Safety of care

Improving patient safety and reducing risks
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.
Hazards in the operating room: Surgical fires and burns
A review of CMPA medical-legal cases involving intra-operative burns, and suggested tactics to help mitigate the risks.
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.
Responding to a billing audit: How good records can help
Adequate record keeping may help during a billing audit.
Chronic care can be improved with skillful communication
CMPA cases involving chronic disease indicate that improving the communication skills of healthcare providers can potentially make the medical care safer for patients with chronic illness and may reduce medical-legal risks for healthcare professionals.
Safe care in obstetrics—Maternal postpartum care: When things don’t go as planned after delivery
Suggested approaches to help avoid difficulties in maternal postpartum care, based on expert opinions in a review of CMPA cases.
Is that eConsultation or eReferral service right for your medical practice?
eConsultation and eReferral services can offer exciting benefits, but to use them successfully physicians should know the areas of potential medical-legal risks so they can be avoided.
International medical graduates face daunting challenges; getting help is key to success
While the challenges facing IMGs can be formidable, resources are available to help.
The ransomware threat: Are you prepared?
Considerations to help prevent and mitigate the damage arising from ransomware attacks to computer systems.
Direct-to-consumer genetic test results: Be prepared
When asked by patients to interpret or take medical action on direct-to-consumer genetic test results, physicians’ best response is to practise sound medicine and follow the profession’s standards of care.
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.
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.
Shining a light on the medical-legal risks of laparoscopic surgery
Laparoscopic surgery requires advanced surgical technique, experience with specialized equipment, and dynamic and complex clinical decision-making.
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.
Safe surgery: Closing the gap with the surgical safety checklist
The use of a surgical safety checklist should decrease the risk of adverse events and surgical complications by fostering a patient safety mindset and encouraging team communication.
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.
The office safety plan
Physicians can take these steps to maintain a safe office environment for their employees.
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.
Patient portals—A new communication tool for doctors and patients
Physicians wanting to communicate with their patients using patient portals should consider the steps they can take to mitigate risks and ensure that portals are used properly and successfully.
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.
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.
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.
Shifting practice settings makes following up investigations and monitoring medication tougher: Strategies for managing risks
Experts in CMPA cases make suggestions on how physicians who work in shifting practice settings can manage risks when providing follow-up care and monitoring medication.
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.
Safe care in obstetrics: Keys to effective interprofessional care
The quality and safety of obstetrical care can be strengthened when all members of the collaborative care team are fully integrated in the functioning of the unit.
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.
Residents and resiliency
Wellness strategies and resources for physician residents
Navigating the challenges of safe antibiotic prescribing
The CMPA’s review of medical-legal cases that involved issues with antibiotic prescribing provides insight into opportunities for improvement in the areas of patient assessments, communications, and patient monitoring and follow-up.
Safe care in obstetrics: Recognizing signs of potential trouble in labour and delivery
Situational awareness is an essential skill for all healthcare providers, particularly those working in high-risk, continuously evolving clinical environments such as labour and delivery.
Safe use of opioid analgesics in the hospital setting
The safe use of opioids in the hospital setting requires strategies to safeguard patients from harm and must involve all healthcare team members.
Emerging trends and medical-legal risks in medical tourism
A review of main issues and new trends in medical tourism and how physicians can minimize risks in treating patients who seek medical tourism in Canada and abroad.
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.
Coordinating critical care: Communication challenges for providers and patients
An examination of coordination of care in the ICU and the importance of good communication.
Safe care in obstetrics: Improving teamwork and communication in an emergency
The management of obstetrical emergencies relies on effective teamwork and communication between members of the care team.
Transparency of physician information: What members need to know
Medical regulatory authorities are making more information about physicians available to the public. This article provides an overview of this trend, and explains how the CMPA helps members.
The newborn with jaundice: We can do better
A review of medical-legal cases involving severe hyperbilirubinemia in newborns highlights the need for better understanding of treatment and adherence to published guidelines.
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.
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.
Medical-legal implications when using restraints
Requirements for consent and other lessons learned related to the use of restraints on patients from a review of CMPA medical-legal cases.
Using electronic communications, protecting privacy
Protecting the privacy of patient information when using digital communication channels, including email, portals, and social media platforms.
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.
ENT practice — Mitigating the risks of procedural complications
This article focuses on the main areas of medical-legal risk for otolaryngologists (ENT specialists) based on the CMPA’s case files and on safety measures that can be taken to mitigate those risks.
