Duties and responsibilities
Expectations of physicians in practice
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 who are familiar with regulatory requirements governing organ and tissue donations can more effectively meet their obligations and mitigate the potential for complaints.
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.
An overview of obligations and issues for doctors when providing or discussing vaccinations with patients or legal guardians.
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.
End-of-life treatment decisions can be difficult for both physicians and patients, but many issues can be avoided by following the key concepts outlined.
The 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 physicians’ obligations when certifying a patient’s death.
A discussion of consent issues that may arise when caring for adults with diminished mental capacity (competency).
Physicians should understand the role of coroners and medical examiners in Canada,
and how and when to provide information to them.
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.
Physicians in non-surgical disciplines who perform invasive procedures may be exposed to medical-legal risks, though these can be effectively mitigated.
While workplace conflict is inevitable, there are steps physicians can take to de-escalate and resolve disputes before they impact patient care.
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.
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.
Considerations for ending the doctor-patient relationship.
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.
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.
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.
An analysis of recent CMPA cases highlighting the medico-legal risks associated with surgical ureteric injury.
Tips to assist physicians in communicating effectively with patients and their families when a patient’s prognosis is terminal.
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.
A review of hospital-based patient safety incidents and common reasons leading to them.
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.
Specific risk management strategies for physicians who are providing care to patients experiencing mental health issues.
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.
Case studies related to boundary crossings and violations.
Physicians can successfully manage online ratings using a reasonable and measured approach.
Highlights of medico-legal issues associated with anaesthesia and analgesia administered by anesthesiologists for surgery and during labour and delivery.
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 have an obligation to protect patient information and can take steps to help prevent privacy breaches associated with sending and receiving faxes.
Physicians participating in clinical research studies should be aware of their relevant legal, ethical, and professional obligations.
This article focuses on the main areas of medico-legal risk for psychiatrists.
A review of problems, pitfalls, and emerging liability issues with the use of electronic patient records
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.
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.
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.
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 need accurate and up-to-date information to provide effective and safe patient care, but information overload can create distraction rather than improve knowledge.
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.
Physicians must stay abreast of changes related to health information privacy, contribute to privacy advancements, and comply with existing and new rules and regulations.
Administrative and management practices, data sharing agreements, confidentiality agreements, and privacy impact assessments can help physicians to achieve compliance with their privacy obligations.
Tips for using electronic records and other technologies.
Physicians should carefully reassess patients who return with symptoms that are not resolving as expected or are worsening.
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
Highlights from CMPA discussion paper “The role of physician leaders in addressing physician disruptive behaviour in healthcare institutions.”
A sample of medico-legal questions posed by CMPA members to physician and legal experts at the Association's education programs.
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.
A review of CMPA medico-legal cases involving feeding tube placement identifies clinical situations of higher risk that can affect patients and physicians.
Appendicitis in many cases remains difficult to diagnose. A review of CMPA medico-legal cases identifies many of the challenges.
Physicians supervising medical trainees must keep in mind their responsibilities to patients when delegating tasks to trainees.
An overview of the principles of retention, sharing and transferring of medical records.
Certain provinces have legislation to prevent apologies for adverse events from being used in court proceedings.
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.
Physicians practising in rural and remote areas should be aware of the medico-legal risks in these circumstances.
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.
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.
An analysis of the CMPA’s pediatric medicolegal cases identified a
number of common factors that resulted in poor clinical outcomes.
A physician must provide certain information to patients to obtain informed consent, even for simpler procedures and treatments.
A review of medico-legal problems associated with hernia repairs in the preoperative, intra-operative, and post-operative stages.
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.
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 practice of medicine is undergoing unprecedented change.
The CMPA believes that medical professionalism has never been more important, both for individual physicians and for the medical community as a whole.
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.
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.
Strategies to reduce medico-legal risk when prescribing medications or using medical devices outside of their licensed indications.
A review of medico-legal cases concerning diagnosis and management of skin cancer.
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.
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.
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.
A review of medico-legal problems related to malfunctions, improper use, and deficiencies in training and supervision when using medical or surgical equipment.
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.
Physicians can find themselves in a difficult ethical and legal position when patients refuse to be treated.
Privacy legislation and policies set the foundation for safeguards to maintain confidentiality of patient information.
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.
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 discussion on how members can help meet the clinical, emotional and informational needs of patients after large scale adverse events.
A review of medico-legal problems related to prescribing and monitoring medications for older patients.
An exploration of privacy and consent issues when using clinical images or recordings of patients to teach medicine.
Poor charting may be perceived as reflecting less attention to detail and risks the conclusion the care provided was poor.
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.
CMPA provides free telephone record pads for physicians to use when documenting telephone advice.
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.
A review of complications and ways to mitigate risks related to cholecystectomies and other laparoscopic procedures.
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.
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.
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on intestinal complications.
Intoxicated patients pose special risks in the emergency department because of their behaviour, and the difficulty of adequate assessment and treatment.
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on biliary tract injuries.
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.
A review of legal actions involving physicianprescribed opioids.
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.
Medical certificates may be relied on by an employer or its insurer when making a determination concerning a patient's benefits.
Physicians discharging patients in need of follow up care may have certain responsibilities.
Risk management considerations for supervising physicians, and supervised residents and other trainees.
Responding to third party requests for a medical report on a patient.
Considerations in responding to patients' requests for support in acquiring firearms.
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.
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.
Considerations for managing suspected prescription or narcotic fraud, forgery or theft.
It is right to express sympathy after an adverse event, but an apology with acceptance of blame may be inappropriate.
Timely, unrushed disclosure of adverse events to patients is an obligation that may strengthen the doctor-patient relationship.
It is important to properly dispose of test reports.
The physician's role in providing a child's medical information to a parent.
Privacy legislation affects physician's collection, use and disclosure of personal information.
A study examining the medico-legal risks of airway management by anaethesiologists from 1993 — 2003.
Avoid medico-legal difficulties by writing factual and objective notes.
Adequate record keeping may help during a billing audit.
CMPA answers your questions about documentation.
Respect and observation of professional boundaries allows you to express concerns about patient care without fear of reprisal.
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.
Notifying and transferring patients and medical records when making a practice transition.
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.
Ontario court decides that a medical clinic is liable for sexual assault committed by a technologist, who was an employee of the medical clinic.
Statements in medical records should be accurate, objective and factual.
An inquiry into the Canadian blood system recommended improved documentation and informed consent, and decreased allogeneic blood use.
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
Legislation requires physicians to report individuals in the transportation industry whose medical condition may constitute a threat to safety.
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.
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.