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Pre-clinical Pre-clerkship
Clinical Clerkship, JURSI

Negligence and civil liability eLearning activity
A successful claim of negligence or civil liability must establish the physician has breached the duty of care to a patient and this breach resulted in harm or injury. This eLearning activity explores the concept of negligence and civil liability including duty of care, breach of duty (or in Québec, fault), causation, and the role of the medical expert. (Nov 18, 2006) Earn CME credits

If a patient relies on your professional opinion...
Before giving advice on medical matters, even informally, physicians should be satisfied they have considered and documented the relevant information. (Mar 1, 2006, Revised: Aug 28, 2008)

How do the Courts determine standard of care?
The CMPA will seek expert opinion regarding a physician's standard of care. (May 1, 2001, Revised: Apr 10, 2008)

Informed consent eLearning activity
Obtaining valid consent is a legal obligation and documenting it contemporaneously contributes to a successful defence. This eLearning activity describes how valid consent is both voluntary and informed, and ideally results in a patient's understanding of the proposed investigation, treatment and alternatives. (Nov 18, 2006) Earn CME credits

Consent: A guide for Canadian physicians
A primer to assist physicians to better understand and implement into practice the requirements of consent to treatment. It includes information on consent in emergency situations, capacity to consent, informed consent, informed discharge, and other topics. There is a section on treatment in Canada of U.S. and other foreign residents. (Jan 1, 2006)

What's best? Informed consent
A physician must provide certain information to patients in order to obtain "informed consent". (Mar 1, 1995, Revised: Jan 1, 2011)

Communicating with your patient about harm: Disclosure of adverse events
Suggestions to help CMPA members meet their patients' clinical, information and emotional needs after an adverse event. Topics include understanding harm, the importance of planning and communication, the stages of disclosure and apology after adverse events. (Apr 1, 2008)

Follow up for "orphan patients"
Physicians discharging patients in need of follow up care may have certain responsibilities. (Sep 1, 2008, Revised: Oct 21, 2008)

How to apologize when disclosing adverse events to patients
It is right to express sympathy after an adverse event, but an apology with acceptance of blame may be inappropriate. (Sep 1, 2006, Revised: May 2, 2008)

Disclosing adverse events to patients: strengthening the doctor-patient relationship
Timely, unrushed disclosure of adverse events to patients is an obligation that may strengthen the doctor-patient relationship. (Mar 1, 2005, Revised: May 1, 2008)

How effective management of test results improves patient safety
There is growing evidence that effectively managing the results of test and diagnostic imaging reports improves patient safety. (Jun 23, 2011)

Tips to avoid trouble (tips 10, 11, 12)
Important considerations in providing telephone advice; issues to consider when transferring the care of a patient. (Sep 1, 2008)

Strengthening inter-professional communication
A discussion of how physicians can improve their inter-professional communication skills, leading to better care for patients and reduced medico-legal risks for physicians. (Mar 17, 2011)

The medical record: A legal document Can it be corrected?
Physicians should exercise care in modifying or correcting medical records. Suggestions on when and how to go about this are provided. (Oct 1, 2009)

Patient information - "Do I need to see this?"
Custodians of health information are expected to have policies to restrict access to those persons with a "need to know" to monitor access and to deal with incidents of inappropriate access. Before examining any health information, individuals should be aware of and comply with the relevant policies. (Apr 28, 2009, Revised: Apr 1, 2009)

Difficult doctor-patient relationships: Preventing problems before they start
Case studies illustrate some of the communication and professional difficulties between physicians and patients. (Dec 17, 2008)

Tips to avoid trouble (tips 10, 11, 12)
Important considerations in providing telephone advice; issues to consider when transferring the care of a patient. (Sep 1, 2008)

Anatomy of a well-written note
Avoid medico-legal difficulties by writing factual and objective notes. (Mar 1, 2005, Revised: May 12, 2008)

Forms and reports: the case for care
Reports and medical records should be complete, objective, accurate and compliant with legislation. (Jun 1, 2002, Revised: Apr 10, 2008)

The importance of inter-specialty communication
Communication among team members facilitates good patient care. (Jan 1, 2000, Revised: Feb 27, 2008)

Gratuitous criticism or "If we had only seen you sooner"
A physician's remarks about prior care may lead to medico-legal difficulties for a previous care provider. It is important to base any comments on a thorough knowledge of the facts. (Dec 1, 1995, Revised: Feb 26, 2008)