Meningitis — Understanding the vulnerabilities
Meningitis poses a significant risk of death and disability, especially in vulnerable populations. Prompt diagnosis and treatment is critical.
Immigrant health issues: What physicians should know and do
Learn how Canadian physicians can meet the care challenges posed by immigrants with a number of specific approaches.
The challenges of relieving chronic pain with opioids
Common medico-legal issues for physicians related to the repeated prescription of opioids for patients with pain unrelated to cancer.
Videoconferencing consultation: When is it the right choice?
Videoconferencing is a valuable tool in healthcare today, though in-person patient consultations are still necessary in many circumstances. Using videoconferencing appropriately improves safety and reduces risk.
Stroke: Can you recognize the signs?
A review of medico-legal cases related to stroke, outlining some of the challenges in diagnosis and providing suggestions from experts to improve care and reduce risk.
Lessons from hip and knee arthroplasty complications
Hip or knee arthroplasty can greatly improve quality of life, yet it may also have significant risks.
When common symptoms resemble rare and serious conditions
Missed or delayed diagnosis of a serious medical condition is often related to inadequate assessment and physical examination, cognitive biases, and deficiencies in the system of care.
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.
Ending the doctor-patient relationship
Considerations for ending the doctor-patient relationship.
Sepsis can be difficult to recognize, but early diagnosis and treatment is essential
Early recognition and treatment of sepsis are imperative to prevent patient harm and medico-legal difficulties for physicians.
Consider the unique aspects of caring for athletes
Providing medical care to athletes has unique aspects. Physicians doing this work should be aware of potential medico-legal risks and take steps to keep their patients and themselves safe.
Part-time practice, full-time safety: Reducing clinical workload while addressing risks
Physicians who reduce or limit their clinical workload to attend to other commitments, for example conducting research or transitioning into retirement, are still obligated to provide patients with continuity of care.
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.
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.
Using email communication with your patients: legal risks
Issues to consider when communicating with patients via email: confidentiality, timeliness, clarity and consent.
Change is good: Taking action on healthcare safety
Strategies for successfully implementing changes in medical practice aimed at improving the quality and safety of care.
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.
How “systems thinking” can lead to safe care
This article discusses the culture of safety and describes system-level strategies for safe care.
Identifying the risks in medical practice
Healthcare safety improvements are contingent on identifying and mitigating risks both at the system and individual levels, and physicians should be aware of such risks in their practice
Collaboration for the future of healthcare safety
Drawing on the expertise of numerous organizations and resources dedicated to improving healthcare safety, healthcare providers can make changes to care practices and reduce the potential of harming patients.
Caring for patients with chronic diseases
How to enhance safety and overall outcomes when treating patients with chronic diseases, while reducing the exposure to medico-legal risks.
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.
Supporting patient engagement: What it means for physicians
Physicians can take specific actions to support patients’ engagement in their healthcare.
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.
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.
Pitfalls in assessing and treating children in hospitals
A review of hospital-based patient safety incidents and common reasons leading to them.
Telemedicine — Opportunities, challenges, and obligations
Physicians practising telemedicine across Canadian provincial or territorial boundaries should be familiar with the applicable licencing and regulatory requirements in their own jurisdiction and in their patients’ jurisdiction.
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.
A is for alias—Getting the right care to the right patient
Misidentifying a patient is a risk and can result in harm.
Lowering patients’ risk of hospital-acquired infections
A review of medico-legal cases involving healthcare-associated infection, and risk reduction strategies to consider.
Diagnosing back pain: Keeping an open mind helps minimize risk
Diagnostic assessment issues related to back pain, based on the experience of CMPA members.
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.
Medico-legal aspects of providing mental healthcare to patients
Specific risk management strategies for physicians who are providing care to patients experiencing mental health issues.
Working the night shift and managing the risks
Strategies to help mitigate risks for physicians who work night shifts.
Emerging trends: Are you socially accountable?
The potential future impacts of social media usage on physicians’ practices.
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.
Physicians in the spotlight: Practical media advice
Advice for physicians facing journalists or negative news coverage.
Top 10 tips for using social media in professional practice
Tips to help physicians participate appropriately in using social media.
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.
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.
Medico-legal risks with fetal heart monitoring
An examination of medico-legal risks with fetal heart monitoring in the antepartum and intrapartum periods.
Online physician reviews: What’s to be done?
Physicians can successfully manage online ratings using a reasonable and measured approach.
