Duties and responsibilities

Expectations of physicians in practice
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.
The ransomware threat: Are you prepared?
Considerations to help prevent and mitigate the damage arising from ransomware attacks to computer systems.
Disarming statements can lessen conflict in the healthcare workplace
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.
Social networks in healthcare: Opportunities and challenges for a connected future
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.
Providing medical records to patients seeking alternative medicine
Physicians should speak with patients about their alternative medicine treatments and, as much as possible, provide guidance on potential negative interactions.
Smartphone recordings by patients: Be prepared, it’s happening
Physicians can take steps to mitigate the medical-legal risks of patients taking photos and making video and audio recordings during healthcare encounters.
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.
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.
How to address vaccine hesitancy and refusal by patients or their legal guardians
An overview of obligations and issues for doctors when providing or discussing vaccinations with patients or legal guardians.
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.
Elder abuse and neglect: Balancing intervention and patients’ right to confidentiality
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.
Smartphone, smarter physician: Safely recommending mobile health apps in your practice
How physicians can take steps to minimize medical-legal risk when using mobile health applications (mHealth) in their practice.
Collegiality promotes safe care
By practising in a collegial manner, physicians may enhance the health outcomes of their patients and themselves.
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.
"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.
Completing medical certificates of death: Who’s responsible?
A discussion of physicians’ obligations when certifying a patient’s death.
Is this patient capable of consenting?
A discussion of consent issues that may arise when caring for adults with diminished mental capacity (competency).
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.
Working with physician assistants: Collaborating while managing risks
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.
Improving patient handovers
Patient handovers can be a time of high risk. Patient safety experts recommend various strategies to improve the performance of this task.
Meeting expectations with reality: Handling consent for elective cosmetic procedures
A review of the most recent 5 years of CMPA medical-legal cases involving cosmetic procedures identified a number of consent deficiency issues.
Using electronic communications, protecting privacy
Protecting the privacy of patient information when using digital communication channels, including email, portals, and social media platforms.
Invasive, non-surgical procedures: What are the risks?
Physicians in non-surgical disciplines who perform invasive procedures may be exposed to medical-legal risks, though these can be effectively mitigated.
Conflict between physicians and what can be done about it
While workplace conflict is inevitable, there are steps physicians can take to de-escalate and resolve disputes before they impact patient care.
Fitness to drive: When do physicians have a duty to report?
An overview of medical-legal problems resulting from physicians' decisions on whether to report patients with medical conditions that may make it dangerous to drive, or from physicians' decisions on whether to support the reinstatement of a licence to drive.
Windows 10 and privacy
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.
Lessons from hip and knee arthroplasty complications
Hip or knee arthroplasty can greatly improve quality of life, yet it may also have significant risks.
Managing access to electronic health records
A discussion of the principles of access, the challenges with access, and managing the risks.
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.
Ending the doctor-patient relationship
Considerations for ending the doctor-patient relationship.
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.
Discharging patients following day surgery
After day surgeries, consider if patients are ready for discharge, require accompaniment on leaving the facility, and have sufficient discharge and follow-up instructions.
Checklist: Disclosing harm from healthcare delivery
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).
The safety performer: Putting safe care at the forefront
Increasingly medical education is focusing on physician competencies that address safe patient care and that enable more accurate assessment of performance.
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.
Recognizing the risk of ureteric injury in abdominal surgery
An analysis of recent CMPA cases highlighting the medico-legal risks associated with surgical ureteric injury.
After the diagnosis: How to communicate with terminally ill patients
Tips to assist physicians in communicating effectively with patients and their families when a patient’s prognosis is terminal.
How office staff can help reduce risk
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.
Pitfalls in assessing and treating children in hospitals
A review of hospital-based patient safety incidents and common reasons leading to them.
Commercial interests and how physicians can avoid the pitfalls
Physicians can take steps to avoid conflicts of interest that can arise when dealing with commercial interests.
Sharing records, improving care, staying safe
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.
Reducing unplanned hospital readmissions
Adequate discharge strategies to help reduce the risk of unplanned hospital readmissions, unfavourable patient outcomes, and medico-legal problems for physicians.
