Duties and responsibilities

Expectations of physicians in practice
Using electronic communications, protecting privacy
Protecting the privacy of patient information when using digital communication channels, including email, portals, and social media platforms.
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.
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.
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.
Resolving conflict between healthcare providers
An overview of communication strategies physicians can use to help resolve conflict with other physicians or other healthcare providers.
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.
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.
"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.
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.
The continuing evolution of medical assistance in dying
An update on the evolving rules and processes around MAID.
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.
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.
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.
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.
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.
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.
Can intraoperative decisions be diagnostic errors?
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.
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.
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.
Writing with care
Documentation in clinical notes and reports to third parties should be factual, objective, and use a suitable tone of medical professionalism.
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.
Clearing the haze: How the legalization of recreational cannabis may affect your medical practice
A look at how the legalization of recreational marijuana may affect physicians’ practices, including whether it will eliminate patients’ requests for medical marijuana.
Disclosing harm associated with pathological analysis or diagnostic imaging: A team-based approach
Practical suggestions for disclosure of discrepancies stemming from pathological analysis or diagnostic imaging.
Cannabis legalization in Canada, one year later: Questions from members
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.
Will you be sorry for saying “I’m sorry”?
Certain provinces have legislation to prevent apologies for adverse events from being used in court proceedings.
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.
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.
Protecting patient health information in electronic records
An overview of information privacy considerations when using electronic medical records in practice.
Accepting new patients: Guidance for specialists
Guidance for specialists on their ethical and professional responsibilities in accepting to care for new patients.
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.
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.
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.
Medical-legal cases in spinal surgery: 3 essential lessons
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.
Treating physician reports, IME reports, and expert opinions: The way forward
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.
Completing medical certificates of death: Who’s responsible?
A discussion of physicians’ obligations when certifying a patient’s death.
Online physician reviews: How to manage your virtual presence, and real reputation
Physicians can successfully manage online ratings using a reasonable and measured approach.
Is it time to rethink your use of chaperones?
Guidance for physicians on assessing whether a chaperone is right for their practice.
Prenatal tests for genetic screening and diagnosing: Changes, choices, challenges
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.
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.
Can border agents search your smartphone?
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.
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.
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.
The new reality of reporting a privacy breach
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 medical-legal risks of opioid therapy: Questions from members
The CMPA analyzes members’ calls and medical-legal questions about opioid treatment of patients suffering chronic non-cancer pain.
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.
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.”
Genetic testing — New options, new obligations
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
How to reduce the risks of dental injury
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.
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.
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.
Laparoscopic cholecystectomy: We can still be safer
A review of medical-legal cases involving complications of cholecystectomy.
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
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.
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.
Medical scribes: An increasing reality
Physicians working with medical scribes should be aware of their obligations as an employer, delegator, and supervisor.
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.
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.
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.
Managing access to electronic health records
A discussion of the principles of access, the challenges with access, and managing the risks.
Ending the doctor-patient relationship
Considerations for ending the doctor-patient relationship.
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).
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.
Online physician reviews: What’s to be done?
Physicians can successfully manage online ratings using a reasonable and measured approach.
Recognizing boundary issues
Case studies related to boundary crossings and violations.
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.
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 medicine and culture intersect
This article discusses what physicians can do to deliver culturally competent and culturally safe medical care.
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.
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.
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.
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.
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.
Closing or leaving a practice: Tips for primary care physicians
Responsibilities of physicians when planning to close or leave a practice due to retirement, illness, or other reasons.
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).
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
Responding to requests for children's medical records
The physician's role in providing a child's medical information to a parent.
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.

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.