The right test at the right time: Striking the proper balance
Considerations when determining a patient’s need for a medical test or procedure.
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.
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.
Long-term care: Quality decisions
Physicians can help contribute to quality of care in long-term care facilities by being mindful of communication issues, coordination of care (including medication reconciliation and management), consent to treatment, advance directives, and regulatory requirements.
Examining risk in psychiatric practice
This article focuses on the main areas of medico-legal risk for psychiatrists.
A challenging diagnosis: Traumatic compartment syndrome
Measures for reducing medico-legal risk in the diagnosis of traumatic compartment syndromes of the lower limb, based on 5 years of CMPA members’ experience.
The physician voice: When advocacy leads to change
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.
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.
“Can I take your vital signs?” Key learnings from 3 case studies
Appropriately obtaining, interpreting, documenting, reassessing, and acting on vital signs are important parts of medical care.
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.
Communicating with pharmacists: Optimizing drug therapy
By communicating effectively with pharmacists, physicians can improve patients’ drug therapy and provide safer care.
Physicians and nurse practitioners: Working collaboratively as independent health professionals
When working with nurse practitioners, physicians should understand the scope, responsibilities, and accountabilities of these independent healthcare providers, and should communicate clearly and in a timely manner.
What to do when patients do not follow the doctor’s advice: Dealing with non-adherence
What can be done to reduce the medico-legal risks for physicians when patients do not heed their advice.
Medication management, quality healthcare
Physicians play a key role in managing medication. Careful attention to risk management strategies will help physicians provide quality care for their patients.
Thinking ahead: The value of situational awareness
Timely diagnosis and treatment depends on obtaining sufficient clinical information, monitoring the situation, and thinking ahead.
Managing information to deliver safer care
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.
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.
Prostate cancer medico-legal issues: Diagnosis, communication, and treatment
Physicians can take a number of actions to reduce the risks in diagnosing prostate cancer and following-up on test results.
Pinpointing medical-legal risk for radiologists
This article focuses on the main areas of medico-legal risk for radiologists, based on the most recent 5 years of CMPA members’ experience.
Practical steps to support effective compliance
Administrative and management practices, data sharing agreements, confidentiality agreements, and privacy impact assessments can help physicians to achieve compliance with their privacy obligations.
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.
Health literacy — An asset in safer care
Steps physicians can take to help patients with poor health literacy skills.
Genetic testing — New options, new obligations
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
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.”
Common medico-legal questions asked by members
A sample of medico-legal questions posed by CMPA members to physician and legal experts at the Association's education programs.
Winding down your practice
Physicians can make their transition into retirement easier for all those affected, particularly patients, by making preparations well in advance and giving ample notice.
Dealing with conflict in the doctor-patient relationship
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.
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.
Appendicitis — Lessons learned
Appendicitis in many cases remains difficult to diagnose. A review of CMPA medico-legal cases identifies many of the challenges.
New approaches: Healthcare integration
This article explores the role of physicians in the organization of integrated health systems such as regional health boards, health authorities, and health networks.
Rural practice — Strategies to reduce medico-legal risk
Physicians practising in rural and remote areas should be aware of the medico-legal risks in these circumstances.
Co-morbidities — Have you considered all health conditions?
An overview of the medico-legal risks of caring for patients with co-morbidities.
Medico-legal vulnerabilities in cervical cancer diagnosis
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.
Preparing for a medical emergency — Anticipating the unexpected in an office or clinic
Physicians should expect that at some time they will have to manage a medical emergency in their office or clinic. Planning, preparation, and practice are key steps in mounting an effective response for both patients, and physicians and their staff.
The most responsible physician: A key link in the coordination of care
Clarity about who is responsible for the care of a patient at any given time improves patient safety and reduces medico-legal risk.
Physician leadership in safer medical care
Physician leadership and participation are essential for successful quality improvement efforts in healthcare.
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.
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.
Effectively managing hospital test results — Key to timely diagnosis and patient safety
Effective management of test results and diagnostic imaging reports in a hospital setting can improve patient safety and mitigate risks.
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.
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.
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.
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.
Pitfalls in the diagnosis and management of skin cancer
A review of medico-legal cases concerning diagnosis and management of skin cancer.
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.
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.
Perils in the prevention of venous thromboembolism
Risk management lessons from a review of medico-legal cases related to venous thromboembolism prophylaxis.
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
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.
Technology unleashed - The evolution of online communication
Physicians should learn about the benefits and medico-legal risks of each new information technology platform before considering using these web-based tools
Practising in a community setting — A hub of patient care
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.