Medico-legal aspects of providing mental healthcare to patients
Specific risk management strategies for physicians who are providing care to patients experiencing mental health issues.
When disclosure generates media interest
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.
Recognizing boundary issues
Case studies related to boundary crossings and violations.
Online physician reviews: What’s to be done?
Physicians can successfully manage online ratings using a reasonable and measured approach.
Issues during surgery, labour and delivery: Managing the risks in anesthesiology
Highlights of medico-legal issues associated with anaesthesia and analgesia administered by anesthesiologists for surgery and during labour and delivery.
A step too far: Lessons from a recent consent case
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).
10 ways physicians can prevent privacy breaches when using fax with other healthcare professionals
Physicians have an obligation to protect patient information and can take steps to help prevent privacy breaches associated with sending and receiving faxes.
Physicians and research: Understanding the legal, ethical, and professional obligations
Physicians participating in clinical research studies should be aware of their relevant legal, ethical, and professional obligations.
Examining risk in psychiatric practice
This article focuses on the main areas of medico-legal risk for psychiatrists.
10 tips for using electronic records
A review of problems, pitfalls, and emerging liability issues with the use of electronic patient records
Medical marijuana: Considerations for Canadian doctors
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.
Can a child provide consent?
Effective communication and awareness of legal requirements are key to obtaining consent for treatment of children.
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.
Know the rules, avoid the risks: Treating family and friends
The circumstances under which physicians can treat themselves, family and friends are limited.
Electronic records handbook
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.
When physicians feel bullied: Effective coping strategies
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.
When medicine and culture intersect
This article discusses what physicians can do to deliver culturally competent and culturally safe medical care.
Managing the risks of labour induction
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.
Managing information to deliver safer care
Physicians need accurate and up-to-date information to provide effective and safe patient care, but information overload can create distraction rather than improve knowledge.
Supporting physicians as clinical supervisors
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.
Privacy: What the future holds
Physicians must stay abreast of changes related to health information privacy, contribute to privacy advancements, and comply with existing and new rules and regulations.
Practical steps to support effective compliance
Administrative and management practices, data sharing agreements, confidentiality agreements, and privacy impact assessments can help physicians to achieve compliance with their privacy obligations.
Protecting patient health information in electronic records
Tips for using electronic records and other technologies.
Stop and think — Return visits offer another chance
Physicians should carefully reassess patients who return with symptoms that are not resolving as expected or are worsening.
Genetic testing — New options, new obligations
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
Addressing physician disruptive behaviour in healthcare institutions
Highlights from CMPA discussion paper “The role of physician leaders in addressing physician disruptive behaviour in healthcare institutions.”
Common medico-legal questions asked by members
A sample of medico-legal questions posed by CMPA members to physician and legal experts at the Association's education programs.
Dealing with conflict in the doctor-patient relationship
Advice and tips on managing conflict, based on CMPA's experience in medico-legal matters, the medical literature, and consultation with experts. Practice management considerations are also discussed.
Managing risks associated with nasogastric and feeding tube insertion
A review of CMPA medico-legal cases involving feeding tube placement identifies clinical situations of higher risk that can affect patients and physicians.
Appendicitis — Lessons learned
Appendicitis in many cases remains difficult to diagnose. A review of CMPA medico-legal cases identifies many of the challenges.
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.
A matter of records: Retention and transfer of clinical records
An overview of the principles of retention, sharing and transferring of medical records.
Apology legislation in Canada: What it means for physicians
Certain provinces have legislation to prevent apologies for adverse events from being used in court proceedings.
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.
Rural practice — Strategies to reduce medico-legal risk
Physicians practising in rural and remote areas should be aware of the medico-legal risks in these circumstances.
Medico-legal vulnerabilities in cervical cancer diagnosis
An analysis of issues relevant to the diagnosis of cervical cancer and based on the 10 most recent years of CMPA closed medico-legal cases.
Overcoming bias in medical practice
Recognizing and eliminating biases and prejudice contributes to safer medical care.
International adoptions — Assisting parents and managing the risks
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.
