Safety of care

Improving patient safety and reducing risks
Walk-in clinics: Unique challenges and medico-legal risks
Physicians working in walk-in clinics face unique challenges and medical-legal risks related to team communication, management of test results, and review of delegated work.
Team debriefings: Participate and minimize your medico-legal risks
Physicians should participate in quality assurance activities such as debriefs and should reduce their medical-legal risks by ensuring the debriefs are properly structured.
Working with physician assistants: Regulation, delegation, and liability protection
Advice for physicians working with physician assistants, including issues such as delegation, supervision, and liability insurance.
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.
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.
Online physician reviews: How to manage your virtual presence
Physicians can successfully manage online ratings using a reasonable and measured approach.
Accepting new referrals: Advice for all physicians
Guidance for specialists on their ethical and professional responsibilities in accepting to care for new 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.
Advocacy for change: An important role to undertake with care
Physicians are advocates for their patients and for healthcare improvements, but this dimension of medical care can be challenging. This article explores what advocacy means and what approaches are most effective and appropriate.
Severe jaundice in newborns: Six important considerations
A review of the precautions that physicians can take to address the risk of sever jaundice in newborns.
10 tips for using social media in professional practice
Advice for physicians for using social media in a way that is mindful of medico-legal risk.
Limiting discussion to one medical issue per visit: Know the risks
Limiting patients to one issue per visit can lead to negative perceptions if not communicated with respect and diplomacy.
Residents and resiliency
Wellness strategies and resources for physician residents
If a colleague relies on your professional opinion, you may have a duty of care
When physicians offer a clinical comment or opinion that will be relied on to care for a patient, they may owe that patient a duty of care—even if they have never met the patient in person.
Is it time to rethink your use of chaperones?
Guidance for physicians on assessing whether a chaperone is right for their practice.
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.
Closing or leaving a practice: Tips for physicians
Responsibilities of physicians when planning to close or leave a practice due to retirement, illness, or other reasons.
When a patient seeks a second opinion
When a patient seeks a second opinion about a diagnosis or treatment plan, the other viewpoint will confirm, modify, or offer alternatives to the initial one, and ultimately the patient is free to decide.
Preventing the misuse of opioids
Physicians can take steps to help prevent abuse of the opioids they prescribe, while improving safety for their patients and reducing their own medico-legal risk.
Emotional support animals
Advice for physicians when a patient presents with an emotional support animal or requests a letter supporting their use of an emotional support animal.
“There’s something you should know about your patient…” Handling collateral information
A review of the concept of collateral patient information, and advice for physicians on what to do with this kind of information.
Diagnostic delays in sepsis
A plain-language review of CMPA’s 2023 research piece about sepsis, featuring key messages and advice for physicians.
When Canadian patients travel abroad for care
Advice for Canadian doctors when their patients seek healthcare outside of Canada as medical tourists.
Using fax in your practice? Ten ways to reduce privacy risks
Suggested ways that physicians can reduce the risk of privacy breaches when using fax to communicate confidential patient information.
Treating transgender and non-binary individuals
Physicians who treat or who are asked to treat transgender individuals should be aware of the ethical and legal considerations in these circumstances to avoid allegations of discrimination.
When you cannot reach a patient
Guidance for physicians who can not reach a patient.
The emergence of AI in healthcare
Physicians can benefit from an early understanding of the potential benefits and challenges that AI brings to patient care, and the possible medical-legal risks associated with using AI technologies.
Patients on long-term opioid therapy: Five key considerations
An outline of key medico-legal considerations for physicians providing care to patients on long-term opioid therapy.
The office safety plan
Physicians can take these steps to maintain a safe office environment for their employees.
Cosmetic medicine: Three key medico-legal issues
Key points for physicians to keep in mind if they are providing cosmetic medicine procedures.
Should you confirm whether your patient is pregnant?
Guidance for physicians about addressing the possibility of pregnancy when preparing patients for procedures that could be harmful.
Five things to keep in mind when treating patients with cognitive decline
A review of the physicians who treat patients with cognitive decline.
Being on call when resources are limited
Consulting physicians may be expected to provide appropriate advice to referring physicians even when their facility cannot accept the patient.
Genetic testing — What are physicians’ options and obligations?
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
Addressing disruptive behaviour from other physicians
Highlights from CMPA discussion paper “The role of physician leaders in addressing physician disruptive behaviour in healthcare institutions.”
Responding to a patient without a health card
Considerations for physicians when a prospective patient does not have a health card.
Accepting new patients: The key to effective practice management
Accepting and refusing new patients is part of managing a primary care practice, and physicians should be aware of their College’s policies on this matter.
Limited healthcare resources: The difficult balancing act
The courts expect physicians to provide appropriate care to patients, making effective use of available resources.