Improving communication between physicians
A discussion of how physicians can improve their inter-professional communication skills, leading to better care for patients and reduced medico-legal risks for physicians. (Jun 23, 2011, Revised: Jun 23, 2011)

Reporting another physician
A review of the legal duties and ethical considerations for physicians to report their reasonable concerns about the professional competency, conduct or behaviour of another physician to health care institutions/hospitals, public health officials or regulatory authorities (Colleges). (Dec 1, 2010)

Thinking about a patient's human rights
It is important to respect your patient's human rights. Although it is usually inadvertent, any appearance of discrimination may lead to a complaint and the physician may be censured. (Mar 16, 2010)

When a physician feels intimidated
Dealing with intimidation by patients and their families, colleagues and other professionals. (Dec 1, 2002, Revised: Apr 10, 2008)

When joking isn't funny
Respect and observation of professional boundaries allows you to express concerns about patient care without fear of reprisal. (Mar 1, 1999, Revised: May 1, 2008)

Privacy and confidentiality: Consent and the circle of care
An overview of the obligations to protect the privacy and confidentiality of patients' personal health information, sharing information within the circle of care of providers, and the requirement for consent in sharing information in other circumstances. (Mar 17, 2011)

Encryption just makes sense
Privacy legislation, regulatory policies and professional obligation require that CMPA members take reasonable measures to protect the privacy of their patients' personal health information. With the advent of electronic records, members should be cognizant that encryption can help secure personal health information and may be required by law. (Dec 1, 2010)

Using social or professional networking websites can breach confidentiality
Physicians should take care to avoid breaching patient confidentiality when participating on social networking websites. (Jun 29, 2010)

Minimizing medico-legal risk when using technology
Strategies to protect information on computers and mobile computing devices from loss or unauthorized access. (Jun 2, 2008)

Duty to report and provide patient information to child protection agencies
Legislation requires physicians to report children at risk of abuse; however, it is important to include in the report only relevant and necessary information. (Dec 1, 2007)

Mandatory reporting: what you need to know
Legislation requires physicians to report individuals in the transportation industry whose medical condition may constitute a threat to safety. (Jun 1, 2005, Revised: Feb 26, 2008)

Anatomy of a well-written note
Avoid medico-legal difficulties by writing factual and objective notes. (Mar 1, 2005, Revised: May 12, 2008)

Collaborative care and medication monitoring: Who's responsible?
Monitoring medications in shared care. (Jun 1, 2003, Revised: Apr 11, 2008)

Documentation eLearning activity
Complete and timely charting facilitates good patient care and contributes to a successful defence. This eLearning activity explores the basic elements of a good medical record and describes problems caused by inadequate record keeping. (Nov 18, 2006) Earn CME credits

Documentation: Charting Medical Records eLearning activity
Documentation is an important part of providing clinical care and in defending a complaint or lawsuit if the care is later questioned. Documentation, Part II, presents two medico-legal case studies and a series of tips with examples that illustrate the importance of complete, clear and legible documentation in the medical record. (Apr 1, 2008) Earn CME credits

A case for keeping good notes
Poor charting may be perceived as reflecting less attention to detail and risks the conclusion the care provided was poor. (Sep 1, 2005, Revised: May 2, 2008)

Anatomy of a well-written note
Avoid medico-legal difficulties by writing factual and objective notes. (Mar 1, 2005, Revised: May 12, 2008)

Ill-considered statements can be costly
Statements in medical records should be accurate, objective and factual. (Jun 1, 2002, Revised: Apr 10, 2008)

Good notes vs bad notes
Tips for producing good documentation (Jan 1, 2000, Revised: Apr 7, 2008)

Cautionary tales: telephone advice
Carefully document telephone advice even if a patient rejects it. (Mar 1, 1998, Revised: May 1, 2008)

Infective endocarditis – still a challenge
A review of a five-year period of medico-legal files related to infectious endocarditis. (Dec 13, 2011)

Breast cancer detection and diagnosis: Part 2
A review of closed medico-legal cases alleging delays in the diagnosis and management of breast cancer, focusing on patients presenting with clinical findings suggesting a possible lesion of the breast. (Oct 1, 2009)

