Advice on effective communications with patients and managing their expectations to help prevent conflicts 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.
Physicians who are familiar with regulatory requirements governing organ and tissue donations can more effectively meet their obligations and mitigate the potential for complaints.
Professional and ethical obligations to keep in mind when considering offering medical services through online virtual clinics.
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 results from ED crowding and can present unique medico-legal risks for ED physicians.
When patients make requests for specific care providers, treatments, or services, physicians should assess whether they can reasonably accommodate such requests.
Advice for physicians on applying resource allocation and ethical decision-making protocols when rationing scarce healthcare resources amid COVID-19.
An overview of obligations and issues for doctors when providing or discussing vaccinations with patients or legal guardians.
A review of CMPA medical-legal cases and research literature describing the non-technical factors contributing to diagnostic errors by surgeons in hospital operating rooms.
An overview of ways in which physicians can use patient decision aids (PDAs) to encourage shared decision-making.
An overview of issues physicians need to consider when conducting treatment or non-treatment capacity assessments.
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.
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.
Documentation in clinical notes and reports to third parties should be factual, objective, and use a suitable tone of medical professionalism.
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.
A look at how the legalization of recreational marijuana may affect physicians’ practices, including whether it will eliminate patients’ requests for medical marijuana.
Practical suggestions for disclosure of discrepancies stemming from pathological analysis or diagnostic imaging.
A review of CMPA member enquiries following the legalization of cannabis for recreational use reveals that the new regulatory regime has generally not had a significant medical-legal impact for our members.
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.
Certain provinces have legislation to prevent apologies for adverse events from being used in court proceedings.
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.
An overview of the principles of retention, sharing and transferring of medical records.
An overview of information privacy considerations when using electronic medical records in practice.
Guidance for specialists on their ethical and professional responsibilities in accepting to care for new patients.
Physicians should understand the role of coroners and medical examiners in Canada,
and how and when to provide information to them.
Explanation of physicians’ mandatory and discretionary obligations to report patients who have a medical condition that may make it dangerous for them to drive.
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.
A review of CMPA medical-legal cases involving spinal surgery performed by a neurosurgeon or orthopaedic surgeon with risk management strategies for all phases of surgical care.
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.
Polices introduced by the medical regulatory authorities (Colleges) reflect concerns expressed by some in the medical community about the use of marijuana for medical purposes and the challenging role given to physicians and other healthcare providers.
A discussion of physicians’ obligations when certifying a patient’s death.
Physicians can successfully manage online ratings using a reasonable and measured approach.
Guidance for physicians on assessing whether a chaperone is right for their practice.
Physicians treating pregnant patients should be knowledgeable about the developments in prenatal testing and the current standards of practice, and be able to communicate testing information so patients can make informed decisions on the future of their pregnancy.
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.
CMPA gives advice to physicians travelling across international borders and having border agents search mobile electronic devices, such as smartphones, that may contain confidential patient information.
Strategies for managing the stress associated with transitioning to a new EMR system for managing patient records.
Physicians acting as clinical supervisors play a valuable role in the remediation of physician colleagues and, as members of the CMPA, are eligible for the Association’s assistance if medico-legal difficulties arise.
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.
The CMPA analyzes members’ calls and medical-legal questions about opioid treatment of patients suffering chronic non-cancer pain.
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.
Highlights from CMPA discussion paper “The role of physician leaders in addressing physician disruptive behaviour in healthcare institutions.”
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
Any medical procedure where instruments are inserted into the mouth may result in dental injury, and physicians should inform patients of this risk and appropriately disclose the injury if it occurs.
Physicians supervising medical trainees must keep in mind their responsibilities to patients when delegating tasks to trainees.
Physicians can be better prepared to transfer patient health information when they understand who has custody of and access to medical records.
A review of medical-legal cases involving complications of cholecystectomy.
Individuals have a general right to access their personal information in independent medical examination files, but there are exceptions to what must be produced
Tips for physicians to help prevent drug diversion and related unlawful prescription activity, and avoid potential medical-legal difficulties.
Physicians may release a patient’s medical records to lawyers only with patient authorization or where required by law.
Physicians working with medical scribes should be aware of their obligations as an employer, delegator, and supervisor.
Physicians, other healthcare professionals, and health system leaders are encouraged to actively seek out patients’ perspectives to improve healthcare planning and delivery.
EHR and EMR technologies change the way medical care is delivered, creating both opportunities and challenges for healthcare providers.
Adequate record keeping may help during a billing audit.
Physicians should try to accommodate patients’ requests to limit access to their personal health information.
Greater clarity in patient care can be achieved through healthcare directives, and when physicians understand their purpose and the rules governing them.