The impact of medical tourism on Canadian physicians
Canadian physicians can take steps to ensure continuity of care for patients engaged in medical tourism, and avoid medico-legal risk.
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.
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.
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.
Infective endocarditis — Still a challenge
A review of a five-year period of medico-legal files related to infectious endocarditis.
When a patient asks for another physician on cultural or religious grounds
Physicians can find themselves in a difficult ethical and legal position when patients refuse to be treated.
Changing physician-hospital relationships: Managing the medico-legal implications of change
Changes in the relationship between physicians and hospitals may have medico-legal implications that could lead to difficulties for physicians, institutions, and patients. Recommendations to address these implications are identified.
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.
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.
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.
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.
Improving communication between physicians
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.
Risk management in elderly patients: Medication issues
A review of medico-legal problems related to prescribing and monitoring medications for older patients.
How effective management of test results improves patient safety
There is growing evidence that effectively managing the results of test and diagnostic imaging reports improves patient safety.
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.
Could the patient be pregnant?
A review of medico-legal problems related to patients who are unknowingly pregnant and have been exposed to investigations and treatments recognized to possibly harm a fetus.
When diagnosing subarachnoid hemorrhage, consider the possibilities
An analysis of medico-legal cases indicates that there are several possible reasons for delays in the diagnosis of SAH. Delays in diagnosis may result in medico-legal risks.
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.
More telephone problems
A case illustrates why it is important to take a sufficient history during a telephone call.
Informal telephone advice
When providing advice informally to others or over the telephone, obtain sufficient information on which to base your professional opinion, as they may rely on the advice.
Delay in diagnosis of ACS
Acute chest pain is a common, chief complaint in both an emergency department and family practice environment. Careful evaluation of the history, physical examination and ECG may provide valuable clues. In some cases, observation and further testing may also be advisable.
Physician-patient communication: Making it better
Physician-patient communication is a critical aspect of effective care that may be enhanced with these suggested approaches.
Lung cancer – The challenge of a timely diagnosis
Suggestions to reduce risk and optimize the timely diagnosis of lung cancer.
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.
Just culture of safety: Why protecting quality improvement reviews is important for everyone
A just culture of patient safety promises better quality and safer care. This article explores protected quality improvement reviews and discusses the benefits of learning from adverse events to limit the likelihood of their reoccurrence.
Medico-legal problems related to cholecystectomy vascular/hemorrhagic complications
A review of complications and ways to mitigate risks related to cholecystectomies and other laparoscopic procedures.
Medico-legal problems related to cholecystectomy: Intestinal complications
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on intestinal complications.
The new reality: Expanding scopes of practice
Potential liability issues for physicians working with independent health care professionals, and steps to mitigate those risks.
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.
Medico-legal problems related to cholecystectomy: Biliary tract injuries
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on biliary tract injuries.
Breast cancer detection and diagnosis: Part 2 Improving breast cancer diagnosis and management
A review of closed medico-legal cases alleging delays in the diagnosis and management of breast cancer, focusing on patients presenting with clinical findings suggesting a possible lesion of the breast.
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.
Anticoagulant, antiplatelet agent and thrombolytic therapy: Amedico-legal perspective
An overview of the medico-legal difficulties associated with the use of anticoagulant, antiplatelet and thrombolytic agents
Indemnification clauses — What you need to know before you sign that contract
Physicians should carefully consider the meaning and implications of indemnification clauses in contracts with employers, research organizations, governments, health care agencies and others.
Breast cancer detection and diagnosis: Part 1
Clear communication among patients, referring physicians, technicians and radiologists, as well as attention to details in follow-up, will permit optimal outcomes from screening programs for breast cancer.
Adverse events — Physician-prescribed opioids
A review of legal actions involving physicianprescribed opioids.
New vaccines — What are your obligations
Issues to consider when discussing vaccination with patients.
Hyponatremia in children
Hyponatremia may occur during rehydration or with maintenance fluids, and can have serious adverse effects, including neurologic impairment and death.
Aminoglycoside therapy: Balancing risk versus benefit
Aminoglycosides are effective antimicrobial drugs but can have serious adverse effects. Indications, alternatives, dose, duration and co-morbidities are some of the important considerations.
Well-limb compartment syndrome
Although most physicians are aware of the possibility of compartment syndrome following trauma to a limb, it may occur in other situations.
Follow up for "orphaned patients"
Physicians discharging patients in need of follow up care may have certain responsibilities.
