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 .
Officers and Councillors 2010-2011
President - Dr. Jean-Marie Auffrey, Shediac
Dr. Zeljko Bolesnikov, Fredericton
Dr. Terrance Brennan, Fredericton
Dr. Santo Filice, Moncton
Dr. Robert J. Fisher, Hampton
Dr. Kathleen L. Keith, Saint John
Registrar - Dr. Ed Schollenberg
Mr. Paul Leger, Rothesay
Ms. Ruth Lyons, Tide Head
Dr. Lachelle V. Noftall, Fredericton
Dr. Teréz Rétfalvi (PhD), Moncton
Dr. Lisa Sutherland, Rothesay
Dr. Mark Whalen, Campbellton
At its meetings on 25 May 2011, Council considered the following matters.
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 patient was undergoing an independent medical examination. During the course of the examination, the physician commented casually on the appearance of surgical scarring unrelated to the system which was being examined. The patient complained that the comment caused unnecessary embarrassment. The physician acknowledged that that may have been the case and apologized. The Committee felt it appropriate to issue a Counsel regarding future encounters. Physicians should particularly note the risk of unintended interpretation of such comments, especially when the physician and patient are not previously known to each other.
A patient claimed that he was treated without consent. He alleged that the physician had prescribed medication without assessing him and solely on the basis of information provided by his family. In response, the physician noted that he had previously seen the patient and began the process of reducing the medication which he had been on for some time. It was understood that the patient may need to resume the medication if certain symptoms recurred. In response to an acute deterioration, the patient’s family contacted the physician for assistance. The consultant was unable to arrange care through the family physician and, consequently, arranged for the medication to be restarted. He felt that any further delay would create a risk for the patient and others. In reviewing the matter, the Committee felt this was one of the circumstances where reinitiating a longstanding treatment on the basis of reliable information would be in the patient’s best interest. In any case, the patient was free to decline to take the prescribed medication.
A physician in an administrative capacity examined a patient to determine entitlement to a benefit. The physician made some comments supportive of the patient’s claim, but noted that the ultimate decision rested with others. When the patient was ultimately denied the benefit, he alleged the physician providing the initial assessment had not been sufficiently supportive. In response, the physician noted that all such assessments are done according to strict regulations and policies. A factual report is prepared for others to determine the patient’s eligibility. The ultimate decision is not with the physician performing the assessment. No fault was found with the care provided.
A family with an infant was attending an evening clinic. A number of patients were waiting. The family alleged that the attending physician, in front of those waiting, took a lengthy break to discuss matters with the staff which appeared to have no relation to patient care or the functioning of the clinic. The family eventually left without being seen. They allege that the physician failed to provide appropriate care. In response, the physician asserted that the conversation was related to a specific scheduling issue. On review of the matter, the Committee felt that the physician could have handled the situation better. If possible, any discussions, whether they relate to the clinic practice or not, should either be deferred, or dealt with away from the waiting room, in order to avoid the impression that patient care was not a priority.
A patient was commencing cancer therapy and was able to make arrangements for such therapy to be continued while he was on vacation out of the country. He stated that the local physician discouraged this approach but did not specifically advise him not to travel. While he was away, he suffered a significant health emergency for an unrelated matter. Subsequently, he was denied coverage for this matter because his insurance policy provided that no coverage could be provided for any health issue if there was any warning against the patient travelling. The physician had noted in one letter that he had discouraged the patient from doing so. He further clarified the matter by making it clear to the insurer that the significant health issue had nothing to do with the patient’s pre-existing condition. Nevertheless, the coverage was still denied. The Committee could find no fault with the care provided. It was noted that, while many physicians and patients would be aware that such policies do not cover conditions which exist prior to departure, the fact that all coverage could still be denied for another illness might be less widely known. Physicians may wish to discuss such with patients in similar situations.
A patient was seen with an acute problem. The physician arranged an immediate referral to a consultant, who recommended a period of therapy after which the patient should be seen if there was no response. Additional more invasive treatment could be offered at that point. When the patient attempted to make the appointment for follow-up, it was not available as quickly as the patient had expected. The patient subsequently went to the Emergency Department again and made arrangements to see another consultant. The patient alleged that the care provided by the first consultant was inappropriate. In response, the physician asserted that the patient was, through the Emergency physician, given appropriate advice and follow-up was timed accordingly. From a clinical point of view, the Committee determined that the care provided was appropriate. There was no advantage in seeing the patient sooner than the completion of initial conservative treatment. Committee did wonder about the communication to the patient regarding this matter. Some of this did occur through the other physician. Nevertheless, when the patient did contact the consultant’s office directly, the Committee felt that clarification at that point would have avoided a complaint arising.
PRESCRIBING TO SELF AND FAMILY
This issue continues to cause concern in a number of situations. Council wishes to remind members of the following provision of the Code of Ethics, which Council believes is self-explanatory:
“limit treatment of yourself or members of your immediate family to minor or emergency services and only when another physician is not readily available; there should be no fee for such treatment.”
In addition, the regulation on professional misconduct makes the following improper at any time:
prescribing, selling, administering, distributing, ordering, or giving any drug legally classified as a controlled substance or recognized as an addictive or dangerous drug to a family member or to himself or herself;
MEDICAL IDENTIFICATION NUMBER FOR CANADA (MINC)
Over the last several months, members have been offered the opportunity to sign release forms in order to be provided with a MINC number. Those who have done so will find enclosed a letter providing them notice of their number. For those who have not yet done so, a release form is available from the College website.
PHYSICIANS AND PARAMEDICS
Council wishes to remind physicians that Ambulance New Brunswick has a policy regarding physicians assisting at emergencies after paramedics have arrived. It is a policy of Ambulance New Brunswick that paramedics follow their established protocols, as well as instructions they receive from their distant supervisors. If a physician attending the scene wishes to take charge of the patient care, they are expected to agree to accept and acknowledge such responsibility fully and attend with the patient until arrival at hospital.