Considerations to help prevent and mitigate the damage arising from ransomware attacks to computer systems.
Disruptive behaviour in the healthcare workplace can take a toll on co-workers and patients, but conflict may be reduced by using a disarming approach.
Online social networks in healthcare provide a means for worldwide collaboration among physicians, but participants should maintain the standards of professionalism expected of the profession.
Physicians should speak with patients about their alternative medicine treatments and, as much as possible, provide guidance on potential negative interactions.
Physicians can take steps to mitigate the medical-legal risks of patients taking photos and making video and audio recordings during healthcare encounters.
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.
The management of elder abuse cases is an increasingly important aspect of physicians’ practices, though determining the appropriateness of actions to address suspected abuse can be challenging.
How physicians can take steps to minimize medical-legal risk when using mobile health applications (mHealth) in their practice.
By practising in a collegial manner, physicians may enhance the health outcomes of their patients and themselves.
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.
A discussion of consent issues that may arise when caring for adults with diminished mental capacity (competency).
Physicians can work collaboratively with physician assistants, but should be aware of the potential risks inherent in this working relationship and how these can be managed.
Patient handovers can be a time of high risk. Patient safety experts recommend various strategies to improve the performance of this task.
A review of the most recent 5 years of CMPA medical-legal cases involving cosmetic procedures identified a number of consent deficiency issues.
Protecting the privacy of patient information when using digital communication channels, including email, portals, and social media platforms.
While workplace conflict is inevitable, there are steps physicians can take to de-escalate and resolve disputes before they impact patient care.
Physicians in non-surgical disciplines who perform invasive procedures may be exposed to medical-legal risks, though these can be effectively mitigated.
The CMPA recommends that member physicians and others working in healthcare adjust the default privacy options of Microsoft 10 to obtain greater control over their personal and patient information and address potential privacy concerns.
Hip or knee arthroplasty can greatly improve quality of life, yet it may also have significant risks.
A discussion of the principles of access, the challenges with access, and managing the risks.
Physicians providing emergency care as good Samaritans often have questions about their legal and ethical obligations and the liability protection available to them.
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.
Considerations for ending the doctor-patient relationship.
After day surgeries, consider if patients are ready for discharge, require accompaniment on leaving the facility, and have sufficient discharge and follow-up instructions.
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).
Increasingly medical education is focusing on physician competencies that address safe patient care and that enable more accurate assessment of performance.
An analysis of recent CMPA cases highlighting the medico-legal risks associated with surgical ureteric injury.
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.
Tips to assist physicians in communicating effectively with patients and their families when a patient’s prognosis is terminal.
A review of hospital-based patient safety incidents and common reasons leading to them.
Physicians’ office staff can contribute to safe care for patients and reduce medico-legal risk. This article reviews several issues identified in the CMPA medico-legal files and provides suggestions on reducing risk.
Physicians can take steps to avoid conflicts of interest that can arise when dealing with commercial interests.
Providing patients with online access to their electronic medical records may offer improvements in patient health. Physicians should keep in mind their obligations to protect patient information and document appropriately.
Adequate discharge strategies to help reduce the risk of unplanned hospital readmissions, unfavourable patient outcomes, and medico-legal problems for physicians.
When patients suffer harm from healthcare delivery, physicians will want to disclose the incident to the patient, and if the media become interested, then prepare appropriately.
Highlights of medico-legal issues associated with anaesthesia and analgesia administered by anesthesiologists for surgery and during labour and delivery.
Physicians can successfully manage online ratings using a reasonable and measured approach.
Case studies related to boundary crossings and violations.
A case study illustrating the legal concepts of informed consent and of battery (or “a violation of the integrity of the person” under Québec’s civil law).
Physicians participating in clinical research studies should be aware of their relevant legal, ethical, and professional obligations.
Physicians have an obligation to protect patient information and can take steps to help prevent privacy breaches associated with sending and receiving faxes.
A review of problems, pitfalls, and emerging liability issues with the use of electronic patient records
Effective communication and awareness of legal requirements are key to obtaining consent for treatment of children.
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.
The circumstances under which physicians can treat themselves, family and friends are limited.
A practical resource for physicians, describing the implementation and use of electronic medical records (EMRs) and electronic health records (EHRs), including benefits, technological issues, and medico-legal risks.
This article discusses what physicians can do to deliver culturally competent and culturally safe medical care.
How to better manage the risk of patient harm, adverse birth outcome, and potential medico-legal problems associated with the administration of oxytocin during labour.
Physicians should carefully reassess patients who return with symptoms that are not resolving as expected or are worsening.
A review of CMPA medico-legal cases involving feeding tube placement identifies clinical situations of higher risk that can affect patients and physicians.
