Bulletins
April 2007
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.
President -
Dr. Malcolm Smith, Tracadie-Sheila |
Registrar -
Dr. Ed Schollenberg |
Council Update
At its meeting on 30 March, 2007, Council considered the following matters:
COMPLAINTS
There
was a complaint that a physician had improperly discharged a patient from
the Emergency Department. The patient arrived complaining of chest pain.
The pain had been unchanged for many hours. There were no other symptoms
or laboratory indicators suggestive of heart pathology. The patient succumbed
to a heart attack several weeks later. The family alleged that the initial
care had been inappropriate. The Committee concluded that the patient
had been properly assessed and discharged with appropriate advice for
follow-up with his family physician.
A patient was treated by a consultant in an Emergency Department. The patient alleged that the physician made some unusual comments which she felt were inappropriate. The physician asserted that he was only trying to put the patient at ease. The Committee noted that the records showed the patient was in a great deal of discomfort at the time. The Committee felt that even well intentioned comments could be misinterpreted in this context. The Committee noted that the physician had apologized for any misunderstanding.
A patient alleged that she was improperly refused transfer to a regional hospital. She asserted that instructions had been left for her to be transferred immediately upon arrival at her local hospital. On reviewing the matter, the Committee could find no evidence that such was the case. The Committee felt the local physician had acted properly, in a non-emergent situation, by first waiting for acceptance of the patient by a consultant.
A patient was referred to a specialist for investigation. She was advised that an appointment would be available in a few months, after the physician reviewed the matter in order to prioritize it. She checked repeatedly with the office and was allegedly given different information as to whether the physician had reviewed the letter of referral. Eventually the patient sought another referral and was treated without significant delay. The Committee noted that there have been ongoing concerns regarding the management of referrals to consultants, especially when their waiting lists were very lengthy. In this context, the delay appeared related to the fact that the physician had not reviewed the referral letter in a timely fashion in order to determine the significance of the patient's problem. Physicians are reminded that they are usually considered to have received the information relating to a patient at the time it arrives.
It is only upon reviewing the available information that the consultant can determine the appropriate priority to give to the matter. Once this is done, the patient should be given as accurate information as is possible on arrangements for an appointment.
A patient complained about two consultants. Unsatisfied with the treatment provided by one, she was referred to another specialist in the same community. She alleged he declined to provide care because of her previous difficulties. In response, the physician asserted that he was willing to treat the patient, but made it clear that the patient may have to accept care from his colleague if he was absent. He asserts the patient was adamant that such was not acceptable. As a consequence, other alternatives in neighbouring communities were offered. While the Committee felt it would be inappropriate to deny care solely because of previous difficulties with a local colleague, in this situation the Committee felt it was the patient who had specifically refused to accept what was locally available. The Committee felt the physician had acted appropriately.
A family complained that an elderly patient had not received appropriate care from her longstanding family physician. In response, the physician noted that the patient had numerous medical problems, and was competent to accept or reject any treatment which was offered. The physician noted that the patient often sought to maintain her independence, even from her family. For example, she would decline appointments rather than have to seek assistance with transportation. The Committee felt the physician had treated the patient appropriately under the circumstances.
A patient had a persistent problem which required several visits to after-hours clinics and the local Emergency Department before the diagnosis of an unusual, but treatable, condition was made. On one of these visits, the patient alleged that the attending physician had expressed frustration with the patient, using several profanities. In response, the physician acknowledged that some of the language was inappropriate and apologized for such. The Committee felt the complaint had provided appropriate admonishment for the physician and determined to take no further action on the matter.
A patient alleged that a family physician failed to make a timely diagnosis of a significant illness. The patient claimed that, rather than arranging appropriate investigation, the physician had instructed him to attend the Emergency Department if the symptoms worsened. In response, the physician acknowledged that, at the outset, he may not have recognized the significance of some of the patient's symptoms. Nevertheless, he felt it appropriate, given the expected delays in investigation and treatment, that the patient may be assessed more quickly through admission in the hospital. The Committee noted that the patient's course was not completely typical, but there had only been a few weeks from initial presentation to final diagnosis. The Committee agreed that the physician may have provided better advice to the patient if the significance of the symptoms had been appreciated.
OTHER
BUSINESS
In other business, Council:
- Agreed
to commence criminal background checks on new applicants.
- A greed
to offer subspecialty recognition to a physician whose practice was
exclusively in that area, but who had completed his training prior
to formal recognition of that subspecialty. Council noted that this
issue had been discussed at length in the past. Council determined
to handle each request on a case-by-case basis.
- Reviewed
and approved the draft budget for Atlantic Provinces Medical Peer
Review. The budget provided for an increase in support payments with
a view to increasing the frequency of assessments and the number of
specialties covered.
- Reviewed
draft financial statements for 2006 showing the College had posted
a surplus for the year.
- Approved
a donation to the New Brunswick Medical Society Foundation.
- Ordered
the interim suspension of a physician whose license had been revoked
in another province.
- Acknowledged
the appointment of two new public members of Council by the government.
They are Dr. Terez Retfalvi (PhD) and Mr. Jean Daigle, both of Moncton.
OUT-OF-COUNTRY
CONSULTATIONS
Council has
been asked to review the question of what obligations physicians have
when a patient requests referral outside of Canada for investigation or
treatment. In order to review this matter, Council would like to hear
from members regarding their own experiences with such issues. These would
include situations where the patient's condition or course was such as
to warrant referral for very specialized treatment. This may also include
patients' requests for less orthodox investigation and treatment at a
foreign centre. Council would like to review physicians' opinions on their
respective obligations to investigate such resources, as well as to acquiesce
to patients' requests for such, particularly if the physician is unconvinced
of the treatment's value. Physicians may provide comments to the College
by any means they wish.
LEGAL
SETTLEMENT CONFERENCES
At the request of the Chief Justice of the Court
of Queen's Bench of New Brunswick, Council wishes to remind members of
their legal obligations during the course of malpractice litigation. During
a law suit, the parties involved may be requested by the presiding judge
to attend a settlement conference to assist in concluding the matter.
Physicians are reminded that, when such is ordered, they are obligated
to attend with their lawyers. Failure to do so can result in the matter
not being settled and additional costs being imposed.
FROM
THE ARCHIVES
100 years ago
In
1907, Council revoked a physician's license solely for leaving the province,
reaffirmed that the Council was there to protect physicians, and complained
that the new province of Alberta was improperly denying access to physicians
from elsewhere. There were 273 physicians licensed.
75
years ago
In 1932, Council decided to require the Medical Council of Canada exams
of all applicants, initially warned hospitals that they could not employ
medical students to provide service, but subsequently agreed to a legislative
change to allow such. Despite pleas from several border communities, they
also reaffirmed that Maine physicians could not practise in New Brunswick
without an appropriate license.
50
years ago
In 1957, Council agreed to establish a Specialist Register. With payment
of $10, physicians could apply for entry on this register. Initially,
only physicians certified by the Royal College of Physicians and Surgeons
of Canada would be eligible. The annual license fee, including the Medical
Society portion, was set at $60.
25
years ago
In 1982, Council raised significant objections to proposed health
disciplines legislation, and decided to have only one snake on the College
seal. The College held its first general election for members of Council.
This encountered some problems, as not all members read the ballot instructions.
There were 849 physicians registered who paid an annual fee of $125.