Aortic dissections: “Tearing” apart the data
The diagnosis of aortic dissection may be complicated by an atypical presentation, but careful documentation and appropriate reassessment can reduce the associated risks. (Jun 2, 2008)

Spinal epidural abscess: a rare, insidious and potentially catastrophic infection
Although spinal epidural abscess is rare and difficult to diagnose, it can have serious consequences for patients. CMPA experience has been reviewed. (Mar 1, 2008)

Cauda equina syndrome: A case for timely recognition and treatment
Cauda equina syndrome is not common, but has the potential for serious and long-lasting disability. Knowing the symptoms and signs, examining the patient adequately, and obtaining timely and appropriate investigations and consultations may help to avoid the risk of disability. (Sep 1, 2007)

Warfarin and INR monitoring: Are you on target?
When anticoagulation with warfarin is indicated, it is important for each treating physician to know the appropriate targets and to monitor INR appropriately. (Sep 1, 2007)

A case of kernicterus
Kernicterus continues to occur. Recognition and appropriate monitoring of hyperbilirubinaemia may permit intervention to prevent this neurological condition. (Jun 1, 2007)

Abdominal aortic aneurysm in the emergency department
The diagnosis of symptomatic abdominal aortic aneurysms is challenging. A review of medico-legal cases related to patients presenting with this diagnosis in emergency departments is presented, with risk management considerations. (Jun 1, 2007)

Thoracic aortic dissection: medico-legal difficulties
Failure to diagnose thoracic aortic dissection is not always due to negligence. (Mar 1, 2007)

Scrotal pain may point to testicular torsion
It is important to consider testicular torsion in young males presenting with abdominal or scrotal pain. (Sep 1, 2006, Revised: May 2, 2008)

How to reduce the risks of dental injury
Any medical procedure where instruments are inserted into the mouth may result in dental injury, despite appropriate care. This article provides advice about obtaining and documenting consent for such procedures, and what to do should a patient allege wrongful damage to the teeth. (Jun 2, 2010)

Tips to avoid trouble (tips 4, 5, 6)
The importance of care in prescribing, documenting and following up. (Dec 1, 2007)

Tips to avoid trouble (tips 1, 2, 3)
Care in communicating with patients may help to prevent misunderstandings about proposed treatment, care given by others, or unexpected events. (Sep 1, 2007)

What's best? Informed consent
A physician must provide certain information to patients in order to obtain "informed consent". (Mar 1, 1995, Revised: Jan 1, 2011)

Informed discharge eLearning activity
Legal cases in which physicians were held accountable for not informing patients of the symptoms and signs that would have alerted the patients to seek further medical attention, referred to as an informed discharge discussion. (Jun 15, 2007) Earn CME credits

Tips to avoid trouble (tips 4, 5, 6)
The importance of care in prescribing, documenting and following up. (Dec 1, 2007)

Informed Discharge
Patients can better take responsibility for their own care if they are told how to recognize symptoms indicating the need for further medical attention. (Jun 1, 2006, Revised: Apr 22, 2008)

College decision: Talking to patients about a complication
When complications occur, it is important to discuss them with the patient even if they are an accepted risk of the intervention. (Dec 1, 2007)

Could the patient be pregnant?
A review of medico-legal problems related to patients who are unknowingly pregnant and have been exposed to investigations and treatments recognized to possibly harm a fetus. (Mar 17, 2011)

"Doc, I can't wear a seatbelt!"
Responding to patient requests for exemptions to wearing a seatbelt while driving. (Dec 1, 2010)

Surgical safety checklists: A team approach to patient safety
The use of a surgical safety checklist should decrease the risk of adverse events and surgical complications by fostering a patient safety mindset and encouraging team communication. (Oct 1, 2010, Revised: Dec 13, 2010)

Lung cancer — The challenge of a timely diagnosis
Suggestions to reduce risk and optimize the timely diagnosis of lung cancer. (Oct 1, 2010)

Medication dosing challenges in the paediatric population
Risk management suggestions for safer paediatric medication practices. (Mar 16, 2010)

Aminoglycoside therapy: Balancing risk versus benefit
Aminoglycosides are effective antimicrobial drugs but can have serious adverse effects. Indications, alternatives, dose, duration and co-morbidities are some of the important considerations. (Dec 17, 2008)