Ending the doctor-patient relationship
Considerations for ending the doctor-patient relationship.
The aging physician: Maintaining competence and practising safely
As physicians age or they experience cognitive or health decline, they will want to be familiar with requirements set out by their College, and understand their ability and possible limitations to deliver safe medical care.
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.
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.
Social media: The opportunities, the realities
Physicians should be aware of the pros and cons of social media and the risks of participating.
Smartphone recordings by patients: Be prepared
Physicians can take steps to mitigate the medical-legal risks of patients taking photos and making video and audio recordings during healthcare encounters.
Patient safety incident reviews: How to report and participate
A just patient safety culture promises the provision of higher quality and safer care. Advice is provided to CMPA members on participation in reporting and reviews of adverse events and close calls in hospitals and institutions.
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.
Deferred care during the pandemic
The CMPA answers members’ medico-legal questions on the implications of deferring patient care during the COVID-19 pandemic.
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.
Protecting patient privacy when delivering care virtually
Protecting the privacy of patient information when using digital communication channels, including email, portals, and social media platforms.
Using clinical practice guidelines wisely
Adherence to credible CPGs can be beneficial and assist in providing quality care, though they do not necessarily establish a standard of care
Mitigating the risk of retained foreign bodies during surgery
An analysis of CMPA medico-legal cases involving unintentionally retained foreign bodies during surgery, and suggested approaches to mitigate the risks.
Alternative medicine – What are the medico-legal concerns?
Whether providing or referring patients to alternative treatments, physicians need to remain mindful of their professional obligations, potential medico-legal risks
What to do when patients do not follow the doctor’s advice: Dealing with non-adherence
What can be done to maintain quality care for patients and reduce medical-legal risks for physicians when patients do not heed medical advice.
What happened to the physical exam?
A description of the impact of overly limited or absent of physical examination on diagnostic error and patient harm using CMPA cases.
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.
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.
Resolving conflict between healthcare providers
An overview of communication strategies physicians can use to help resolve conflict with other physicians or other healthcare providers.
Tired? You’re not alone...
While fatigue can negatively affect the performance of individual physicians, systematic and standardized approaches to teamwork and communication may help mitigate patient safety risks.
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.
Challenging patient encounters: How to safely manage and de-escalate
Communication and conflict resolution skills may help physicians deal effectively and safely with challenging patient encounters.
Can a child provide consent?
Effective communication and awareness of legal requirements are key to obtaining consent for treatment of children.
College complaints on the rise: Better communication can help
Although communication is identified as an underlying issue in the significant 10-year rise in the number of members asking for CMPA help with College complaints, research suggests physicians can improve their interactions with better communication skills.
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.
What to do if you’re notified of a College complaint
For many physicians, a regulatory authority (College) complaint is stressful, but can be managed by speaking with the CMPA, assessing the complaint, and responding professionally and respectfully.
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.
Performing lower extremity joint surgery? Take proactive steps to enhance safe surgical care
An analysis of CMPA medico-legal cases involving lower extremity joint surgery and the non-technical factors contributing to patient harm and medico-legal risk.
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.
Know what you’re signing: Employment contracts, procedural protection, and CMPA assistance
An overview of the different legal protections attaching to different practice arrangements.
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.
The changing practice of medicine: Employment contracts and medical liability
Physicians considering various arrangements for practising medicine, other than the privileges-based model, need to consider any medico-legal implications.
Results and expectations: Test follow-up and the office-based family physician
Focusing on the follow-up phase of clinical testing for office-based family physicians, this article presents actionable advice based on a review of CMPA legal and College cases.
Leadership essentials: 3 steps to creating psychological safety
A discussion of three practical steps physician leaders can take to create psychologically safe environments in their organizations, and deliver highly reliable and safe healthcare.
Can intraoperative decisions be diagnostic errors?
A review of CMPA medico-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.
Mind the gap: Challenges for safe mental health care
Care for patients with mental health concerns can be complicated, especially when access to psychiatric expertise is limited. Consider these strategies to address medical-legal risks when managing patients’ mental health needs.
Hidden impacts of the opioid crisis: Rare infections are on the rise
This article discusses infections associated with intravenous drug use. These infections are on the rise and can be diagnostically challenging.
Who is the most responsible physician? Check your knowledge
Clarity about who is responsible for the care of a patient at any given time improves patient safety and reduces medico-legal risk.
Walk-in clinics: Unique challenges to quality of care, medical-legal risk
Physicians working in walk-in clinics face unique challenges and medical-legal risks related to team communication, management of test results, and review of delegated work.
Closing the loop on effective follow-up in clinical practice
This article offers practical tips and techniques for building a robust system for follow-up of clinical test results that can be applied in both office and hospital practice settings.

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.