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.
An analysis of the CMPA’s pediatric medicolegal cases identified a
number of common factors that resulted in poor clinical outcomes.
Recognizing and eliminating biases and prejudice contributes to safer medical care.
Assisting prospective parents seeking to adopt a child from abroad can pose challenges for physicians, particularly when they are asked to assess a child’s condition without a physical examination or to prescribe medication for a child with whom they do not have a doctor-patient relationship.
A review of medico-legal problems associated with hernia repairs in the preoperative, intra-operative, and post-operative stages.
A physician must provide certain information to patients to obtain informed consent, even for simpler procedures and treatments.
The practice of medicine is undergoing unprecedented change.
Physicians assume key responsibilities in healthcare including the provision of much needed medical care, research into new treatments, teaching the future generation of doctors, and managing healthcare facilities, centres, or clinics.
As healthcare delivery relies increasingly on integrated or collaborative care, a growing number of physicians are working in teams composed of physicians and other healthcare professionals.
To respond appropriately to a request to release patient information, physicians must understand the legal rules surrounding the ownership and handling of the information.
Trust, loyalty, and honesty are the foundations of a good doctor-patient relationship and of professionalism in the practice of medicine.
Medico-legal issues for ophthalmologists related to the pre-operative, intra-operative, and post-operative periods of cataract surgery.
A review of medico-legal cases concerning diagnosis and management of skin cancer.
Strategies to reduce medico-legal risk when prescribing medications or using medical devices outside of their licensed indications.
As the healthcare environment continues to change, physicians remain committed to quality patient care, while keeping in mind accompanying risk management considerations.
Engaged and empowered patients take an active role in managing their healthcare, and physicians must be aware of the medico-legal implications.
A review of the medico-legal issues with bariatric surgery in the pre-operative, intra-operative, and post-operative periods
A complaint to a medical regulatory authority (College) initiates a process that warrants a physician's attention and timely response.
Risk management suggestions related to verbal and written communication in the trauma setting and when resources are limited.
Risk management suggestions from an analysis of medico-legal cases related to the diagnosis of trauma patients.
A review of medico-legal problems related to malfunctions, improper use, and deficiencies in training and supervision when using medical or surgical equipment.
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.
Physicians should be prepared to respond to patient enquiries about complementary and alternative medicine and natural health products.
As the Canadian population ages, physicians may need to adjust their practices to better meet the needs and expectations of older adults and avoid potential medico-legal risks.
Litigation related to the placement of central lines is most often related to consent, delegation, standard of care, and documentation.
Privacy legislation and policies set the foundation for safeguards to maintain confidentiality of patient information.
There are a number of steps that can be taken to reduce the likelihood of patient dissatisfaction with Independent Medical Evaluation.
Physicians undertaking clinical research are expected to obtain valid consent.
A review of medico-legal problems related to prescribing and monitoring medications for older patients.
A discussion on how members can help meet the clinical, emotional and informational needs of patients after large scale adverse events.
Responsibilities of physicians when planning to close or leave a practice due to retirement, illness, or other reasons.
An exploration of privacy and consent issues when using clinical images or recordings of patients to teach medicine.
Responding to patient requests for exemptions to wearing a seatbelt while driving.
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).
A review of some of the medico-legal risks related to the use of medical directives in emergency departments, and patients who LWBS by a physician or sign out AMA.
In the case of E. (Mrs.) vs. Eve (1986), the Supreme Court of Canada established limitations related to therapeutic sterilization of mentally incapable (incompetent) patients.
Intoxicated patients pose special risks in the emergency department because of their behaviour, and the difficulty of adequate assessment and treatment.
It is well recognized that health care providers continuously strive to ensure the best possible clinical outcomes for their patients. They do so cognizant that no one individual or system can ever fully eliminate the risk and occurrence of adverse events
Delays in the diagnosis of ectopic pregnancies may lead to poor patient outcomes and medico-legal difficulties for physicians.
Risk management considerations for supervising physicians, and supervised residents and other trainees.
Considerations in responding to patients' requests for support in acquiring firearms.
Passport applications no longer need to be signed by specified professionals, and when signing certain personal information must be included.
Appropriate use of aminoglycosides requires awareness of the potential side effects and their symptoms.
A study examining the medico-legal risks of airway management by anaethesiologists from 1993 — 2003.
The physician's role in providing a child's medical information to a parent.
Physicians may be asked to attest to the capacity of a patient if the patient's will is contested or at the time the will is being prepared.
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
Clinical care is increasingly provided by collaborative teams with the promise of better outcomes for patients. This document identifies potential medico-legal risks in collaborative care and proposes solutions to lessen those risks for patients and providers.