between the parties.

 A dispute arose between some family members of a terminal patient and the physician providing care.  The Committee could find no fault with the care provided by the physician, but noted that there had been some interference from a family member who was a physician in another province.  From a distance, this individual had been critical of many aspects of the care provided.  It was felt this added stress to an already difficult situation.  The Committee noted that the situation was not particularly unusual.  The best the local physician can do is recognize the stresses involved for family members who are separated from their relative at such a time.  The Committee also hoped that the distant physician would also realize how unhelpful certain interference can be.

OFFICE SAFETY

The College has become aware of an issue which has recently arisen regarding the safety of certain offices, specifically concerning the disposal of “sharps”.  In one case, a small child was injured after accessing the disposal container.  In a case in another province, an adult was injured by sharp debris which had fallen on the floor.  Even if such injuries are minor, they can create a great deal of stress.  Physicians should review office arrangements and procedures to limit the risk of such occurrences. 

OTHER BUSINESS
In other business, Council:

• Approved the budget for 2007-2008, which required no increase in annual dues.
   
• Reviewed, in a preliminary fashion, further proposals regarding enhanced prescribing provisions for pharmacists.  Council determined to work with the Medical Society and the pharmacists’ groups to develop initiatives which enhance patient care and preserve patient safety. 
   
• Noted the increasingly improper use of the term “osteopathy” by non-physicians.  This terminology properly applied only to physicians graduating from osteopathic medical schools, but has increasingly been used by other therapists. 
  
  
• Determined to continue to allow physicians without full credentials to have their practice assessed after one year for purposes of upgrading their license status.
   
• Welcomed three newly elected members of Council:

Dr. Lachelle Noftall, Frederiction
Dr. Santo Filice, Moncton
Dr. Anthony Lordon, Saint John

•  Elected the following Executive Committee for 2007-2008:

President:                              Dr. Robert Rae
Vice-President:                     Dr. Paula Keating
Past-President:                     Dr. Malcolm Smith
Member at Large:                 Dr. Terry Brennan
Public Member:                    Mr. Gilbert Doucet

 FROM THE ARCHIVES

 90 years ago
In 1917, Council decided that the Medical Council of Canada exams were not sufficient for licensure in New Brunswick.  They also objected to a recent malpractice judgment and agreed to help the physician with the costs of the appeal.  The registrar resigned to take on overseas military service.  He resumed his duties on his return two years later.

60 years ago
In 1947, Council refused a request from the government to amend eligibility rules to allow refugee physicians to practise in provincial institutions.  They countered that greater remuneration would make these positions more attractive for Canadian physicians.

30 years ago
In 1977, Council reviewed a recent national report on physician resources and expressed its disagreement with several of the recommendations.  They also agreed to allow residents to write prescriptions, and determined to set the fee for a postgraduate license at $50.  Council also tentatively approved a recommendation from the Medical Society to set up local committees to deal with minor complaints against physicians.