Duties and responsibilities

Expectations of physicians in practice
Difficult patient encounters: What you can do to prevent, manage, and de-escalate
Advice on effective communications with patients and managing their expectations to help prevent conflicts in medical practice.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Cannabis for medical purposes: 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.
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.
How the patient’s voice advances safe care
Physicians, other healthcare professionals, and health system leaders are encouraged to actively seek out patients’ perspectives to improve healthcare planning and delivery.
Using electronic record systems with care
EHR and EMR technologies change the way medical care is delivered, creating both opportunities and challenges for healthcare providers.
Responding to a billing audit: How good records can help
Adequate record keeping may help during a billing audit.
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.
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.
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.
"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.
Is this patient capable of consenting?
A discussion of consent issues that may arise when caring for adults with diminished mental capacity (competency).
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.
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.
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.
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.
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.
Ending the doctor-patient relationship
Considerations for ending the doctor-patient relationship.
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.
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.
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.
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.
Pitfalls in assessing and treating children in hospitals
A review of hospital-based patient safety incidents and common reasons leading to them.
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.
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.
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.
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.
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.
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).
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.
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.
10 tips for using electronic records
A review of problems, pitfalls, and emerging liability issues with the use of electronic patient records
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 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.
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.
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.
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.
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.
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.
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.
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.
Physician professionalism — Is it still relevant?
The practice of medicine is undergoing unprecedented change.
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.
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.
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.
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.
Pitfalls in the diagnosis and management of skin cancer
A review of medico-legal cases concerning diagnosis and management of skin cancer.
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.
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.
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.
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.
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.
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.
Privacy and a wired world — Protecting patient health information
Privacy legislation and policies set the foundation for safeguards to maintain confidentiality of patient information.
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.
Risk management in elderly patients: Medication issues
A review of medico-legal problems related to prescribing and monitoring medications for older patients.
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.
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.
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.
"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.
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.
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.
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.
Delegation and supervision of medical trainees
Risk management considerations for supervising physicians, and supervised residents and other trainees.
Physicians and the Firearms Act: a dilemma
Considerations in responding to patients' requests for support in acquiring firearms.
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.
Anesthesia airway management
A study examining the medico-legal risks of airway management by anaethesiologists from 1993 — 2003.
Responding to requests for children's medical records
The physician's role in providing a child's medical information to a parent.
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.
Relying on hospital staff
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
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.