Hyponatremia in children
Hyponatremia may occur during rehydration or with maintenance fluids, and can have serious adverse effects, including neurologic impairment and death. (Dec 17, 2008)

Tips to avoid trouble (tips 10, 11, 12)
Important considerations in providing telephone advice; issues to consider when transferring the care of a patient. (Sep 1, 2008)

Specimen and Report mix-ups
Pathological examination of a surgical specimen is the mid-point of a complex process involving many people. Mix-ups can occur at any point in the process, with adverse effects for patient and difficulties for health-care personnel. (Dec 1, 2007)

Lung cancer — The challenge of a timely diagnosis
Suggestions to reduce risk and optimize the timely diagnosis of lung cancer. (Oct 1, 2010)

Tips to avoid trouble (tips 10, 11, 12)
Important considerations in providing telephone advice; issues to consider when transferring the care of a patient. (Sep 1, 2008)

Tips to avoid trouble (tips 7, 8, 9)
Effective verbal or written communication with patients and with other health care professionals is a two-way process, and confidentiality is always an issue. (Jun 2, 2008)

Communication vital when transferring care of a patient
The importance of communicating a patient's condition and anticipated treatment plan when transferring care to another physician. (Dec 1, 2005, Revised: May 2, 2008)

Anatomy of a well-written note
Avoid medico-legal difficulties by writing factual and objective notes. (Mar 1, 2005, Revised: May 12, 2008)

Forms and reports: the case for care
Reports and medical records should be complete, objective, accurate and compliant with legislation. (Jun 1, 2002, Revised: Apr 10, 2008)

Nurses' notes and communication
Documenting communications with other health care professionals is helpful for good patient care and reduces medico-legal risk. (Dec 1, 2000, Revised: Apr 7, 2008)

Reducing your risk when you're not available
Clear messages regarding physician availability help reduce medico-legal risk. (May 1, 2000, Revised: Apr 7, 2008)

The importance of inter-specialty communication
Communication among team members facilitates good patient care. (Jan 1, 2000, Revised: Feb 27, 2008)

More Telephone Problems
A case illustrates why it is important to take a sufficient history during a telephone call. (Nov 1, 1998, Revised: Jan 1, 2011)

Transfer of care can create problems
Advice to decrease medico-legal difficulties in shared care. (Jun 1, 1997, Revised: May 2, 2008)

Informal telephone advice
When providing advice informally to others or over the telephone, obtain sufficient information on which to base your professional opinion, as they may rely on the advice. (Mar 1, 1996, Revised: Jan 1, 2011)

Ensuring report distribution
An ECG report of an acute myocardial infarction was not distributed to the ordering or subsequent treating physicians, contributing to the patient's premature death. (Mar 1, 1996, Revised: Jan 1, 2011)

Delegation and supervision eLearning activity
Medical trainees acquire hands-on experience when a supervising physician delegates tasks and increasing levels of responsibility to the trainee. This eLearning activity presents medico-legal case studies and tips to show how problems can be minimized if the delegation is appropriate and the supervision of the trainee is adequate. (Sep 30, 2008) Earn CME credits

Delegation and supervision of medical trainees
Risk management considerations for supervising physicians, and supervised residents and other trainees. (Sep 1, 2008, Revised: Oct 21, 2008)

When a physician feels intimidated
Dealing with intimidation by patients and their families, colleagues and other professionals. (Dec 1, 2002, Revised: Apr 10, 2008)

When joking isn't funny
Respect and observation of professional boundaries allows you to express concerns about patient care without fear of reprisal. (Mar 1, 1999, Revised: May 1, 2008)

Reporting of gunshot and stab wounds
Several provinces have legislation requiring hospitals and healthcare facilities to report gunshot wounds; some also require reporting of stab wounds. Physicians should be aware of the legislation in their jurisdiction and the policies and procedures in their facilities, and disclose only the information required to permit the hospital to fulfill its obligation. (Apr 28, 2009)

When the loss of independence can save a life!
Legal and societal obligations to report drivers who may be unfit to drive. (Mar 1, 2007)

Anatomy of a well-written note
Avoid medico-legal difficulties by writing factual and objective notes. (Mar 1, 2005, Revised: May 12, 2008)

Providing medical records to coroners
What to do when a Coroner asks for clinical records. (May 1, 2000, Revised: Feb 28, 2008)

