Duties and responsibilities

Expectations of physicians in practice
Why do you need to know? A balancing act for accessing personal health information
Physicians may face a privacy breach when viewing personal health information that is not required for current clinical care and without the patient’s or information custodian’s consent.
Physician incivility in the healthcare workplace
A review of the impact of incivility in healthcare workplaces.
When a patient fakes or alters a test requisition
Steps physicians can take if they receive results of a lab test they did not request.
Preparing expert opinion reports
Advice for Canadian doctors on how to prepare an expert opinion report.
Preparing treating physician reports and IME reports
Physicians who respond affirmatively to a request for a medical-legal report should prepare the report with care and in keeping with their College’s policies and guidelines.
Texting safely about patient care: Strategies to minimize the risks
Text messaging offers the potential for improved communication among physicians and healthcare teams, and using it appropriately can mitigate some of the inherent risks of this channel.
Workplace injuries: The duty to report when your patient is an injured worker
Reporting obligations when a patient presents with a workplace injury.
Completing medical certificates of death: Who’s responsible?
A discussion of physicians’ obligations when certifying a patient’s death.
Protecting children — Reporting child abuse
If physicians have reason to believe a child is in need of protection, they are responsible for informing the appropriate authority in a timely manner. Planning what to say to the family is important.
Online physician reviews: How to manage your virtual presence
Physicians can successfully manage online ratings using a reasonable and measured approach.
Accepting new referrals: Advice for all physicians
Guidance for specialists on their ethical and professional responsibilities in accepting to care for new patients.
Media requests: Points to consider if you are asked for an interview
Points for physicians to consider if a journalist asks for an interview.
Providing quality end-of-life care
End-of-life treatment decisions can be difficult for both physicians and patients, but many issues can be avoided by following the key concepts outlined.
The continuing evolution of medical assistance in dying
An update on the evolving rules and processes around MAID.
Privacy requirements are getting stricter: What physicians need to know
An overview of changes to federal and provincial privacy laws.
AI Scribes: Answers to frequently asked questions
Answers to questions physicians have been asking about the use of AI scribe services
Recording clinical encounters with patients: What physicians need to know
When physicians wish to record a clinical encounter, they should first obtain express consent from the patient and have in place security measures to ensure confidentiality.
The physician as teacher: What are the responsibilities?
Physicians supervising medical trainees must keep in mind their responsibilities to patients when delegating tasks to trainees.
When to disclose confidential information
Physicians owe patients a duty to keep their personal health information confidential, yet there are times when this conflicts with other statutory duties or with concerns for public safety.
Did you know? You need authorization to provide medical records to lawyers
Physicians may release a patient’s medical records to lawyers only with patient authorization or where required by law.
Can border agents search your mobile device?
Advice for physicians travelling across international borders and carrying devices that may contain patient information.
Is it time to rethink your use of chaperones?
Guidance for physicians on assessing whether a chaperone is right for their practice.
Advance care planning: The key to person-centred end-of-life care
Physicians should consider encouraging patients to engage in advance care planning and appointing a substitute decision-maker early, before the patient no longer has the capacity to consent to end-of-life care.
Closing or leaving a practice: Tips for physicians
Responsibilities of physicians when planning to close or leave a practice due to retirement, illness, or other reasons.
Do you need to report another health professional?
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).
Doctors’ certificates: Real or fake?
How to respond to queries seeking to verify the authenticity of doctors’ certificates.
Using fax in your practice? Ten ways to reduce privacy risks
Suggested ways that physicians can reduce the risk of privacy breaches when using fax to communicate confidential patient information.
Using clinical photography and video for educational purposes
An exploration of privacy and consent issues when using clinical images or recordings of patients to teach medicine.
Physicians and research: Understanding your obligations
Physicians participating in clinical research studies should be aware of their relevant legal, ethical, and professional obligations.
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.
Responding to requests for children's medical records
The physician's role in providing a child's medical information to a parent.