Diagnostic delays in pediatrics
An analysis of the CMPA’s pediatric medicolegal cases identified a number of common factors that resulted in poor clinical outcomes.
Consent and minor procedures — What physicians need to know
A physician must provide certain information to patients to obtain informed consent, even for simpler procedures and treatments.
Managing the risks of hernia repair
A review of medico-legal problems associated with hernia repairs in the preoperative, intra-operative, and post-operative stages.
The voice of professionalism within the system of care
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.
Releasing a patient’s personal health information: What are the obligations of the physician?
To respond appropriately to a request to release patient information, physicians must understand the legal rules surrounding the ownership and handling of the information.
Physician professionalism — Is it still relevant?
The practice of medicine is undergoing unprecedented change.
Medical professionalism — What the future holds
The CMPA believes that medical professionalism has never been more important, both for individual physicians and for the medical community as a whole.
Respect and understanding — How professionalism affects teamwork
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.
The enduring value of trust — Professionalism with patients and families
Trust, loyalty, and honesty are the foundations of a good doctor-patient relationship and of professionalism in the practice of medicine.
Risk management in cataract surgery
Medico-legal issues for ophthalmologists related to the pre-operative, intra-operative, and post-operative periods of cataract surgery.
Risk management when using drugs or medical devices off-label
Strategies to reduce medico-legal risk when prescribing medications or using medical devices outside of their licensed indications.
Pitfalls in the diagnosis and management of skin cancer
A review of medico-legal cases concerning diagnosis and management of skin cancer.
The new realities of medical care
As the healthcare environment continues to change, physicians remain committed to quality patient care, while keeping in mind accompanying risk management considerations.
The engaged and empowered patient
Engaged and empowered patients take an active role in managing their healthcare, and physicians must be aware of the medico-legal implications.
Know the issues and risks of bariatric surgery
A review of the medico-legal issues with bariatric surgery in the pre-operative, intra-operative, and post-operative periods
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.
Trauma care in the emergency department - Effective communication and resources vital to quality patient care
Risk management suggestions related to verbal and written communication in the trauma setting and when resources are limited.
Practising in a community setting — A hub of patient care
Physicians should be aware of the medico-legal risks that are inherent in practising in a community care location.
Trauma care in the emergency department — Early diagnosis a key factor in improving patient outcomes
Risk management suggestions from an analysis of medico-legal cases related to the diagnosis of trauma patients.
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.
Alternative medicine — What are the medico-legal concerns?
Physicians should be prepared to respond to patient enquiries about complementary and alternative medicine and natural health products.
Working with medical equipment — Reducing the risks
A review of medico-legal problems related to malfunctions, improper use, and deficiencies in training and supervision when using medical or surgical equipment.
The aging patient — Responding to changing demographics
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.
Managing the medico-legal risks of placing a central line
Litigation related to the placement of central lines is most often related to consent, delegation, standard of care, and documentation.
When a patient asks for another physician on cultural or religious grounds
Physicians can find themselves in a difficult ethical and legal position when patients refuse to be treated.
Privacy and a wired world — Protecting patient health information
Privacy legislation and policies set the foundation for safeguards to maintain confidentiality of patient information.
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.
Independent medical evaluations: be prepared
There are a number of steps that can be taken to reduce the likelihood of patient dissatisfaction with Independent Medical Evaluation.
Consenting to research
Physicians undertaking clinical research are expected to obtain valid consent.
Effective multi-patient disclosure
A discussion on how members can help meet the clinical, emotional and informational needs of patients after large scale adverse events.
Risk management in elderly patients: Medication issues
A review of medico-legal problems related to prescribing and monitoring medications for older patients.
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.
Why good documentation matters
Poor charting may be perceived as reflecting less attention to detail and risks the conclusion the care provided was poor.
Reporting patients with medical conditions affecting their fitness to drive
An overview of medico-legal problems resulting from physicians' decisions on whether or not to report patients with medical conditions that may make it dangerous to drive, or from physicians' decisions on whether or not to support the reinstatement of a licence to drive.
A good defence depends on good records
CMPA provides free telephone record pads for physicians to use when documenting telephone advice.
