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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 2008-2009

Council Update
At its meeting on 5 June, 2009, Council considered the following matters:

COMPLAINTS

A patient complained that a consultant had performed an improper examination. It was alleged that he had failed to provide appropriate draping, failed to have an attendant present, and conducted an examination in an inappropriate manner. Regarding the examination itself, the Committee did not feel it had sufficient evidence to pursue the matter further. However, the Committee was concerned that the physician had not followed appropriate guidelines regarding respecting patient privacy and the availability of an attendant. The physician has modified his practice in this regard. Members are reminded of longstanding College guidelines on this point. Such are available on the website or by contacting the College office.

A patient alleged that an Emergency Room physician had failed to properly respond to a complaint of vision loss related to a detached retina. It was alleged that this delayed treatment. The physician acknowledged that he had not made the diagnosis on first presentation, but had encouraged the patient to come back to see him the next day. This would have been the soonest she could have been referred to an ophthalmologist in any case. The Committee agreed that there had not been any inappropriate delay in treatment. However, the situation may have been aggravated by comments the physician may have made at the time of initial presentation.

A patient in his fifties alleged that a physician had failed to respond to rising levels of prostate surface antigen (PSA) over several months, consequently delaying the diagnosis of a prostate tumor. In reviewing the matter, the Committee noted that, over the course of six months, the patient’s PSA level had risen from approximately 2 to 5 to 7. It was only when the patient developed symptoms that the physician referred him to a specialist. On earlier occasions, the physician had neither examined the patient, nor made a referral. The Committee did not feel such was an acceptable response and advised the physician to review prevailing guidelines on the significance of PSA levels in this age group.

A patient was referred to a consultant for an assessment. At the outset of the visit, the patient alleged the physician became upset when he became aware that she was involved in a legal action. The patient alleged that this compromised the quality of the assessment the physician performed. In reviewing the matter, the Committee could find no evidence that the assessment provided was inadequate. However, the physician could have raised the issue of legal action in a different way. While it should have had no impact on the service provided, it was reasonable to advise the patient of any limits on how his report might be used.

A patient had been seeing a psychiatrist for many years. She was on a wide range of medication, including clonazepam. She misplaced several days supply of the latter and asked the physician to reissue the prescription. He initially declined to do so, but later provided such in a reduced dose. The patient alleged that this response was inappropriate. In reviewing the matter, the Committee noted that the patient was well known to the physician, this was the first episode of any prescription loss, and there was no reason to believe the patient’s explanation was false. Moreover, the Committee was concerned that the discontinuation of the medication for a short period of time could cause significant discomfort. The Committee felt the physician may have responded unduly harshly to the situation, but also noted that the complete context of the matter may not be clear.

 CONSULTATIONS/REFERRALS

From time to time, the College hears concerns expressed regarding the process by which family physicians and others refer their patients to consultants.  Difficulties appear to arise from the initial communication, the setting of appointments, the consultant’s report, to questions regarding the follow up and responsibility of investigations and other matters.  Council wonders whether some guidance in this area might be useful to members.

Before considering such, Council would appreciate it if members could forward any concerns or difficulties they have experienced regarding this process.  Any anecdotal information, opinions, or suggestions would be very much appreciated in order to suggest areas where improvements might be made.  Such can be communicated to the College by any means, mail, fax, or e-mail. 

 Medical Act AND REGULATIONS

The legislature has recently enacted a bill amending the Medical Act in a number of ways.  These principally streamline certain disciplinary proceedings and provide for disciplinary hearings to be open, subject to a number of exceptions.  They also provide greater authority for College committees to order a range of assessments regarding physicians for whom concerns have arisen. 

The Act also now contains provisions which had previously been in the Regulations regarding physicians’ obligations to report concerns regarding colleagues, actions taken against themselves, as well as the commencements of civil actions.

Finally, a number of the registration and licensing  provisions were simplified.  This required further amendments to the College’s Regulation on the matter.  These should not significantly impact members.   

Copies of the amended Act and Regulations are available on the website or by contacting the College office.

 COUNCIL ELECTIONS

Elections to Council were recently held. Newly elected members are:

Dr. Eric J.Y. Basque of Pointe des Robichaud
Dr. Robert J. Fisher of Hampton
Dr. Barbara M. Ross of Moncton

Re-elected by acclamation was Dr. François Guinard of Edmundston.