Safety of care

Improving patient safety and reducing risks
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.
Resolving conflict between healthcare providers
An overview of communication strategies physicians can use to help resolve conflict with other physicians or other healthcare providers.
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.
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.
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.
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.
The office safety plan
Physicians can take these steps to maintain a safe office environment for their employees.
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.
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.
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.
End-of-life: Planning for compassionate care during COVID‑19
Advice for physicians on the importance of advance care planning, communication, and compliance with legal requirements amid COVID-19.
You have medico-legal questions on deferring care during the pandemic—The CMPA has answers
The CMPA answers members’ medico-legal questions on the implications of deferring patient care during the COVID-19 pandemic.
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.
Providing virtual care during the COVID-19 pandemic
Advice for physicians on providing safe virtual care via telephone and video amid COVID-19.
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.
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.
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.
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.
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.
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.
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.
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.
Scarce resources: Caring for patients during COVID-19
Advice for addressing healthcare resource dilemmas, reducing patient harm, and minimizing medical-legal risk amid COVID-19.
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.
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.
The diagnostic challenges of chest pain: Recognizing acute coronary syndrome
While acute coronary syndrome is a challenging diagnosis, appropriate patient risk stratification and test management systems contribute to safer care and may lower medical-legal risk for physicians.
Team debriefs: Participate and minimize your medical-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.
Early detection of colorectal cancer can help save a patient’s life
Survival rates for colorectal cancer may be improved through early detection and diagnosis, and physicians can take steps to help ensure a timely diagnosis.
Treating transgender 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.
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.
Recognizing subarachnoid hemorrhage: The role of situational awareness in preventing serious patient harm
An exploration of the role of situation awareness in the timely diagnosis of subarachnoid hemorrhage.
Accepting new patients: Guidance for specialists
Guidance for specialists on their ethical and professional responsibilities in accepting to care for new patients.
Can AI assist you with your clinical decisions? Looking at the benefits and risks of AI technologies in medicine
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.
Prescribing for non-residents: Know your risks
Prescribing to non-resident patients whose primary purpose for coming to Canada is to obtain medication can increase your medical-legal risk.
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.
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.
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.
Online physician reviews: How to manage your virtual presence, and real reputation
Physicians can successfully manage online ratings using a reasonable and measured approach.
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.
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.
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.
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.
Limited healthcare resources: The difficult balancing act
The courts expect physicians to provide appropriate care to patients, making effective use of available resources.
Avoiding pitfalls in the emergency department: Recognizing and managing risks of diagnostic error
A review of CMPA legal cases involving diagnostic error by physicians working in the emergency department, with risk management strategies for assessing patients.
Safe prescribing: Risks for older patients
A study of CMPA medical-legal cases examines the risks of prescribing medication to older adults.
Thinking ahead: The value of situational awareness
Timely diagnosis and treatment depends on obtaining sufficient clinical information, monitoring the situation, and thinking ahead.
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.
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.
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.
The unanticipated complicated airway: Are you ready?
The CMPA examined legal cases involving rare but serious complications in airway management and found that situational awareness, adequate preparation, and well-coordinated teams were crucial for patient safety.
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.
Health literacy — An asset in safer care
Steps physicians can take to help patients with poor health literacy skills.
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.
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.
Leadership essentials: How physician leaders can nurture teams that provide highly reliable healthcare
Physician leaders may consider using the Framework for Safe, Reliable, and Effective Care when planning and designing highly reliable healthcare delivery systems.
Responding to a patient without a health card
Considerations for physicians when a prospective patient does not have a health card.
Evaluating and implementing quality improvement initiatives in surgery
The CMPA supports quality improvement activities that have the potential to create safer surgical care and decrease adverse events.
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.
Is your patient a woman of reproductive age? Consider pregnancy
Any physician contemplating an investigation or treatment for a woman of reproductive age should consider ruling out pregnancy.
Navigating the complexities when treating patients with Alzheimer’s disease and other dementias
Learnings from a review of CMPA medical-legal cases related to the care of patients with Alzheimer’s disease and other dementias.
Medical scribes: An increasing reality
Physicians working with medical scribes should be aware of their obligations as an employer, delegator, and supervisor.
Just culture of safety: How to report and participate in reviews of patient safety incidents
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.
New to practice? Practical tips for physicians in the first 5 years
Physicians in their first 5 years of practice are often unfamiliar with the regulations and guidelines of their medical regulatory authority (College) and find themselves in medical-legal difficulties as a result.
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.
Residents and resiliency
Wellness strategies and resources for physician residents
Ending the doctor-patient relationship
Considerations for ending the doctor-patient relationship.
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.
On message: The physician as spokesperson
Advice for physicians acting as media spokespersons
Social media: The opportunities, the realities
Physicians should be aware of the pros and cons of social media and the risks of participating.
Top 10 tips for using social media in professional practice
Tips to help physicians participate appropriately in using social media.
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.
Online physician reviews: What’s to be done?
Physicians can successfully manage online ratings using a reasonable and measured approach.
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.
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.
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.
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.
Clinical practice guidelines: What is their role in legal proceedings?
In legal proceedings where courts are determining if the care provided met the standard of care, authoritative clinical practice guidelines may be considered as one piece of evidence.
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.
Strengthening inter-professional communication
A discussion of how physicians can improve their inter-professional communication skills, leading to better care for patients and reduced medico-legal risks for physicians.
Clinical practice guidelines — Guidance or a standard of practice?
Most physicians agree that clinical practice guidelines (CPG) can improve the quality of clinical care. In a legal case, however, a court may place more weight on the standard of care of a "prudent colleague" than on a CPG.
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.
Physician-patient communication: Making it better
Physician-patient communication is a critical aspect of effective care that may be enhanced with these suggested approaches.
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
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.