Understanding how Colleges handle complaints or allegations of professional misconduct
A complaint to a medical regulatory authority (College) initiates a process that warrants a physician's attention and timely response.
Family disputes and the physician: Staying focused on safe care
Physicians can take reasonable steps to maintain the best interests of the patient in the midst of family disputes concerning the care of children or of elder patients.
Writing with care
Documentation in clinical notes and reports to third parties should be factual, objective, and use a suitable tone of medical professionalism.
How to reduce the risks of procedure-based dental injury
Steps that physicians can take to reduce the risk of dental injury to patients.
Genetic testing — What are physicians’ options and obligations?
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
Addressing disruptive behaviour from other physicians
Highlights from CMPA discussion paper “The role of physician leaders in addressing physician disruptive behaviour in healthcare institutions.”
Providing access to independent medical examinations
Individuals have a general right to access their personal information in independent medical examination files, but there are exceptions to what must be produced
Ending the doctor-patient relationship
Considerations for ending the doctor-patient relationship.
When can you safely delegate?
A summary of key principles relating to safe delegation.
Reporting a privacy breach: What are your responsibilities?
Addressing privacy breaches has become more complex as the rules around notifying and reporting have recently changed or are about to change across the country.
Suspect unlawful activity with prescriptions or medications? Here’s how to respond
Tips for physicians to help prevent drug diversion and related unlawful prescription activity, and avoid potential medical-legal difficulties.
Who has custody of medical records, and who can they be shared with?
Physicians can be better prepared to transfer patient health information when they understand who has custody of and access to medical records.
Deceased patients’ medical records: When can they be disclosed?
Considerations for physicians when responding to requests for deceased patients’ medical records.
Managing access to electronic health records
A discussion of the principles of access, the challenges with access, and managing the risks.
Smartphone recordings by patients: Be prepared
Physicians can take steps to mitigate the medical-legal risks of patients taking photos and making video and audio recordings during healthcare encounters.
Fitness to participate: Reduce your risk when patients ask for a certificate of fitness
An overview of how to reduce medico-legal risks when completing fitness to participate forms.
Responding to an incident that affects multiple patients
Guidance for providing disclosure following harmful incidents in which more than one patient is affected.
Understanding the role of coroners and medical examiners
Physicians should understand the role of coroners and medical examiners in Canada, and how and when to provide information to them.
How to manage your medical records: Retention, access, security, storage, disposal, and transfer
An overview of the principles of retention, sharing and transferring of medical records.
Know the rules, avoid the risks: Treating family and friends
The circumstances under which physicians can treat themselves, family and friends are limited.
Helping patients make informed decisions
This article explores the role of physicians in promoting the exchange of information and active decision-making by patients. It also examines the relationship between decision-making and consent.
Protecting patient privacy when delivering care virtually
Protecting the privacy of patient information when using digital communication channels, including email, portals, and social media platforms.
Healthcare directives: What you really need to know
Greater clarity in patient care can be achieved through healthcare directives, and when physicians understand their purpose and the rules governing them.
Cybersecurity threats: Are you prepared?
How doctors can help protect their information technology systems from cybersecurity threats and what they should do in the event of a cybersecurity incident.
Hit the brakes: Do you need to report your patient’s fitness to drive?
Explanation of physicians’ mandatory and discretionary obligations to report patients who have a medical condition that may make it dangerous for them to drive.
“I’m sorry this happened.” Understanding apology legislation in Canada
Certain provinces have legislation to prevent apologies for adverse events from being used in court proceedings.
Continuity of care: Helping patients avoid falling through the cracks
The Colleges outline expectations for continuity of care, and physicians can enhance continuity when they are aware of their professional obligations, and have the necessary systems in place for managing tests, patient transfers, and availability and coverage.
A team’s approach to patient communication can improve the surgical journey: Three strategies for physicians
A review of CMPA medico-legal cases showed opportunities for physicians to improve their communication and coordination of care for patients undergoing non-urgent in-hospital surgery.
Did you know? Patients can restrict access to their health information
Physicians should try to accommodate patients’ requests to limit access to their personal health information.