"Doc, I can't wear a seatbelt!"
Responding to patient requests for exemptions to wearing a seatbelt while driving.
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).
Medico-legal risks in busy and overcrowded emergency departments
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.
Medico-legal problems related to cholecystectomy vascular/hemorrhagic complications
A review of complications and ways to mitigate risks related to cholecystectomies and other laparoscopic procedures.
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.
The legal limits of sterilizing the mentally incapable
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.
Medico-legal problems related to cholecystectomy: Intestinal complications
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on intestinal complications.
Managing intoxicated patients in the emergency department
Intoxicated patients pose special risks in the emergency department because of their behaviour, and the difficulty of adequate assessment and treatment.
Medico-legal problems related to cholecystectomy: Biliary tract injuries
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on biliary tract injuries.
Learning from adverse events: Fostering a just culture of safety in Canadian hospitals and healthcare institutions
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
Timely diagnosis of ectopic pregnancy a key factor in reducing risk
Delays in the diagnosis of ectopic pregnancies may lead to poor patient outcomes and medico-legal difficulties for physicians.
Adverse events — Physician-prescribed opioids
A review of legal actions involving physicianprescribed opioids.
Third parties in the operating room
Before permitting persons not a part of the surgical team to be present in the operating room, it is important to consider many issues, among them patient privacy and confidentiality, consent, and safety.
Legal liability of physician for medical certificates
Medical certificates may be relied on by an employer or its insurer when making a determination concerning a patient's benefits.
Follow up for "orphaned patients"
Physicians discharging patients in need of follow up care may have certain responsibilities.
Delegation and supervision of medical trainees
Risk management considerations for supervising physicians, and supervised residents and other trainees.
Timely responses to requests for reports
Responding to third party requests for a medical report on a patient.
Physicians and the Firearms Act: a dilemma
Considerations in responding to patients' requests for support in acquiring firearms.
Preparing medico-legal reports: suggestions for physicians
Care should be taken when writing medico-legal reports, such as reports of treating physicians, independent medical examinations and expert opinions. Suggestions are made as to factors to consider when preparing such reports.
Physicians acting as guarantors—New Canadian passport requirements
Passport applications no longer need to be signed by specified professionals, and when signing certain personal information must be included.
Aminoglycosides — A fine balance
Appropriate use of aminoglycosides requires awareness of the potential side effects and their symptoms.
Responding to prescription fraud
Considerations for managing suspected prescription or narcotic fraud, forgery or theft.
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.
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.
Keep privacy in mind when disposing of test reports
It is important to properly dispose of test reports.
Responding to requests for children's medical records
The physician's role in providing a child's medical information to a parent.
Office privacy compliance
Privacy legislation affects physician's collection, use and disclosure of personal information.
Anesthesia airway management
A study examining the medico-legal risks of airway management by anaethesiologists from 1993 — 2003.
Anatomy of a well-written note
Avoid medico-legal difficulties by writing factual and objective notes.
Billing matters
Adequate record keeping may help during a billing audit.
Medical records: Advice about maintaining their integrity and providing them to lawyers
CMPA answers your questions about documentation.
When joking isn’t funny
Respect and observation of professional boundaries allows you to express concerns about patient care without fear of reprisal.
Avoid pitfalls when preparing medico-legal reports
Exercise caution in preparing medico-legal reports: consider the nature and extent of risks and whether those risks are probable or, if serious but remote, would be risks the patient would want to be informed about. Avoid potentially misleading statements.
Considerations when leaving a medical practice
Notifying and transferring patients and medical records when making a practice transition.
Physicians and their patients' wills: issues to consider
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.
Clinic held liable for a sexual assault
Ontario court decides that a medical clinic is liable for sexual assault committed by a technologist, who was an employee of the medical clinic.
Ill-considered statements can be costly
Statements in medical records should be accurate, objective and factual.
Provincial counsel commentary: The Krever Inquiry
An inquiry into the Canadian blood system recommended improved documentation and informed consent, and decreased allogeneic blood use.
Relying on hospital staff
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
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.
Collaborative care: A medical liability perspective
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.
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.

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.