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Managing risk in office practice

This page is your starting point to CMPA's articles on managing medico-legal risk in office practice settings.

Policies and procedures

Physicians should establish appropriate policies and procedures in their office practices to help ensure efficiency while maintaining a high level of patient safety and limiting exposure to medico-legal risk.

A safe working environment encompasses not only the safety of patients, but also of staff — for example, the prevention of violence. Physicians in office practice are encouraged to take stock of risks and dangers in their workplace. This includes taking steps to ensure that medical equipment is properly maintained, is in good working order, and is used properly. Providing care in unfamiliar settings, such as when doing house calls, also carries challenges and potential risks.

Wait times is an ongoing issue with potential medico-legal implications, particularly in the areas of cancer and cardiac care, diagnostic imaging, joint replacement, and vision restoration. One way some physicians in office practice try to keep pace with increasing patient volumes is to limit patient visits to one medical issue, and post notices in their offices to that effect.

Many patients are increasingly obtaining episodic care at walk-in clinics and emergency departments, sometimes creating confusion regarding physicians' responsibility for follow-up of investigations and laboratory reports. Regardless of where the care takes place, physicians ordering investigations have a duty to communicate the results to the patient and to make reasonable efforts to ensure appropriate follow-up is arranged.

Occasionally physicians may encounter situations where a prescription pad is lost or stolen, a narcotic or controlled drug goes missing from a clinic's stock, or a pharmacy reports a suspected prescription forgery by a patient. Physicians faced with these situations should take the necessary actions while maintaining patient confidentiality. Similarly, physicians should be wary of patient requests for narcotic prescriptions.

Paperwork — not just for administrators

Timely and accurate paperwork is more than just an important component of a physician's work: it maintains good doctor-patient relationships and helps to avoid medico-legal difficulties.

Physicians have a professional responsibility to fill out patient forms, such as insurance forms, in a timely manner and in keeping with their medical regulatory authority's (College) recommendations.

To help avoid allegations of negligent misrepresentation in medico-legal reports, physicians are advised to take care in the preparation of medico-legal reports and avoid making potentially misleading statements.

Patients who believe that marijuana is an effective treatment for certain symptoms can apply for authorization to possess and use marijuana under the Marihuana Medical Access Regulations. The CMPA recommends that physicians who complete the medical declaration request the patient to sign the CMPA's "release from liability" form.

Physicians are often asked to sign contracts with employers, research organizations, governments, or healthcare agencies. These contracts may include a clause requiring the physician to indemnify the other party for any losses it may sustain as a result of that physician's work, which in some cases may be unfair to physicians. It is advisable for physicians to have their own lawyer review and advise them on such contracts.

Leaving your practice

There comes a time in every physician's career when you leave your practice due to retirement or other reasons.

In "Estate planning — Prepare a will and make a plan," learn how to plan for unexpected illness or death such as making arrangements to notify the organizations of which you are a member, including the CMPA.

In "Considerations when leaving a medical practice," learn about notifying patients and transferring their medical records to ensure a smooth closing of your practice, whether that is due to relocation of your practice, retirement, or planning for illness or death.