Failure to make the diagnosis of colorectal cancer: A window of opportunity missed
This risk identification paper identifies six areas associated with potential delays in the diagnosis of colorectal cancer.
If a patient relies on your professional opinion, you may have a duty of care
Before giving advice on medical matters, even informally, physicians should be satisfied they have considered and documented the relevant information.
It's a small world after all! Foreign travel, exotic diseases and your practice
Physicians may find it prudent to seek assistance from credible sources when patients seek pre-travel advice about, or later present with symptoms after travel.
Aminoglycosides — A fine balance
Appropriate use of aminoglycosides requires awareness of the potential side effects and their symptoms.
Aortic dissections: “Tearing” apart the data
The diagnosis of aortic dissection may be complicated by an atypical presentation, but careful documentation and appropriate reassessment can reduce the associated risks.
Reporting to quality improvement committees in hospitals
Quality improvement activities can be expected to improve patient care, but care should be taken to avoid undue medico-legal risk.
How to apologize when disclosing adverse events to patients
It is right to express sympathy after an adverse event, but an apology with acceptance of blame may be inappropriate.
Scrotal pain may point to testicular torsion
It is important to consider testicular torsion in young males presenting with abdominal or scrotal pain.
Disclosing adverse events to patients: strengthening the doctor-patient relationship
Timely, unrushed disclosure of adverse events to patients is an obligation that may strengthen the doctor-patient relationship.
Keep privacy in mind when disposing of test reports
It is important to properly dispose of test reports.
Shared care: issues you should consider
In a shared care environment, consider liability issues, the scope of practice and qualifications of other team members, and the importance of good communication.
Office privacy compliance
Privacy legislation affects physician's collection, use and disclosure of personal information.
Anesthesia airway management
A study examining the medico-legal risks of airway management by anaethesiologists from 1993 — 2003.
Safety and the practice of medicine
Steps to create a safe working environment.
Cautionary tales: telephone advice
Carefully document telephone advice even if a patient rejects it.
Steroid eye drops: Use caution in repeating prescriptions
Exercise caution in repeating prescriptions.
Collaborative care and medication monitoring: Who's responsible?
Monitoring medications in shared care.
Considerations when leaving a medical practice
Notifying and transferring patients and medical records when making a practice transition.
Provincial counsel commentary: The Krever Inquiry
An inquiry into the Canadian blood system recommended improved documentation and informed consent, and decreased allogeneic blood use.
Reducing your risk when you're not available
Clear messages regarding physician availability help reduce medico-legal risk.
Keeping a sharp eye on sharps
The proper disposal of materials such as sharps is important.
Relying on hospital staff
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
Being on call when resources are limited
Physicians may be expected to provide appropriate advice to referring physicians even when their facility cannot accept the patient.
Spinal epidural abscess: a rare, insidious and potentially catastrophic infection
Although spinal epidural abscess is rare and difficult to diagnose, it can have serious consequences for patients. CMPA experience has been reviewed.
House calls: What the courts have said
House calls place the doctor in an unfamiliar situation where it may be more difficult to obtain a history or to perform a physical examination.
Gratuitous criticism or "If we had only seen you sooner"
A physician's remarks about prior care may lead to medico-legal difficulties for a previous care provider. It is important to base any comments on a thorough knowledge of the facts.
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.
Specimen and report mix-ups
Pathological examination of a surgical specimen is the mid-point of a complex process involving many people. Mix-ups can occur at any point in the process, with adverse effects for patient and difficulties for health-care personnel.
Estate planning — Prepare a will and make a plan
Certain practice management issues arise when a physician dies, and should be considered as part of estate planning.
Limited health-care resources: The difficult balancing act
The Courts expect physicians to provide appropriate care to patients, making use of available resources. Physicians can be discussing limitations with patients and may discuss concerns and options with other physicians and administrators.
Cauda equina syndrome: A case for timely recognition and treatment
Cauda equina syndrome is not common, but has the potential for serious and long-lasting disability. Knowing the symptoms and signs, examining the patient adequately, and obtaining timely and appropriate investigations and consultations may help to avoid the risk of disability.
Abdominal aortic aneurysm in the emergency department
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.
Thoracic aortic dissection: Medico-legal difficulties
Failure to diagnose thoracic aortic dissection is not always due to negligence.
Wait-time benchmarks — Medico-legal considerations
Considerations for consultants and referring physicians with regard to wait times.

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.