Navigating triage protocols amid COVID-19
Advice for physicians on applying resource allocation and ethical decision-making protocols when rationing scarce healthcare resources amid COVID-19.
Resolving conflict between healthcare providers
An overview of communication strategies physicians can use to help resolve conflict with other physicians or other healthcare providers.
"Dictated but not read": Unreviewed clinical record entries may pose risks
The practice of marking transcribed reports or entries “dictated but not read” gives rise to medical-legal risks and can create uncertainty for those relying on that information in providing patient care.
Patient portals—Considerations for safety and medico-legal risk
Actions physicians can take to mitigate potential risks of using patient portals to communicate clinical information with patents.
Age of consent for sexual activity and duty to report
Changes to the Criminal Code have raised the age of consent for sexual activity. Physicians should be guided by legislation in each province and territory on their duty to report such activity to the appropriate authorities if there are reasonable grounds to believe the child is being abused.
Are there risks to acting as a good Samaritan?
Physicians providing emergency care as good Samaritans often have questions about their legal and ethical obligations and the liability protection available to them.
Vaccinating: Doing it safely, and addressing vaccine hesitancy and refusal
The CMPA advises on how to reduce medico-legal risks from vaccination, and how to address vaccine hesitancy and refusal.
Can a child provide consent?
Effective communication and awareness of legal requirements are key to obtaining consent for treatment of children.
How to manage conflict and aggressive behaviour in medical practice
Physicians regularly encounter patients or family members who behave aggressively and make demands that may be unrealistic and potentially harmful. In their medical practice, physicians need strategies and tools to manage conflict and such challenging behaviours.
Organ and tissue donation: Who has the final say?
Physicians who are familiar with regulatory requirements governing organ and tissue donations can more effectively meet their obligations and mitigate the potential for complaints.
Thinking of working with virtual clinics? Consider these medical-legal issues
Professional and ethical obligations to keep in mind when considering offering medical services through online virtual clinics.
Safe care amid the pandemic—virtually and in person
Physicians should use their professional judgment when determining whether a virtual assessment, an in-person assessment, or a hybrid of both is best for individual patients.
Ambulance offload delay at the emergency department: Clarifying your duty of care
Ambulance offload delay results from ED crowding and can present unique medico-legal risks for ED physicians.
Is this patient capable of consenting?
A discussion of consent issues that may arise when caring for adults with diminished mental capacity (competency).
When patients make special requests, how should you respond?
When patients make requests for specific care providers, treatments, or services, physicians should assess whether they can reasonably accommodate such requests.
Can intraoperative decisions be diagnostic errors?
A review of CMPA medico-legal cases and research literature describing the non-technical factors contributing to diagnostic errors by surgeons in hospital operating rooms.
Engaging patients in their own care: Patient decision aids
An overview of ways in which physicians can use patient decision aids (PDAs) to encourage shared decision-making.
Capacity assessments: Understanding the challenges for physicians
An overview of issues physicians need to consider when conducting treatment or non-treatment capacity assessments.
When physicians feel bullied or threatened
Physicians can take steps to address bullying and other abusive behaviours they may be subjected to by patients and their families, colleagues and other healthcare workers, and third parties.
My patients, my records?
Practising physicians, particularly those at the beginning of their career, should ensure they have enduring access to medical records after leaving a practice for medical-legal purposes.
Managing stress when transitioning to new electronic record systems
Strategies for managing the stress associated with transitioning to a new EMR system for managing patient records.
Leadership essentials: Creating a culture of accountability
Physician leaders who foster a culture of accountability in their teams and institutions help promote learning from undesirable behaviours that include human error, and at-risk and reckless behaviour.
Disclosing harm from healthcare delivery: Open and honest communication with patients
This publication provides guidance and good practices about physician communications with patients concerning the disclosure of harm stemming from healthcare delivery, and aligns with the Canadian Patient Safety Institute’s (CPSI) Canadian Disclosure Guidelines (2011).

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.