Safety of care

Improving patient safety and reducing risks
Difficult patient encounters: What you can do to prevent, manage, and de-escalate
Advice on effective communications with patients and managing their expectations to help prevent conflicts in medical practice.
How to manage conflict and aggressive behaviour in medical practice
Physicians regularly encounter patients or family members who behave aggressively and make demands that may be unrealistic and potentially harmful. In their medical practice, physicians need strategies and tools to manage conflict and such challenging behaviours.
The office safety plan
Physicians can take these steps to maintain a safe office environment for their employees.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Safe prescribing: Risks for older patients
A study of CMPA medical-legal cases examines the risks of prescribing medication to older adults.
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.
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.
Health literacy — An asset in safer care
Steps physicians can take to help patients with poor health literacy skills.
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.
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.
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.
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.
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.
Medical scribes: An increasing reality
Physicians working with medical scribes should be aware of their obligations as an employer, delegator, and supervisor.
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.
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.
Responding to a billing audit: How good records can help
Adequate record keeping may help during a billing audit.
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.
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.
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.
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.
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.
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.
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.
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.
Elder abuse and neglect: Balancing intervention and patients’ right to confidentiality
The management of elder abuse cases is an increasingly important aspect of physicians’ practices, though determining the appropriateness of actions to address suspected abuse can be challenging.
Smartphone, smarter physician: Safely recommending mobile health apps in your practice
How physicians can take steps to minimize medical-legal risk when using mobile health applications (mHealth) in their practice.
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.
Residents and resiliency
Wellness strategies and resources for physician residents
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.
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.
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.
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.
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.
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.
Coordinating critical care: Communication challenges for providers and patients
An examination of coordination of care in the ICU and the importance of good communication.
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.
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.
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.
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.
Meningitis — Understanding the vulnerabilities
Meningitis poses a significant risk of death and disability, especially in vulnerable populations. Prompt diagnosis and treatment is critical.
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.
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.
Lessons from hip and knee arthroplasty complications
Hip or knee arthroplasty can greatly improve quality of life, yet it may also have significant risks.
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.
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.
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.
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.
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.
Pitfalls in assessing and treating children in hospitals
A review of hospital-based patient safety incidents and common reasons leading to them.
How office staff can help reduce risk
Physicians’ office staff can contribute to safe care for patients and reduce medico-legal risk. This article reviews several issues identified in the CMPA medico-legal files and provides suggestions on reducing risk.
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.
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.
A is for alias—Getting the right care to the right patient
Misidentifying a patient is a risk and can result in harm.
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.
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.
Social media: The opportunities, the realities
Physicians should be aware of the pros and cons of social media and the risks of participating.
Physicians in the spotlight: Practical media advice
Advice for physicians facing journalists or negative news coverage.
On message: The physician as spokesperson
Advice for physicians acting as media spokespersons
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.
Issues during surgery, labour and delivery: Managing the risks in anesthesiology
Highlights of medico-legal issues associated with anaesthesia and analgesia administered by anesthesiologists for surgery and during labour and delivery.
Online physician reviews: What’s to be done?
Physicians can successfully manage online ratings using a reasonable and measured approach.
The right test at the right time: Striking the proper balance
Considerations when determining a patient’s need for a medical test or procedure.
Medico-legal risks with fetal heart monitoring
An examination of medico-legal risks with fetal heart monitoring in the antepartum and intrapartum periods.
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.
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.
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.
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.
Stop and think — Return visits offer another chance
Physicians should carefully reassess patients who return with symptoms that are not resolving as expected or are worsening.
Managing risks associated with nasogastric and feeding tube insertion
A review of CMPA medico-legal cases involving feeding tube placement identifies clinical situations of higher risk that can affect patients and physicians.
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.
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.
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.
Physician leadership in safer medical care
Physician leadership and participation are essential for successful quality improvement efforts in healthcare.
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.
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.
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.
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.
Pitfalls in the diagnosis and management of skin cancer
A review of medico-legal cases concerning diagnosis and management of skin cancer.
Risk management when using drugs or medical devices off-label
Strategies to reduce medico-legal risk when prescribing medications or using medical devices outside of their licensed indications.
The new realities of medical care
As the healthcare environment continues to change, physicians remain committed to quality patient care, while keeping in mind accompanying risk management considerations.
The 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 engaged and empowered patient
Engaged and empowered patients take an active role in managing their healthcare, and physicians must be aware of the medico-legal implications.
Know the issues and risks of bariatric surgery
A review of the medico-legal issues with bariatric surgery in the pre-operative, intra-operative, and post-operative periods
Perils in the prevention of venous thromboembolism
Risk management lessons from a review of medico-legal cases related to venous thromboembolism prophylaxis.
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
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.
Working with medical equipment — Reducing the risks
A review of medico-legal problems related to malfunctions, improper use, and deficiencies in training and supervision when using medical or surgical equipment.
Protecting children — Reporting child abuse
If physicians have reason to believe a child is in need of protection, they are responsible for informing the appropriate authority in a timely manner. Planning what to say to the family is important.
Alternative medicine — What are the medico-legal concerns?
Physicians should be prepared to respond to patient enquiries about complementary and alternative medicine and natural health products.
The aging patient — Responding to changing demographics
As the Canadian population ages, physicians may need to adjust their practices to better meet the needs and expectations of older adults and avoid potential medico-legal risks.
Infective endocarditis — Still a challenge
A review of a five-year period of medico-legal files related to infectious endocarditis.
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.
Risk management in elderly patients: Medication issues
A review of medico-legal problems related to prescribing and monitoring medications for older patients.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Aminoglycosides — A fine balance
Appropriate use of aminoglycosides requires awareness of the potential side effects and their symptoms.
Anesthesia airway management
A study examining the medico-legal risks of airway management by anaethesiologists from 1993 — 2003.
Relying on hospital staff
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
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.
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.
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.

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.