Physician interactions with police
An overview of a physician's duty to maintain confidentiality and protect the privacy of patients' personal health information in instances of disclosure requests from third parties, including the police or other authorities. (Mar 17, 2011)

Medication dosing challenges in the paediatric population
Risk management suggestions for safer paediatric medication practices. (Mar 16, 2010)

Anticoagulant, antiplatelet agent and thrombolytic therapy: A medico-legal perspective
An overview of the medico-legal difficulties associated with the use of anticoagulant, antiplatelet and thrombolytic agents (Jun 17, 2009)

Hyponatremia in children
Hyponatremia may occur during rehydration or with maintenance fluids, and can have serious adverse effects, including neurologic impairment and death. (Dec 17, 2008)

Aminoglycosides — A fine balance
Appropriate use of aminoglycosides requires awareness of the potential side effects and their symptoms. (Jun 2, 2008)

The complexity of psychotropic medication
Some of the medico-legal issues related to prescribing psychotropic medications are identified. (Mar 1, 2008)

Use Caution when treating patients for chronic non-malignant pain
Because patients with chronic pain often have co-morbidities and consultative resources are limited, treatment poses a problem for many family physicians. (Mar 1, 2006, Revised: Aug 28, 2008)

Steroid eye drops: Use caution in repeating prescriptions
Exercise caution in repeating prescriptions. (Jun 1, 2004, Revised: Apr 7, 2008)

Collaborative care and medication monitoring: Who's responsible?
Monitoring medications in shared care. (Jun 1, 2003, Revised: Apr 11, 2008)

Adverse medication events
Misidentification of medications and/or incorrect dosage or route of administration may cause severe harm to patients. (Mar 1, 1995, Revised: Feb 26, 2008)

Why good documentation matters
Poor charting may be perceived as reflecting less attention to detail and risks the conclusion the care provided was poor. (Mar 17, 2011)

Medication dosing challenges in the paediatric population
Risk management suggestions for safer paediatric medication practices. (Mar 16, 2010)

Protecting sensitive electronic health information — think encryption
Theft or loss of electronic devices containing patient information could breach privacy laws as well as breach patient confidentiality. Encryption and password protection can protect against both breaches. (Sep 3, 2007)

Anatomy of a well-written note
Avoid medico-legal difficulties by writing factual and objective notes. (Mar 1, 2005, Revised: May 12, 2008)

Keep privacy in mind when disposing of test reports
It is important to properly dispose of test reports. (Dec 1, 2004, Revised: May 2, 2008)

Physicians and the Firearms Act: a dilemma
Considerations in responding to patients' requests for support in acquiring firearms. (Dec 1, 2001, Revised: Jul 22, 2008)

Physicians' notes help decide the outcome
Documentation of the care provided is pivotal to a successful defence. (Oct 1, 2001, Revised: Apr 10, 2008)

Put it in writing, with care
Documentation in clinical notes and in reports to third parties should be factual, objective, and appropriate to the purpose. (Oct 1, 2001, Revised: Aug 28, 2008)

Put it in writing, the sooner the better
Timely recording of information in the medical record is invaluable when questions arise. (May 1, 2000, Revised: Apr 10, 2008)

Good notes vs bad notes
Tips for producing good documentation (Jan 1, 2000, Revised: Apr 7, 2008)

Cautionary tales: telephone advice
Carefully document telephone advice even if a patient rejects it. (Mar 1, 1998, Revised: May 1, 2008)

Clinical practice guidelines— Guidance or a standard of practice?
Most physicians agree that clinical practice guidelines (CPG) can improve the quality of clinical care. In a legal case, however, a court may place more weight on the standard of care of a "prudent colleague" than on a CPG. (Mar 17, 2011)

Public health emergencies and catastrophic events
Protection against medico-legal risk for physicians during emergencies that overload health resources. (Mar 1, 2008)

Protecting privacy when treating extended families
Physicians who treat multiple members of a family may be at risk for breach of confidentiality (Jun 1, 2006, Revised: Aug 28, 2008)

Suspecting sepsis in asplenic patients
Bacterial sepsis a concern for asplenic patients. (Dec 1, 2002, Revised: Feb 26, 2008)

About the risk of co-signing US prescriptions
Physicians co-signing US prescriptions may not be eligible for CMPA assistance in the event of a suit in the US. (May 1, 2000, Revised: Apr 10, 2008)

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